[Assessment of osteosynthesis in X-ray images]. / Beurteilung von Osteosynthesen im Röntgenbild.

Osteosynthesis refers to various surgical procedures, closed or open, for the treatment of fractures of any age. To document and control the osteosynthesis and the healing process X­ray controls of the affected skeletal segment are performed during the operation and at regular intervals. To assess the quality of an osteosynthesis or to identify a complication, a comprehensive and systematic image review is useful. This includes the assessment of the restoration of the functional anatomy, the position of the material in relation to the surrounding structures, an evaluation of the stability as far as this is possible, and a control of the bone healing in a functionally correct position.

Bond-specific fragmentation of oligopeptides via electronic stopping of swift heavy ions in molecular films.

Highly bond-specific fragmentation of oligopeptides induced by swift heavy ion (SHI) irradiation was investigated by means of mass spectrometry. In pronounced contrast to measurements of samples irradiated with keV ions, oligopeptides which were exposed to 946 MeV Au ions show a high abundance of specific fragments. The highly bond-specific nature of SHI-induced fragmentation is attributed to electronic stopping as the most relevant energy loss mechanism for SHI in the oligopeptide samples in combination with the subsequent coupling between the excited electronic and the atomic subsystem. Fragmentation induced by SHI is observed to be further influenced by the structure of the oligopeptides, suggesting that electronic excitation and/or the electronic-vibrational coupling depend on the details of the molecular structure.

[Assessment of patellar dislocations in childhood and adolescence : Accident-related or predisposition-related?] / Begutachtung von Patellaluxationen im Kindes- und Jugendalter : Unfall- oder anlagebedingt?

BACKGROUND: Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear. AIM: This study investigated whether the analysis of the accident mechanism and anatomical predisposition in juvenile patellar dislocations enables a conclusion as to the causality. MATERIAL AND METHODS: Retrospective cohort study, evidence level III. In-house employers' liability insurance association (BG) cases with the diagnosis of patella dislocation in patients under 18 years were descriptively evaluated with respect to demographic and predisposing aspects as well as regarding accident information. The accident mechanisms were sorted into subgroups: direct impact, trivial trauma, fall, torsional trauma. RESULTS: A total of 54 patellar dislocations were identified with a patient age of 14 years (range 9-18 years). A mild valgus configuration was found in 39% of the cases, on average normal torsion, a tibial tuberosity-trochlea groove (TTTG) distance of 17 mm (range 8-24mm), with 41% a high proportion of patella alta and a trochlear deformity in 57%. Only 20% of the children had no relevant predispositions. The trivial traumas showed the highest proportion of recurrent dislocations with 50% and in the other accident categories the proportion of first dislocations was >75%. In the fall cohort the rate of children without relevant predisposition was highest. CONCLUSION: The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.

Alzheimer's disease medication and outcomes of hospitalisation among patients with dementia.

AIMS: The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. METHODS: A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. RESULTS: A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. CONCLUSIONS: Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.

[Simple elbow dislocations in children : Systematic review and meta-analysis]. / Einfache Ellenbogenluxationen beim Kind : Systematische Übersicht mit Metaanalyse.

BACKGROUND: Simple elbow dislocations in childhood are rare. Nevertheless, they have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed. AIM: The purpose of the study was to review the literature and to derive a recommendation for the best treatment concept. MATERIAL AND METHODS: A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified (initially nonspecific for age) and evaluated in a stepwise approach. Of these publications four met the inclusion criteria of the authors. The analysis was carried out descriptively and in a meta-analysis. RESULTS: The 4 publications included described simple elbow dislocations in 81 children (≤16 years). The weighted average age was 9.9 years with a gender ratio of 3.8 (boys:girls). The median follow-up was 49 months. Posterior and posterolateral dislocations were the most common with 73%. In 69 children the treatment was conservative and of these 66 were immobilized for longer than 2 weeks after closed reduction. The 12 children who had surgical treatment suffered dislocations that had not been reduced for longer than 3 weeks. The success rate of the conservatively treated immobilized group was 88%, of the conservatively treated non-immobilized group 70% and of the surgical group 42%. The differences between the success rates of the treatment methods was significant (p = 0.032). CONCLUSION: Simple elbow dislocations in children are rare. They most commonly occur in posterior and posterolateral directions. The prognosis is favorable; however a timely diagnosis and correct reduction are relevant for a good outcome.

