Displacement of Dental Implants in Trabecular Bone under a Static Lateral Load in Fresh Bovine Bone

Aim: The study aims to provide objective data for the displacement of titanium screw implants in trabecular bone specimens. One hundred Semados implants (Bego, Bremen, Germany) were inserted in bovine type IV bone specimens. All implants had a diameter of 3.75 mm; 50 implants had a length of 8.5 mm and 50 implants had a length of 15 mm. Insertion torque was determined at intervals of 10, 20, and 30 Ncm. Implants were loaded horizontally with 10, 20, and 30 N for 2 seconds. An indicator strip was attached to the implant abutment to allow direct observation of implant movement relative to the bone surface. Horizontal displacement was assessed with an accuracy of measurement of 10 µm. Seven implants got lost by visible loosening. Degree of displacement was subject to evaluation with all others. Those implants showed a mean displacement of 59 µm for 10 N (n = 100), 173 µm for 20 N (n = 99), and 211 µm for 30 N (n = 93). The mean displacement of 15‐mm implants (16, 37, 51 µm) was significantly lower compared with 8.5‐mm implants (103, 311, 396 µm) corresponding to 10, 20, and 30 N as lateral loads. Conclusions: Displacement of screw implants in trabecular bone can be detected and visualized using commercially available endoscopes with a high magnification. A lateral load of 20 N indicates a mean displacement of over 100 µm and therefore results in a critical displacement.     

Relationship between multimorbidity and direct healthcare costs in an advanced elderly population

Objectives

The goal of this work was to analyze the impact of the extent of multimorbidity on health service resource utilization and, thus, direct healthcare costs of advanced elderly in the German population.

Methods

Based on a cross-sectional sample aged 72 or above in Germany (n?=?1,937), a bottom-up study assessing resource utilization and corresponding costs was performed. Main data sources were patient-reported information concerning morbidity and health service resource utilization administered via telephone interviews within the framework of the PRISCUS trial. To value resource utilization, unit costs were determined for all services under consideration. In order to estimate the impact of multimorbidity on mean annual direct costs, a cumulative multimorbidity index was constructed. Influencing factors on annual average costs were identified via multivariate linear regression models.

Results

Mean annual direct costs of 3,315?EUR (95%?confidence interval (CI) 3,118; 3,512) at 2010 prices were caused by the involved patients: 25% of mean annual costs were due to inpatient care, 20% to outpatient physician services, 20% to pharmaceuticals, 12% to assisted living and transportation, 8% to healthcare products and dentures, 7% to rehabilitation services, 5% to outpatient nonphysician providers, and 3% to spending from compulsory long-term care insurance. Each additional comorbidity was accompanied by a cost increase of 563?EUR (95%?CI 488; 638). Participants with no diseases mentioned in the multimorbidity index caused average annual costs of 1,250?EUR. In contrast, respondents with 10?+ diseases caused the highest mean annual costs of 6,862?EUR.

Conclusion

Longer life expectancy has become commonplace and is often associated with the simultaneous occurrence of several diseases. A clear understanding of the impact of multimorbidity on costs is highly relevant for health policy decision makers. The present study provides a well-founded basis to analyze the relationship between multiple morbidity and associated costs due to healthcare resource consumption of older adults in Germany.     

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy‐induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence‐based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation.     

Psychische Gesundheit von übergewichtigen und adipösen Jugendlichen unter Berücksichtigung von Sozialstatus und Schulbildung

Background

International studies showed that overweight and obese adolescents are more likely to have mental health problems compared to normal weight peers.

Objectives

This study analyses the relation between overweight/obesity and mental health problems among adolescents in Germany as well as potential modifying factors of this relation.

Materials and Methods

Data base was a subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n?=?6,813, 11–17 years) which was conducted by the Robert Koch Institute from May 2003 to May 2006. Body height and weight were measured in a standardised manner and body mass index (BMI) was calculated. Indications of mental health problems and strengths were collected with the Strengths and Difficulties Questionnaire (SDQ) in the following areas: emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. Socio-economic status (SES) and education are analysed as modifying variables. Prevalence and odds ratios with 95?% confidence intervals were calculated by binary logistic regression.

Results

Obese boys and overweight and obese girls showed more indications of mental health problems compared to normal weight peers. The most common problem areas were conduct problems and peer relationship problems. Obese girls were also more likely to show indications of emotional symptoms compared to normal weight girls. The age stratified analysis showed that the differences in the occourrence of mental health problems between normal weight and obese boys as well as between normal weight and overweight/obese girls are more pronounced aged 11 to 13 years than aged 14 to 17 years. The results on the impact of SES and education showed that in girls, SES had a modyfying impact on the relation between overweight/obesity and mental health problems in favour of the high SES group. In boys, SES only had a modifying impact on the relation between overweight and mental health problems, but here in favour of the low SES group. Only in girls education had a modifying impact on the relation between obesity and mental health problems in favour of the low education group.

Conclusion

In adolescence, overweight and especially obesity go along with a higher risk for mental health problems. In the context of prevention measures and care services for overweight and obesity at a young age, psychosocial aspects should be considered.