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Inanspruchnahme medizinischer und paramedizinischer Versorgung bei Säuglingen mit exzessivem Schreien: Querschnittsanalyse und Eltern-Survey
No full textBackground Infants can present in the first year of life with excessive, recurrent crying without an apparent illness or failure to thrive. The excessive crying results in a wide variety of problems for infants, parents and health care service.Objectives This study aimed at evaluating how often parents of children with excessive crying seek help in the medical and paramedical health care system and which therapies are prescribed.Materials and methods This study uses data collected within KUNO Kids health study. Families who participated completed questionnaires 4 weeks after birth and answered questions which screened for excessive crying. Families whose child was screened positive completed an additional questionnaire on symptoms, parental management and health care utilization. Data were analysed using descriptive statistics.Results We received 238 questionnaires from children with excessive crying, 105 fulfilled the modified Wessel criteria. Of these 37 children (36%) were seen by a pediatrician because of crying. 57 (55%) received medications by the pediatrician. 51 (49%) of the parents specified that they also used paramedical therapies due to crying or whining, most often osteopathy. 45 (43%) adapted their own nutrition or their child's nutrition.Conclusions Our study shows that parents experience problems in dealing excessive crying. Frequent consultations with pediatricians or use of paramedical therapies are common, demanding additional resources. The parents received different diagnoses for excessive crying. Available drugs like Simeticon, homeopathy or manual therapy are recommended and applied despite largely missing evidence
Sleep and Aging. A Polysomnographic Follow‐Up Study, Some 40 Years Later
Get PDFThe aim of the present study was to explore age-related sleep alterations in normal subjects whose sleep had been recorded for the first time 40.4 ± 4.8 years ago. For the follow-up polysomnography (3 nights) 15 participants (5 female, 10 male, age 56–74 years) were recruited. Recording conditions and sleep scoring were adapted to the previous study. In all older participants, the amount of slow-wave sleep and REM sleep was decreased, while stage 1 and wakefulness were increased. There was no significant change in stage 2 or in any of the additional REM sleep parameters (REM density, latency, number and duration of REM cycles). Sleep stage transition analysis showed a markedly reduced stability of SWS from young to older age. While none of the single sleep parameters showed intra-individual stability with age, a pattern analysis, which combined seven sleep parameters (sleep stages, total sleep time and REM density), showed that the concordance rate of the combined sleep parameters correlated significantly with the age at follow-up. The results of this longitudinal study over a period of about 40 years are largely consistent with those of cross-sectional studies. While the lack of significant correlation of the individual sleep parameters between the younger and older age groups did not allow for the identification of any of them as trait markers, the result of the pattern analysis, which combined a set of sleep parameters, indicates that the stability of the sleep structure decreases significantly in the age range between the late 50s and early 70s
Catalyst-Free, Scalable, Green-Light-Mediated Iodoamination, and Further Transformation of Olefins Under Continuous Flow Conditions
Get PDFWe report the iodoamination of alkenes in continuous flow under metal-free, visible-light-mediated conditions with commercially available N-iodosuccinimide and protected amines. Unactivated and activated alkenes as well as Michael acceptors are amenable substrate classes for this process, allowing the synthesis of 1,2-iodoamines with a broad scope and in high yields (59–94%). The steadiness of the protocol is demonstrated in a continuous flow experiment over 4.5 h for the coupling of styrene, NIS, and N-tosyl-amine, which gave rise to 14 g (91%) of the iodoaminated product, corresponding to a productivity of 3.1 g h–1. Additionally, the direct conversion of the products without prior isolation into aziridines, enamines, amino alcohols, or azidoamines is possible, underscoring the synthetic value of this approach. Variation of the reaction conditions by adding typical impurities in reagents or solvents or changing the irradiation from green to blue light had a minimal effect on the yield, giving credit to the robustness of the process
The health-economic burden of hip and knee periprosthetic joint infections in Europe
Get PDFAbstract
Aims
Periprosthetic joint infections (PJIs) pose significant challenges to patients and healthcare systems worldwide. The aim of this study was to estimate the health-economic burden of reimbursement payment in Europe for PJIs following primary hip and knee arthroplasty.
Methods
The calculation was based on health-economic modelling using data on primary hip and knee arthroplasties for the year 2019 from the Statistical Office of the European Union (Eurostat) and published infection rates to estimate the total number of hip and knee PJIs in 30 European countries. Revision procedures were stratified into: 1) debridement, antibiotics, and implant retention (DAIR); 2) one-stage exchange; and 3) two-stage revision procedures. The cases were then multiplied by the respective healthcare system reimbursement payments. Payment data were acquired from a survey of 13 countries (Austria, Croatia, France, Germany, Italy, Lithuania, Netherlands, Norway, Portugal, Slovenia, Switzerland, Turkey, and the UK) and extrapolated for the remaining countries.