[Detection of a Disease Cluster by the Health Authorities of Stendal District due to Campylobacter jejuni in a Nursery After the Consumption of Raw Milk]. / Ermittlungsweg des Gesundheitsamtes des Landkreises Stendal bei einer Erkrankungshäufung durch Campylobacter jejuni in einer Kindertagesstätte nach dem Verzehr von Rohmilch.

A notification from a laboratory concerning the detection of Campylobacter jejuni in a 6-year-old boy initiated the investigation carried out by the health authorities from Stendal district, in order to explain the morbidity rate caused by the germ. The day after the boy's pediatrician informed about a visit to a farm, which was confirmed by the head of the nursery. She told the health authorities about the consumption of raw milk during their visit at the farm.The following days more children fell sick. Within 10 days the total number of diseased children was 21. The health authorities asked for stool samples of the diseased children, nursery nurses and the head of the farm since raw milk presents a potential cause of infection. The health authorities together with the Saxony-Anhalt State Office for Consumer Protection conducted a retrospective cohort study. The aim was to explain the association between the exposure from raw milk consumption and the occurrence of the disease from C. jejuni. Based on a questionnaire data about the food and milk intake at the nursery and at home and about the trip to the farm were collected. 91% of the children's cohort and 86% of the adults' cohort were captured.The exposed group at risk showed a higher risk of falling ill than the group, which was not exposed. The risk factor raw milk explained the difference. Furthermore, the analysis of milk samples taken by the district veterinary office from 2 cows and from the farm's tank was able to detect the germs. The correlation of the illness, the consumption of raw milk, the detection of C. jejuni in the samples taken from the children and the samples taken from the cows was evident. Based on the case the health authorities recommended that heads of nurseries as well as heads of dairy farming in the district of Stendal needed to be advised on raw milk. Nurseries are still allowed to take trips to farms. However, raw animal derivates including milk must not be consumed.

Chromatin organisation in duckweed interphase nuclei in relation to the nuclear DNA content.

The accessibility of DNA during fundamental processes, such as transcription, replication and DNA repair, is tightly modulated through a dynamic chromatin structure. Differences in large-scale chromatin structure at the microscopic level can be observed as euchromatic and heterochromatic domains in interphase nuclei. Here, key epigenetic marks, including histone H3 methylation and 5-methylcytosine (5-mC) as a DNA modification, were studied cytologically to describe the chromatin organisation of representative species of the five duckweed genera in the context of their nuclear DNA content, which ranged from 158 to 1881 Mbp. All studied duckweeds, including Spirodela polyrhiza with a genome size and repeat proportion similar to that of Arabidopsis thaliana, showed dispersed distribution of heterochromatin signatures (5mC, H3K9me2 and H3K27me1). This immunolabelling pattern resembles that of early developmental stages of Arabidopsis nuclei, with less pronounced heterochromatin chromocenters and heterochromatic marks weakly dispersed throughout the nucleus.

[Comparison of rehabilitation between in-hospital geriatric departments and geriatric out-of-hospital rehabilitation facilities. Analysis of routine data using the example of femur fractures]. / Vergleich der geriatrischen frührehabilitativen Komplexbehandlung und der geriatrischen Anschlussrehabilitation. Routinedatenanalyse am Beispiel der Femurfraktur.

