Talker- and language-specific effects on speech intelligibility in noise assessed with bilingual talkers: Which language is more robust against noise and reverberation?

Objective: Investigate talker- and language-specific aspects of speech intelligibility in noise and reverberation using highly comparable matrix sentence tests across languages. Design: Matrix sentences spoken by German/Russian and German/Spanish bilingual talkers were recorded. These sentences were used to measure speech reception thresholds (SRTs) with native listeners in the respective languages in different listening conditions (stationary and fluctuating noise, multi-talker babble, reverberated speech-in-noise condition). Study sample: Four German/Russian and four German/Spanish bilingual talkers; 20 native German-speaking, 10 native Russian-speaking, and 10 native Spanish-speaking listeners. Results: Across-talker SRT differences of up to 6 dB were found for both groups of bilinguals. SRTs of German/Russian bilingual talkers were the same in both languages. SRTs of German/Spanish bilingual talkers were higher when they talked in Spanish than when they talked in German. The benefit from listening in the gaps was similar across all languages. The detrimental effect of reverberation was larger for Spanish than for German and Russian. Conclusions: Within the limitations set by the number and slight accentedness of talkers and other possible confounding factors, talker- and test-condition-dependent differences were isolated from the language effect: Russian and German exhibited similar intelligibility in noise and reverberation, whereas Spanish was more impaired in these situations.     

Impact of obesity on adverse in-hospital outcomes in patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip® procedure - Results from the German nationwide inpatient sample

Background and aimThe number of percutaneous edge-to-edge mitral regurgitation (MR) valve repairs with MitraClip® implantations increased exponentially in recent years. Studies have suggested an obesity survival paradox in patients with cardiovascular diseases. We investigated the influence of obesity on adverse in-hospital outcomes in patients with MitraClip® implantation.Methods and resultsWe analyzed data on characteristics of patients and in-hospital outcomes for all percutaneous mitral valve repairs using the edge-to-edge MitraClip®-technique in Germany 2011–2015 stratified for obesity vs. normal-weight/over-weight.The nationwide inpatient sample comprised 13,563 inpatients undergoing MitraClip® implantations. Among them, 1017 (7.5%) patients were coded with obesity. Obese patients were younger (75 vs.77 years,P < 0.001), more often female (45.4% vs.39.5%,P < 0.001), had more often heart failure (87.1% vs.79.2%,P < 0.001) and renal insufficiency (67.0% vs.56.4%,P < 0.001). Obese and non-obese patients were comparable regarding major adverse cardiac and cerebrovascular events (MACCE) and in-hospital death. The combined endpoint of cardio-pulmonary resuscitation (CPR), mechanical ventilation and death was more often reached in non-obese than in obese patients with a trend towards significance (20.6%vs.18.2%,P = 0.066). Obesity was an independent predictor of reduced events regarding the combined endpoint of CPR, mechanical ventilation and death (OR 0.75, 95%CI 0.64–0.89,P < 0.001), but not for reduced in-hospital mortality (P = 0.355) or reduced MACCE rate (P = 0.108). Obesity class III was associated with an elevated risk for pulmonary embolism (OR 5.66, 95%CI 1.35–23.77,P = 0.018).ConclusionsWe observed an obesity paradox regarding the combined endpoint of CPR, mechanical ventilation and in-hospital death in patients undergoing MitraClip® implantation, but our results failed to confirm an impact of obesity on in-hospital survival or MACCE.     

Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States

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Depression and changed pain perception: hints for a central disinhibition mechanism

Although patients with a depressive disorder report often of pain, their sensitivity to experimental pain is controversial, probably due to differences in sensory testing methods and to the lack of normal values. Therefore, we used a standardized and validated comprehensive sensory testing paradigm to assess the peripheral and central nervous system performance in depressive patients compared to healthy controls and chronic pain patients with fibromyalgia syndrome (FMS), in which depression is a common comorbidity. Twenty-five depressive psychiatric inpatients (pain-free: n=20), 35 FMS outpatients and 25 healthy controls underwent quantitative sensory testing (QST), including thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimuli (wind-up). In depressive disorder (to a lesser extent also in FMS), significantly decreased cold pain thresholds and an increased wind-up were found, although the mechanical pain thresholds and pain sensitivity were comparable to those of the healthy controls. All the detection thresholds were within the normal range in all the groups. In depressive disorder, there were no significant side differences in the detection and pain thresholds. The results contradict the former assumption of a general insensitivity to experimental pain in depressive disorder. In the mostly pain-free patients signs of an enhanced central hyperexcitability are even more pronounced than usually found in chronic pain patients (e.g. FMS), indicating common mechanisms in depressive disorder and chronic pain in accordance with the assumption of non-pain associated mechanisms in depressive disorder for central hyperexcitability, e.g. by inhibited serotonergic function. Furthermore, this trial demonstrates the feasibility of QST in depressive patients.     

Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia

Persistent infection with HPV 16 and 18 has been causally associated with the development of cervical cancer and its precursor lesions as well as with other carcinomas and their precursors, e.g. some vulvar and vaginal cancers. Furthermore HPV 6 and 11 are responsible for anogenital condylomata acuminata in more than 90% of cases. With the recently developed prophylactic bivalent (HPV 16 and 18) and quadrivalent (HPV 6, 11, 16 and 18) vaccines, it is possible to prevent infection of the cervical epithelium and other squamous epithelia, the development of premalignant lesions and, in the case of the quadrivalent vaccine, the development of condylomata acuminata. The following paper represents a summary of the full-text version of the German evidence-based Guidelines, including all evidence-based recommendations regarding the safety as well as the efficacy of the vaccines in preventing CIN, VIN/VaIN, genital warts and other HPV-associated lesions.     

Brain potentials to morphologically complex words during listening

This study uses event-related brain potentials (ERPs) to investigate the processing of morphologically regular and irregular words during auditory comprehension. ERPs were recorded, while 23 German-speaking subjects listened to correctly and incorrectly inflected noun plural forms presented in sentential contexts. ERP responses to violations of morphological structure were different to those of lexical (word-level) violations: the former elicited LAN/P600 effects, and the latter an enhanced N400 component relative to the correctly inflected plural forms. This difference replicates previous results from visual ERP studies and supports the distinction between combinatorial and memory-based processing of morphologically complex words. In addition, LAN/P600 effects were found to be more prominent in the auditory domain than in a previous visual study using similar materials.     

Development of a self-reporting questionnaire, BURMIG, to evaluate the burden of migraine

We developed a 77-item self-reporting questionnaire to assess the burden of migraine (BURMIG), including headache characteristics, migraine associated disability, comorbidities, management, and the consequences on the patients' lives. We translated BURMIG into four languages (French, Portuguese, German and English) and tested it in 130 headache patients (20 pain clinic, 17 primary care and 93 general public) in Luxembourg. We performed a linguistic and a face-content validation and tested the questionnaire for its comprehensiveness, internal consistency and for its retest-reliability at an interval of 1 month (completion rates were 79.6 and 76.4%, for test and retest, respectively). Retest-reliability for the different parts of the questionnaire varied between 0.6 and 1.0 (Kappa coefficient), with an intracorrelation coefficient of 0.7-1.0. The internal consistency was between 0.74 and 0.91 (Cronbach's alpha). The questionnaire BURMIG is suitable to evaluate the burden of migraine and can be used in English, German, French and Portuguese.     

Features of probable multiple system atrophy patients identified among 4770 patients with parkinsonism enrolled in the multicentre registry of the German Competence Network on Parkinson’s disease

Summary We identified 221 patients with probable multiple system atrophy (MSA) among 4770 patients enrolled in the multicentre registry of the German Competence Network on Parkinson’s disease (PD) according to the established consensus criteria to characterize their clinical presentation. Analyses of more than 100 recorded clinical items revealed several specifics: I) 50% of patients with probable MSA had asymmetry of symptoms at disease onset and tremor at rest was present in 25%; II) a positive response to levodopa was recorded in 51% of patients identified initially with severe autonomic failure and cerebellar ataxia; III) a positive family history was recorded in 11% (n = 23), two of these patients were identified with spinocerebellar ataxia type 3 (SCA3). Thus asymmetry of symptoms, tremor at rest and a positive response to levodopa are not as specific for idiopathic PD as believed previously. Patients with SCA3 may present with the clinical features of MSA.     

The National Socialist Sisterhood: an instrument of National Socialist health policy

When Adolf Hitler (1889–1945) came to power in 1933, the new Nazi government focused the German health system on their priorities such as the creation of a racially homogeneous society and the preparation of war. One of the measures to bring nursing under their control was the foundation of a new sisterhood. In 1934, Erich Hilgenfeldt (1897–1945), the ambitious head of the National Socialist People's Welfare Association (Nationalsozialistische Volkswohlfahrt), founded the National Socialist (NS) Sisterhood (Nationalsozialistische Schwesternschaft) to create an elite group that would work for the goals of the National Socialist German Workers' Party (Nationalsozialistische Deutsche Arbeiterpartei, NSDAP). Hilgenfeldt proclaimed community nursing as a priority for NS Sisterhood nurses. Catholic and Protestant sisters, who were traditionally dedicated to community nursing, were to be gradually replaced. However, other competing priorities, such as hospital service for the training of junior nurses and work in conquered regions, as well as the lack of NS nursing personnel, hampered the expansion of community nursing. The paper also addresses areas for future research: everyday activities of NS nurses, the service of NS Sisterhood nurses for NSDAP organisations such as the elite racist paramilitary force SS (Schutzstaffel, Protective Squadron), and involvement in their crimes have hardly been investigated as yet.