Results
In 2019, a total of 2,048,778 primary total joint replacements were performed (total hip arthroplasty (THA) = 1,147,316 and total knee arthroplasty (TKA) = 901,462), with an estimated 20,416 cases of PJIs (11,131 hip and 9,285 knee) in Europe. This results in an estimated total reimbursement burden of €346,262,026 for European healthcare systems. The breakdown for hip PJI reimbursement was €197,230,953 (€9,751,962 for DAIR procedures, €45,135,894 for one-stage revisions, and €142,343,097 for two-stage revisions). For knee PJIs, the analysis yielded a total reimbursement of €149,031,073 (€9,335,075 for DAIR procedures, €48,058,479 for one-stage revisions, and €91,637,518 for two-stage revisions).
Conclusion
This is the first study to evaluate the health-economic burden of PJIs in Europe, revealing a substantial impact on healthcare systems with an estimated case load of 20,414 cases and overall reimbursement of €346,262,026 for primary THAs and TKAs performed in 2019.
Cite this article: Bone Jt Open 2025;6(3):298–311.
Take home message
This is the first study to evaluate the health-economic burden of periprosthetic joint infections in Europe of primary arthroplasties of the hip and knee performed in 2019, revealing a substantial impact on healthcare systems with an estimated case load of 20,414 cases and overall reimbursement of €346,262,026
Cholesteryl Ester Species but Not Serum Proprotein Convertase Subtilisin/Kexin Type 9 Levels Decline in Male Patients with Active Inflammatory Bowel Disease
Get PDFBackground/Objectives: Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates serum cholesterol levels and inflammation, both of which are dysregulated in inflammatory bowel disease (IBD). Free cholesterol (FC) and the various types of cholesteryl ester (CE) have different functions in the body. However, it is not yet known whether these lipids undergo parallel changes in male and female patients with active IBD, nor whether PCSK9 correlates with these lipids and disease severity in either sex. The present study measured the serum levels of PCSK9, FC, and 15 CE species in IBD patients, focusing on the associations of these molecules with sex, each other, and with disease severity. Methods: The serum PCSK9 levels of 80 IBD patients (42 males and 38 females) and 24 controls (12 males and 12 females) were measured by enzyme-linked immunosorbent assay. In addition, FC and 15 CE species levels of 53 randomly selected IBD patients and 16 controls were determined by direct flow injection analysis (FIA) using a high-resolution hybrid quadrupole-orbitrap mass spectrometer (FIA-FTMS). Results: Serum PCSK9 levels in controls and IBD patients were comparable and did not correlate with disease severity in IBD patients. There was no discernible difference in serum PCSK9, FC, and CE levels between patients with Crohn’s disease (CD) and those with ulcerative colitis (UC). FC and almost all CE species decreased in male patients with active IBD but were not related to disease severity in the female patients. The decrease in different CE species in male IBD patients with diarrhea compared to those with normal stool consistency appears to be related to IBD severity. Bile acids regulate serum cholesterol levels, and FC and CE levels were positively correlated with fecal levels of secondary bile acids in the patients with UC but not CD. This association also existed in male UC patients and could not be evaluated in women due to the small sample size. Conclusions: In active IBD, a reduction in FC and almost all CE species was observed only in males, while serum PCSK9 levels remained within normal ranges in both sexes. It can be hypothesized that blocking PCSK9 may further reduce serum cholesterol levels, which may have adverse effects in male patients with active IBD
Erfassung und Auswertung humangenetischer Befunde von mehr als 1000 Patienten mit Netzhautdystrophie
Get PDFIn diese retrospektive Kohortenstudie wurden 1150 Patienten mit klinischem Verdacht auf Retinitis pigmentosa (n=746), Leberscher kongenitaler Amaurose (n=175) oder dem Usher-Syndrom (n=229) eingeschlossen, die von 2006 bis 2018 am Institut für Humangenetik der Universität Regensburg molekulargenetisch untersucht wurden. Damit repräsentiert diese Studie eine große HND-Kohorte in Deutschland.
Zur molekulargenetischen Diagnostik kamen zunächst Microarray Analysen und die Sequenzierung nach Sanger für Einzelgenanalysen zum Einsatz. Mit der Hochdurchsatzsequenzierung unter Verwendung der IonTorrent™ PGM oder der Illumina MiSeq Sequenzierplattform wurden bis zu 96 Genen gleichzeitig untersucht.