AIM OF THE STUDY: The goal of this study was to compare two types of rehabilitation for geriatric patients with femoral fracture in Germany, i.e. care in geriatric hospital departments (§109 SGB V) and care in geriatric out-of-hospital rehabilitation facilities (§111 SGB V). METHODS: Based on claims data of the AOK ("Allgemeine Ortskrankenkasse"=local insurance fund) insurants with a documented hospital stay with discharge diagnosis fracture of the femur in 2007 (n=25,954) were included and allocated to the respective form of rehabilitative health care via the OPS (German procedure classification for inpatient procedures) procedure 8-550 (§109, n=2028) or via admission to a geriatric rehabilitation unit (§111, n=4061). Excess costs (costs in the first year after fracture--costs in the previous year), risk of rehospitalization due to femoral fracture, and risk of death during the 1-year follow-up were compared using multivariate regression analyses. RESULTS: No significant differences were observed related to the outcomes rehospitalization due to femoral fracture and death. However, slight but significantly higher excess costs were observed in the health care type §109 (compared to §111) in patients with low excess costs. Moreover, insured members treated according to health care type §109 were more often receiving long-term care. CONCLUSION: Further analyses including qualitative endpoints, e.g., achievements of rehabilitation aims, are warranted.

No evidence of pathogenic involvement of cathelicidins in patient cohorts and mouse models of lupus and arthritis.

Apart from their role in the immune defence against pathogens evidence of a role of antimicrobial peptides (AMPs) in autoimmune diseases has accumulated in the past years. The aim of this project was to examine the functional impact of the human cathelicidin LL-37 and the mouse cathelicidin-related AMP (CRAMP) on the pathogenesis of lupus and arthritis. Serum LL-37 and anti-LL-37 levels were measured by ELISA in healthy donors and patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA). Pristane-induced lupus was induced in female wild type (WT) and cathelicidin-deficient (CRAMP-/-) mice. Serum levels of anti-Sm/RNP, anti-dsDNA, and anti-histone were determined via ELISA, cytokines in sera and peritoneal lavages were measured via Multiplex. Expression of Interferon I stimulated genes (ISG) was determined by real-time PCR. Collagen-induced arthritis (CIA) was induced in male WT and CRAMP-/- mice and arthritis severity was visually scored and analysed histomorphometrically by OsteoMeasure software. Serum levels of anti-LL-37 were higher in SLE-patients compared to healthy donors or patients with RA. However, no correlation to markers of disease activity or organ involvement was observed. No significant differences of autoantibody or cytokine/chemokine levels, or of expression of ISGs were observed between WT and CRAMP-/- mice after pristane-injection. Furthermore, lung and kidney pathology did not differ in the absence of CRAMP. Incidence and severity of CIA and histological parameters (inflammation, cartilage degradation, and bone erosion) were not different in WT and CRAMP-/- mice. Although cathelicidins are upregulated in mouse models of lupus and arthritis, cathelicidin-deficiency did not persistently affect the diseases. Also in patients with SLE, autoantibodies against cathelicidins did not correlate with disease manifestation. Reactivity against cathelicidins in lupus and arthritis could thus be an epiphenomenon caused by extensive overexpression in blood and affected tissues. In addition, other cationic AMPs could functionally compensate for the deficiency of cathelicidins.

Costs of Diabetes Mellitus (CoDiM) in Germany, direct per-capita costs of managing hyperglycaemia and diabetes complications in 2010 compared to 2001.

INTRODUCTION: To identify direct health care costs of patients with diabetes in Germany in 2010, with focus on costs of treating hyperglycaemia and costs caused by diabetes complications, and to compare findings with results from the CoDiM study 2001. MATERIAL AND METHODS: The cost analysis was based on administrative data (18.75% random sample of 1.5 million insured persons). Medical costs covered by statutory health insurance and costs covered by nursing care insurance were included. Incremental differences in costs of patients with diabetes (n=30 987) and age and sex-matched subjects without a diagnosis of diabetes (controls) were estimated according to the number and type of complications. Costs were standardised to the German population. RESULTS: In 2010, incremental medical costs attributed to diabetes were € 2 391 (95% confidence interval: 2 257-2 524) per patient with diabetes. Of that amount, 26.5% were spent for the management of hyperglycaemia (€ 633 (622-644)) and 73.5% for the treatment of comp-lications (€ 1 758 (1 627-1 889)). Nursing care contributed incremental costs of € 289 (249-330), of which 98.8% was due to complications. From 2001 to 2010 the incremental per-capita costs for medical and nursing care decreased by 4.8% (controls: +3.9%), the per-capita costs for treating hyperglycaemia increased by 2.0% and the per-capita costs for complications decreased by 7.0%. CONCLUSION: Cost for diabetes is largely caused by management of complications. It is important to prevent complications by consequent management of diabetes as well as by primary prevention of its onset.

