[Working Time of Physicians in Germany: Results of the Micro-Census with a Focus on Established Practitioners]. / Arbeitszeit von Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus mit Fokus auf Niedergelassene.

Medical practitioners are considered to be an occupational group with a high workload. However, findings on working hours are incomplete. Therefore, we investigated data on "normal" working hours and corresponding preferences in the course of an analysis of the Microcensus 2017. Established physicians reported an average working time of 48,8 h per week for full-time employment, 46,2 h as dependent employees. Dependent employees working part-time, reported about 4 h more than established doctors. Male doctors reported about 4 h more than female doctors when working full-time, and 5 h less when working part-time. The proportion of part-time work was significantly higher for female physicians than for male physicians (28% vs. 10%). The specific analysis for established doctors also showed an inverse discrepancy: if part-time, female physicians worked 4 h more than male physicians; if full-time, male physicians worked 4 h more than female physicians. Established doctors worked less than employees when working part-time. Here, too, the rate was higher for female physicians (19,5% vs. 10,6%). Overall, 14% worked part-time (just under 20 h per week), 86% full-time (just under 49 h). Dentists reported slightly lower working hours, while general practitioners and specialists were about the same at 45 hours. This difference was due to differences in full-time work, which is about 50 h for general practitioners and specialists and 46 h for dentists. In contrast, part-time dentists worked longer hours (24 vs. 18 h). Only a few physicians, especially those working part-time (6,5%), stated that they would like to work more. Most of them would like to work slightly more hours. The majority of women cited family obligations (68%) as the reason for part-time work, while men mostly cited "other" reasons (76%) and less often childcare or personal/family obligations (15%). A total of 13% of those working full-time would like to work fewer hours, women slightly more often. This analysis complements sources such as the Zi Practice Panel. At the overall level, the microcensus average was 5 h lower than the ZiPP (50 h/week). The limitations for survey data known from methodology are countered by the very high sample quality.

[Income of physicians in private practice in Germany: Results of a micro census]. / Einkommen von niedergelassenen Ärztinnen und Ärzten in Deutschland: Ergebnisse des Mikrozensus.

EINLEITUNG: Daten zum Einkommen von Ärzt:innen in Deutschland sind bisher nur teilweise verfügbar. Die Einkommen der niedergelassenen Ärzteschaft werden vor allem aus den Praxiserträgen abgeleitet, was aber große Interpretationsspielräume eröffnet. Ziel des Artikels ist es, diese Lücke zu schließen. METHODIK: Hierfür werden die Einkommensangaben aus dem Mikrozensus 2017 ausgewertet - mit besonderem Fokus auf niedergelassene Ärzt:innen. Neben dem persönlichen Einkommen erfolgt eine Darstellung der Einkommenssituation auf Haushaltsebene. Die Einkommensziffern werden nach Tätigkeitsumfang, Tätigkeitsgruppe (Allgemein-/Fach-/Zahnärzte), Geschlecht und Stadt/Land differenziert. ERGEBNISSE UND SCHLUSSFOLGERUNG: Das verfügbare persönliche Nettoeinkommen niedergelassener Ärzt:innen beträgt bei Vollzeittätigkeit im Mittel knapp 7.900 € pro Monat. Fachärzt:innen liegen bei 8.250 €, Allgemein- und Zahnärzt:innen bei ca. 7.700 €. Eine finanzielle Benachteiligung von Landärzt:innen lässt sich nicht feststellen, Allgemeinärzt:innen aus Gemeinden<5.000 Einwohnerinnen und Einwohner haben mit 8.700 € sogar das höchste Durchschnittseinkommen - bei einer mittleren Arbeitszeit von 51 Stunden pro Woche. Ärztinnen arbeiten häufiger in Teilzeit als Ärzte. Ein niedrigeres Einkommen resultiert überwiegend aus einem geringeren Tätigkeitsumfang. INTRODUCTION: Data on the income of physicians in Germany are only partially available to date. The income of physicians in private practice is derived primarily from practice income, but this opens up considerable scope for interpretation. The aim of this article is to close this gap. METHODOLOGY: For this purpose, the income data from the 2017 micro census were evaluated, with a special focus on physicians in private practice. In addition to personal income, the income situation was presented at the household level. The income figures were differentiated according to the scope of activity, activity group (general practitioners/specialists/dentists), gender and city/country. RESULTS AND CONCLUSION: The disposable personal income of physicians in private practice was just under € 7,900 per month on average for full-time employment. Specialists earned € 8,250, while general practitioners and dentists earned about € 7,700. Rural physicians were not found to suffer from financial disadvantages; general practitioners from municipalities with<5,000 inhabitants even had the highest average income of € 8,700, with an average working time of 51 hours per week. Female physicians worked part-time more often than did male physicians. A lower income resulted primarily from a lower scope of activity.

Fluorescein angiographic findings in eyes of patients with a subretinal electronic implant.