Im Anschluss an die systematische Sammlung der in den humangenetischen Befunden aufgeführten Sequenzvarianten wurde eine Reevaluierung dieser Sequenzvarianten hinsichtlich der Pathogenität nach den ACMG-Empfehlungen von Richards et al. 2015 durchgeführt. Bei dieser Reevaluierung änderte sich bei einem Viertel der Sequenzvarianten die Einschätzung der Pathogenität zugunsten einer Kategorie mit niedrigerer Evidenz für die Krankheitsrelevanz.
Die diagnostische Aufklärungsquote lag in der Kohorte insgesamt bei 40 %, variierte jedoch je nach klinischer Verdachtsdiagnose. Bei RP-Patienten konnte die klinische Verdachtsdiagnose in 45 % der Fälle molekulargenetisch gesichert werden, während dies bei 34 % der LCA-Patienten und 30 % der Patienten mit Usher-Syndrom der Fall war. Bei 27 % der Patienten wurden zwar klinisch möglicherweise relevante Varianten identifiziert, doch die genetische Ursache der Erkrankung konnte nicht vollständig aufgeklärt werden. Schließlich gelten weitere 33 % der Fälle als ungelöst. Insgesamt wurden 1031 verschiedene Sequenzvarianten mit den Bewertungen pathogen, wahrscheinlich pathogen und Variante unklarer Signifikanz in 99 Genen identifiziert. Die häufigsten Gene bei Patienten mit molekulargenetisch gesicherter Diagnose waren RPGR bei Retinitis pigmentosa, CEP290 bei Leberscher kongenitaler Amaurose und USH2A beim Usher-Syndrom.
Zusammenfassend bieten die Ergebnisse der vorliegenden Arbeit einen repräsentativen Einblick in die diagnostische Aufklärungsquote und das vielfältige Spektrum molekulargenetischer Ursachen von hereditären Netzhautdystrophien mit peripherem Beginn
Das Ökologische hat das Soziale dominiert und fast unerreichbar werden lassen. Interview von Michael Höfling mit Immobilienwirtschafts-Experte Tobias Just
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Restorative und Transitional Justice im Völkerrecht
Get PDFDas Völkerrecht behandelt Regimewechsel und Post-Konflikt-Situationen eher aus der Perspektive der Transitional Justice behandelt als aus der der Restorative Justice. Es sieht eine breite Palette von Mechanismen vor, die sich auf (1.) Wahrheitsfindung, (2.) Strafjustiz, (3.) Wiedergutmachung und (4.) Garantien der Nichtwiederholung beziehen.
Internationale Institutionen haben wichtige Standards der Transitional Justice kodifiziert. Die UN-Grundprinzipien und -Leitlinien für das Recht auf einen Rechtsbehelf und Wiedergutmachung und die UN-Grundsätze zur Bekämpfung der Straflosigkeit sind Beispiele dafür. Einige Institutionen wie der IStGH sind direkt an der Schaffung von Transitional Justice beteiligt. Der Al-Mahdi-Fall veranschaulicht, wie eine internationale Institution internationale Standards im Bereich der Transitional Justice und insbesondere der Wiedergutmachung weiterentwickeln kann.
Schließlich bieten auch die internationalen Menschenrechtsnormen einen Rahmen für den Umgang mit der Transitional Justice. Dies gilt insbesondere für EMRK mit den vom EGMR entwickelten spezifischen Standards. So muss jedes Projekt der Transitional Justice oder der Restorative Justice die internationalen Standards der Herrschaft des Rechts respektieren
Відновне та перехідне правосуддя в міжнародному праві
Get PDFInternational law deals with regime change and post-conflict situations under the perspective of transitional justice rather than restorative justice. It envisages a broad range of mechanisms which relate to (1.) truth-seeking, (2.) criminal justice, (3.) reparations, and (4.) guarantees of non-recurrence.
International institutions have codified important standards for transitional justice. The UN Basic Principles and Guidelines on the Right to a Remedy and Reparation and the UN Principles to Combat Impunity are examples of this. Some institutions like the International Criminal Court are directly involved in providing transitional justice. The Al-Mahdi case illustrates how an international institution can further develop international standards pertaining to transitional justice and to reparation in particular.
Finally, international human rights law provides a framework for dealing with transitional justice. This is particularly true for the European Convention on Human Rights with the specific standards developed by the European Court of Human Rights. In essence, any project of transitional or restorative justice must respect the international rule of law