The Spirodela polyrhiza genome reveals insights into its neotenous reduction fast growth and aquatic lifestyle.

The subfamily of the Lemnoideae belongs to a different order than other monocotyledonous species that have been sequenced and comprises aquatic plants that grow rapidly on the water surface. Here we select Spirodela polyrhiza for whole-genome sequencing. We show that Spirodela has a genome with no signs of recent retrotranspositions but signatures of two ancient whole-genome duplications, possibly 95 million years ago (mya), older than those in Arabidopsis and rice. Its genome has only 19,623 predicted protein-coding genes, which is 28% less than the dicotyledonous Arabidopsis thaliana and 50% less than monocotyledonous rice. We propose that at least in part, the neotenous reduction of these aquatic plants is based on readjusted copy numbers of promoters and repressors of the juvenile-to-adult transition. The Spirodela genome, along with its unique biology and physiology, will stimulate new insights into environmental adaptation, ecology, evolution and plant development, and will be instrumental for future bioenergy applications.

[Rehabilitation in geriatric patients after ischemic stroke--a comparison of 2 organisational systems in Germany using claims data of a statutory health insurance fund]. / Rehabilitation geriatrischer Patienten nach Schlaganfall--Ein Vergleich zweier Versorgungssysteme in Deutschland anhand von Routinedaten der gesetzlichen Krankenkasse.

UNLABELLED: Due to historical aspects in some federal states in Germany rehabilitation of geriatric patients is organized in geriatric departments in hospitals (§ 109 SGB V). In other states rehabilitation of these patients is mainly realized in geriatric rehabilitation facilities outside hospital care after approval by the health insurance (§ 111 SGB V). Thus, it is of interest to compare both types of health care with respect to differences in population characteristics, resource utilization and outcome parameters (i.e., excess costs, rehospitalization, fracture risk and mortality) using a common geriatric indication, the ischemic stroke, as an example. METHODS: Claims data of the AOK (Local Health Care Fund) from seven federal states in Germany were used. Insured persons with a documented hospital stay with discharge diagnosis cerebral infarction/stroke (ICD-10 I63, I64, below denoted by "ischemic stroke") in 2007 (N=39,887) were included and allocated to the respective form of rehabilitative health care via the OPS (German procedure classification for inpatient procedures) procedure 8-550 (§ 109, N=1,272) or via admission to a geriatric rehabilitation unit within 1 month after hospital discharge (§ 111, N=2,200). All direct costs were ascertained and presented with and without costs of long-term care. Excess costs were calculated as the difference of costs between the first year after insult and the costs in the previous year. Excess costs in the 2 types of care were compared using multivariate quantile regression analysis. Risk of hospitalization (due to ischemic stroke or fracture) and risk of death in a 1-year follow-up was analysed using multivariate cox regression. RESULTS: Insured members treated according to health care type § 109 were somewhat older (mean: 81 vs. 80 years of age), more frequently female (72 vs. 67%), more often receiving long-term care (27 vs. 19%) and had more often documented sequelae after insult (>=4 diseases 39 vs. 28%). No significant differences in excess costs between both types of care were observed (quantile regression: 25%-percentile-comparison: p=0.49 and 0.11; median-comparison: p=0.99 and 0.13; 75%-percentile-comparison: p=0.13 and 0.30, with and without costs of long-term care, respectively). Moreover, no significant differences were observed related to the outcomes 'rehospitalization due to ischemic stroke' (hazard ratio - HR [95% confidence interval - CI])=1.12 [0.85-1.48], p=0.43) and death (HR [95% CI]=1.03 [0.88-1.20], p=0.75) in the multivariate model (reference: health care type § 111). Insured members in health care type § 109 had a significant lower risk of rehospitalization due to fracture (HR [95% CI]=0.61 [0.40-0.93], p=0.02). CONCLUSION: According to health care type § 109 and § 111, geriatric patients differ in certain characteristics such as gender, statutory care and documented sequelae after insult. Except for the outcome 'fracture', no significant differences between both types of care have been observed in the selected outcomes. Primary studies with more differentiated data collection may focus on specific treatment and on aims and achievements of rehabilitation.