PURPOSE: One approach for restoring vision in end-stage hereditary retinal diseases is implantation of a subretinal microphotodiode array. We analyzed retinal fluorescein angiography findings of the implant area. METHODS: In this pilot study, patients (n = 11; 10 men, one woman; ages 45.2 ± 8.7 years), with visual acuity of light perception or worse resulting from a hereditary retinal degenerative disease, received active electronic subretinal visual implants. Implants were removed after 4 weeks (n = 7 subjects) or 4 months (n = 4 subjects). Following implantation, regular fluorescein angiography was performed. Regions of retinal capillary loss, microaneurysms, capillary alterations, neovascularization and leakage over the implant were scored at time points T1 (days 1-14), T2 (days 15-28) and T3 (months 3-4). Occurrence and changes of fluorescein angiographic phenomena are reported. RESULTS: In terms of the number of patients in whom retinal alterations were observed (compared to available images) the occurences of the angiographic phenomena (for time points T1, T2 and T3, respectively) were as follows: regions of capillary loss (five of seven, 10 of 11 and five of five patients), microaneurysms (0 of seven, two of 11 and three of five patients), calibre alterations of the capillaries (three of seven, eight of 11 and five of five patients), retinal neovascularization (one of seven, one of 11 and 0 of five) and leakage (three of seven, seven of 11 and four of five). The Friedman test revealed no significant changes in capillary loss, calibre alteration of the capillaries, neovascularization or leakage. Microaneurysms increased significantly (p = 0.037). CONCLUSIONS: Subretinal visual implants lead to increased capillary microaneurysms, a possible compensatory mechanism following recovery of inner retinal activity. There were no significant changes in capillary loss, calibre alteration of the capillaries, retinal neovascularization and leakage at 4 months. Further study will determine whether and to what degree long-term vascular changes are affected by the surgical procedure, the implant itself and/or recovery of retinal neuronal activity.

Predictive value of platelet activation for the rate of cognitive decline in Alzheimer's disease patients.

Vascular risk factors contribute to the progression of dementia in Alzheimer's disease (AD) and influence platelet activation. However, the degree of platelet activation as a possible underlying mechanism of this progression has not been studied till now. Significantly higher baseline expression of both platelet activation biomarkers, activated glycoprotein IIb-IIIa complex and P-selectin, was observed in patients with AD with fast cognitive decline compared with AD patients with slow cognitive decline during a 1-year follow-up period. These results suggest that platelet activation could be a putative prognostic biomarker for the rate of cognitive decline and a potential new treatment target in AD patients.

Expression of stromal-cell-derived factor-1 on circulating platelets is increased in patients with acute coronary syndrome and correlates with the number of CD34+ progenitor cells.

AIMS: Previous experimental studies have suggested that platelet stromal-cell-derived factor-1 (SDF-1) regulates mobilization and recruitment of haematopoietic progenitor cells supporting revascularization in mice. However, there are no clinical data available regarding platelet-bound SDF-1 in patients with acute coronary syndrome (ACS). The objective of this study was to evaluate the platelet-surface expression of SDF-1 in patients with ACS. METHODS AND RESULTS: Patients with ACS (n = 418) showed a significantly enhanced SDF-1 expression on admission compared with those with stable angina pectoris (SAP, n = 486) [SAP (mean fluorescence intensity (MFI) +/- SD): 13.48 +/- 5.27; ACS: 18.45 +/- 12.85; P < 0.001) independent of cardiovascular risk factors and medication. Enhanced platelet-bound SDF-1 expression was found in patients with reduced left ventricular ejection fraction (LVEF <55%) in comparison to patients with normal LVEF (P = 0.005). Platelet-bound SDF-1 expression positively correlated with the degree of platelet activation [CD62P: r = 0.325; glycoprotein VI (GPVI): r = 0.277; PAC-1: r = 0.501; P < 0.001 for all] and showed a significant, but slight association with plasma levels of SDF-1 (r = 0.084; P = 0.045). In a subgroup of patients with coronary artery disease, platelet-bound SDF-1, but not other platelet activation markers, significantly correlated with the number of circulating CD34(+) progenitor cells (r = 0.252; P = 0.002) or CD34(+)/CD133(+) endothelial progenitor cells (r = 0.352; P = 0.008). CONCLUSION: Platelet-bound SDF-1 may play an important role in peripheral homing of circulating progenitor cells thus in tissue regeneration.

Accuracy of Ein Bild Röntgen Analyse in determining wear in total hip arthroplasty in vitro.

The Ein Bild Röntgen Analyse system is used to radiographically measure femoral head penetration in total hip replacement components. Because determining the accuracy of any wear analysis system is more precise and comparable under in vitro conditions, we used a femoral head migration simulator to assess the accuracy of Ein Bild Röntgen Analyse and determine the effect of magnification factors on accuracy. We used onscreen magnifications of 100% and 200% to measure anteroposterior radiographs, which improved the accuracy of determining femoral head penetration. Improvements averaged 0.056 mm (95% CI +/- 0.013 mm) in the X direction and 0.024 mm (95% CI +/- 0.027 mm) in the Y direction. Femoral head penetration was simulated in 0.25-mm steps from 0-1 mm. Accuracy ranged from 0-0.029 mm (95% CI, 0.035-0.067 mm) for the X direction and from 0.001-0.013 mm (95% CI, 0.046-0.079 mm) for the Y direction. Assuming the worst accuracy combined for the X and Y directions, Ein Bild Röntgen Analyse can accurately detect femoral head penetration greater than 0.128 mm. These results are comparable with reported accuracy values for different systems and suggest that magnification tools should be considered with Ein Bild Röntgen Analyse when measuring wear radiographically.