[Prevalence and temporal trend of known diabetes mellitus: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Prävalenz und zeitliche Entwicklung des bekannten Diabetes mellitus: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1, 2008-2011) allows for up-to-date, representative prevalence estimates of known diabetes amongst the 18- to 79-year-old resident population of Germany. Temporal trends can be shown by comparing the survey findings with those of the "German National Health Interview and Examination Survey 1998" (GNHIES98). The definition of known diabetes was based on self-reports in physician-administered interviews that asked respondents if they had ever been diagnosed with diabetes by a doctor or were on anti-diabetic medication. Overall, diabetes had been diagnosed in 7.2 % of the adults (7.4 % of the women; 7.0 % of the men). The prevalence increased substantially with advancing age and was higher in persons of low than of high socioeconomic status. Prevalence varied depending on the type of health insurance held and was highest amongst those insured with AOK health insurance funds. In comparison with GNHIES98, there was a 38 % increase in prevalence, of which approximately one third is to be attributed to demographic ageing. In the context of other nationwide studies, the results indicate a figure of at least 4.6 million 18- to 79-year-olds having been diagnosed with diabetes at some point. Planned analyses of undiagnosed diabetes will contribute to the interpretation of the observed increase in the prevalence of known diabetes. An English full-text version of this article is available at SpringerLink as supplemental.

Genetic characterization of a reciprocal translocation present in a widely grown barley variety.

Artificially induced translocation stocks have been used to physically map the barley genome; however, natural translocations are extremely uncommon in cultivated genotypes. Albacete is a barley variety widely grown in recent decades in Spain and carrying a reciprocal translocation which obviously does not affect its agronomical fitness. This translocation has been characterized by a combination of cytological and molecular genetic approaches. Firstly, recombination frequencies between markers on chromosomes 1H and 3H were estimated to determine the boundaries of the reciprocal interchange. Secondly, 1H-3H wheat barley telosome addition lines were used to assign selected markers to chromosome arms. Thirdly, fluorescence in situ hybridization (FISH) with rDNA probes (5S and 18S-5.8S-26S) and microsatellite probes [(ACT)(5), (AAG)(5) and (CAG)(5)] was used to determine the locations of the translocation breakpoints more precisely. Fourthly, fine-mapping of the regions around the translocation breakpoints was used to increase the marker density for comparative genomics. The results obtained in this study indicate that the translocation is quite large with breakpoints located on the long arms of chromosomes 1H and 3H, between the pericentromeric (AAG)(5) bands and above the (ACT)(5) interstitial distal bands, resulting in the reciprocal translocation 1HS.1HL-3HL and 3HS.3HL-1HL. The gene content around the translocation breakpoints could be inferred from syntenic relationships observed among different species from the grass family Poaceae (rice, Sorghum and Brachypodium) and was estimated at approximately 1,100 and 710 gene models for 1H and 3H, respectively. Duplicated segments between chromosomes Os01 and Os05 in rice derived from ancestral duplications within the grass family overlap with the translocation breakpoints on chromosomes 1H and 3H in the barley variety Albacete.

Colonoscopy and fecal occult blood test use in Germany: results from a large insurance-based cohort.

BACKGROUND AND STUDY AIMS: Colonoscopy and guaiac-based fecal occult blood tests (FOBT) are recommended and offered for colorectal cancer (CRC) screening in Germany. We aimed to explore their utilization in a large insurance-based cohort. PATIENTS AND METHODS: Claims data from between 2000 and 2008 were collected for 170493 individuals who were insured by a large health insurance plan in the federal state of Hesse, Germany. The percentages of individuals who had recently utilized CRC screening-related procedures were calculated. Additionally, multiple test use and identification of CRC screening providers were ascertained. RESULTS: Following the inception of the current CRC screening program in 2002, colonoscopy utilization rates varied only slightly and FOBT use decreased in individuals aged ≥50 years. At the end of 2008, the age-standardized percentages of individuals who had undergone colonoscopy within ≤10 years were 23% for men and 26% for women. The proportions of individuals who had used FOBT within ≤1 year were 14% for men and 22% for women. Patient education had been utilized by 38% of eligible persons and was increasingly followed by screening colonoscopy. For women, practices that specialized in gynecology were the main providers of FOBT (93%) and patient education (61%). CONCLUSIONS: This study provides new insights into the inter-related utilization of colonoscopy, FOBT, and patient education in Germany, and may be particularly informative for the design of strategies to increase CRC screening uptake. It indicates that sex differences in CRC screening test use could result to a large extent from general visits to different types of specialist physicians involved in the CRC screening process.

Direct costs of diabetes mellitus in Germany - CoDiM 2000-2007.

INTRODUCTION: The prevalence of treated diabetes in Germany and direct health care costs of individuals with diabetes were analysed for the 8-year period from 2000 to 2007, based on administrative data. Special interest was given to the incremental costs attributed to diabetes. MATERIAL AND METHODS: An 18.75% sample of all members of a large local German statutory health insurance provider, "AOK - Die Gesundheitskasse" in the federal state of Hesse was analysed with regard to cases of treated diabetes. To assess the incremental diabetes-related direct costs, the cost data of individuals with diabetes was compared to that of an age- and sex-matched group of persons without diabetes. Prevalence and costs were standardized according to the gender and age distribution of the German population. RESULTS: Between 2000 and 2007, the administrative prevalence of treated diabetes rose continuously in Germany, from 6.5 to 8.9% (+36.8%). The number of patients treated with 'insulin' or 'insulin & oral antidiabetic agents' increased by +54.7 and +61.7%, respectively. Direct costs per patient with diabetes, calculated using the unit costs reimbursed by statutory health and nursing care insurances, rose from € 5 197 to € 5 726 (+10.2%). Incremental per-capita costs were € 2 400 in 2000 and € 2 605 in 2007 (+8.5%). However, the total direct cost burden of diabetes in Germany grew from € 27.8 billion to € 42.0 billion (+51.1%). The incremental diabetes-related cost burden increased from € 12.9 billion to € 19.1 billion (+48.6%). CONCLUSIONS: There was a continuous increase in the prevalence of diabetes in Germany during the 8-year period. Although there was only a modest increase in annual diabetes-related per-capita costs, total healthcare expenditure rose substantially due to the growing number of patients being treated for diabetes.

[Differences in antibiotic prescribing between general practitioners and pediatricians in Hesse, Germany]. / Unterschiede im Verschreibungsverhalten von Antibiotika bei Allgemein- und Kinderärzten in Hessen.

BACKGROUND: A careful consideration of antibiotic prescription is necessary due to emerging antibiotic resistance. Differences in prescription rates between physician groups have only rarely been examined. We compared the prescription of antibiotics for systemic use in children between pediatricians and general practitioners (GPs). METHOD: Data source was the statutory health insurance sample AOK Hesse/KV Hesse. Overall, 47,033 insured children in 2006 between 2 and 17 years of age were included in the analysis. Odds ratios (OR) and 95% confidence intervals (CI) for an antibiotic prescription were calculated by logistic regression adjusted for confounders, comparing pediatricians with GPs. Diagnosis-specific models were constructed. RESULTS: GPs and pediatricians prescribed 79.3% of all antibiotics in 2006 (40.6% and 38.7%, respectively). Significantly decreased ORs for an antibiotic prescription were observed for pediatricians, with OR (95% CI) of 0.46 (0.43-0.49), 0.40 (0.30-0.54) and 0.40 (0.30-0.53) for respiratory tract infections, urinary tract infections and nonsuppurative otitis media, respectively. No significant associations were observed assessing scarlet fever, pneumonia and suppurative otitis media, respectively. CONCLUSION: In this retrospective analysis, pediatricians were associated with a lower antibiotic prescription rate regarding diagnoses where antibiotic therapy is not clearly indicated. However, in diagnoses where antibiotic therapy is clearly indicated, no differences in prescription rates between pediatricians and GPs were observed. Further studies are warranted to gain insight into different treatment strategies between different groups of medical practitioners.

[Internal confirmation of diagnoses in routine statutory health insurance data: concept with examples and case definitions]. / Interne Validierung von Diagnosen in GKV-Routinedaten: Konzeption mit Beispielen und Falldefinition.

Over the course of the last few decades, statutory health insurance data have become increasingly important for health services research. Of particular interest in this context are diagnoses. Since all health insurance data are originally collected for billing purposes, secondary analyses should examine the completeness, plausibility, and validity of the information provided. While an external validation through, for example, a comparison with the physician's records or a second independent medical examination can be seen as a gold standard, this is often not feasible. For this reason, internal validation approaches are recommended for studies based upon diagnoses drawn from routine data. For such approaches, no established standards are currently available. The aim of this contribution is to introduce a generic internal validation concept for chronic diseases. Data employed in the present contribution stem from the health insuree sample of the AOK health insurance fund Hesse. Criteria for assessing the validity of diagnoses (e.g., repetitions, codes assigned by various physicians, prescriptions) are presented for three chronic diseases - heart failure, dementia, and tuberculosis. Building upon these criteria, algorithms for the definition of epidemiologically certain cases are developed and prevalence estimates formed on the basis of these algorithms are compared with other data sources (registers and surveys). Internal confirmation of the diagnoses of heart failure and dementia was possible in 97% and 80% of cases, respectively. The difference between the two diagnoses is due to the low rate of treatment with specific pharmaceuticals in the case of dementia. Prevalence estimates are comparable with those based on other sources. Inpatient discharge diagnoses of tuberculosis were internally confirmed in 100% and outpatient diagnoses in 40% of cases. For this reason, outpatient diagnoses were not considered for the case definition of tuberculosis. A comparison with tuberculosis surveillance data reveals a somewhat higher incidence in the insuree sample. In selecting and weighting criteria as well as employing a case definition, the research aim of the respective investigation must be taken into account. The adopted procedure is to be presented in a transparent manner.

[Herpes zoster in Germany. A retrospective analyse of SHL data]. / Herpes zoster in Deutschland. Eine retrospektive Analyse von GKV-Daten.

The incidence of herpes zoster in the elderly (50 years and older) 2004 in Germany was determined by retrospectively analysing representative treatment data of the statutory health insurance sample of AOK Hesse/KV Hesse. The overall observed incidence rate of herpes zoster was 9.4 cases per 1,000 person-years (PY). 10.1% of herpes-zoster-patients suffered at least 1 month from pain, the so called postherpetic neuralgia (PHN1), 6.9% had at least 3 months pain (PHN3). Incidence rate of herpes zoster rose markedly with age: from 6.8 per 1,000 PY in 50 to 54 year-olds to 12.4 PY in persons 80 years and older. Incidence rate in the immunocompromised was higher (11.6 per 1,000 PY) than in the immunocompetent (9.1 per 1,000 PY). According to a standardized extrapolation of the sample to the German population, about 300,000 persons 50 years and older suffered from acute herpes zoster on the year 2004 in Germany.