Disparities in dental health among school children in the city of Stuttgart

ZusammenfassungFragestellung In dieser ökologischen Studie wurde untersucht, ob sich sozialräumliche Unterschiede im Hinblick auf die Zahngesundheit bei Grundschulkindern in Stuttgart zeigen.Methoden Verwendet wurde eine Aufteilung von 67 in sich homogenen Sozialräumen in sieben Sozialraumtypen mit ähnlicher sozioökonomischer Struktur. Ausgewertet wurden zahnärztliche Daten von 16755 Grundschulkinder aus dem Schuljahr 1999/2000.Ergebnisse Der Anteil der Kinder mit naturgesunden bleibenden Gebissen differeirte zwischen den Sozialraumtypen von 74,6% bis 88,0% (Durchschnitt: 81,7%). Nicht die Kinder aus Stadtteilen mit dem höchsten Armutspotenzial, sondern die aus innerstädtischen Verdichtungsgebieten erzielten die schlechtesten Ergebnisse. Sie haben doppelt so häufig ein nicht naturgesundes bleibendes Gebiss wie Kinder in guten Wohnlagen und dreimal so oft ein behandlungsbedürftiges Gebiss.Schlussfolgerungen Die zahnärztliche Gruppenprophylaxe sollte in sozial benachteiligten Stadtteilen verstärkt werden.

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SummaryObjectives In an ecological study, we investigated differences in dental health among children attending elementary schools in Stuttgart.Methods We used a classification of 67 socially homogeneous districts into seven clusters with comparable socio-economic structures. Public health service dentists data of the school years 1999/2000 on 16755 children were assigned to the seven clusters.Results 81.7% of children had healthy natural permanent teeth (variation among the clusters: 74.6–88.0%). Not children in the poorest areas had the worst results but children living in inner-city areas. They were twice as likely not to have healthy natural teeth and three times as likely to be in need of dental treatment than children living in affluent areas.Conclusions Efforts in prevention of dental health should be strengthened in nurseries and schools in socially deprived areas.

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RésuméObjectifs Dans une étude écologique, nous avons étudié les différences en santé dentaire d'élèves fréquentant les écoles primaires de la ville de Stuttgart.Méthodes Nous avons classé 67 secteurs de la ville en sept groupes de structure sociale comparable. Les données obtenues par des dentistes sur 16755 élèves (année scolaire 1999/2000) ont été reparties sur les groupes.Résultats 81,7% des enfants avaient des dents permanentes saines (variation entre les groupes de 74,6 et 88,0%). Ce ne sont pas les enfants des secteurs les plus pauvres qui avaient les plus mauvais résultats mais les enfants du centre-ville. Ils avaient deux fois plus souvent des dents traitées ou à traiter et trois fois plus souvent des dents à traiter que les enfants des quartiers aisés.Conclusions Les efforts préventifs parmi les enfants dans les quartiers défavorisés doivent renforcés.

     

Pet birds and risk of lung cancer in North-Western Germany

The relationship between non-small cell lung cancer and platelet counts, serum levels of vascular endothelial growth factor (VEGF) and endostatin, is unclear. Platelet counts and serum VEGF and endostatin levels were measured preoperatively in 99 patients with non-small cell lung cancer, and the relationship between these factors and clinicopathological features, including prognosis, was examined. Mean serum VEGF level was slightly higher in patients than in healthy subjects (P=0.23). Mean serum endostatin level was 42.4+/-40.4 ng/ml in patients compared to 16.3+/-10.3 ng/ml in healthy subjects (P=0.0003). Serum endostatin levels were significantly higher in patients with involvement greater than T2 or stage IB, compared to other patients. Platelet count and serum endostatin level greater than the median were associated with poor prognosis. Our results suggested that platelet count and serum endostatin level may be useful markers for non-small cell lung cancer.     

Characterization of dose distributions through the max and mean dose concept

A new approach for the determination of the equivalent uniform dose (EUD) for inhomogeneously irradiated normal organs is developed and tested. The EUD is calculated as a linear combination of the maximum and the mean dose: EUD = alphaDmax + (1 - alpha)D. We call this the max & mean model. The values of alpha are determined by a fit to the Emami tables for complication levels of 5% and 50%. The predictions of the max & mean model are compared with the Emami tables for different treatment volume fractions. The quality of the fit is also compared with the well-known power-law EUD model. The max & mean model makes it possible to make useful predictions of the EUD for organs having an organization anywhere between serial and parallel. The model can be fitted to the Emami tables within the same error range as the widely used power-law model (about 10%) and can be integrated into linear multicriteria optimization algorithms for planning of intensity-modulated radiotherapy.     

Psychophysiological correlates of peritraumatic dissociative responses in survivors of life-threatening cardiac events

The psychophysiological startle response pattern associated with peritraumatic dissociation (DISS) was studied in 103 survivors of a life-threatening cardiac event (mean age 61.0 years, SD 13.95). Mean time period since the cardiac event was 37 (79 IQD) months. All patients underwent a psychodiagnostic evaluation (including the Peritraumatic Dissociative Experiences Questionnaire) and a psychophysiological startle experience which comprised the delivery of 15 acoustic startle trials. Magnitude and habituation to trials were measured by means of electromyogram (EMG) and skin conductance responses (SCR). Thirty-two (31%) subjects were indexed as patients with a clinically significant level of DISS symptoms. High-level DISS was associated with a higher magnitude of SCR (ANOVA for repeated measures p = 0.017) and EMG (p = 0.055) and an impaired habituation (SCR slope p = 0.064; EMG slope p = 0.005) in comparison to subjects with no or low DISS. In a subgroup analysis, high-level DISS patients with severe post-traumatic stress disorder (PTSD; n = 11) in comparison to high-level DISS patients without subsequent PTSD (n = 19) exhibited higher EMG amplitudes during all trials (repeated measures analysis of variance F = 5.511, p = 0.026). The results demonstrate exaggerated startle responses in SCR and EMG measures - an abnormal defensive response to high-intensity stimuli which indicates a steady state of increased arousal. DISS patients without PTSD exhibited balanced autonomic responses to the startle trials. DISS may, therefore, unfold malignant properties only in combination with persistent physiological hyperarousability.     

Cognitive impairment correlates with hypothalamo-pituitary-adrenal axis dysregulation in multiple sclerosis

Hypothalamo-pituitary-adrenal (HPA) dysregulation has recently been demonstrated in multiple sclerosis (MS) by means of combined dexamethasone corticotropin-releasing hormone (Dex-CRH) suppression tests. Authors found a correlation with course of disease and to a lesser extent with depressive symptoms. In this study, we aimed to further evaluate whether HPA disturbances in MS are correlated with cognitive impairment, disability status, and fatigue. Dex-CRH tests were performed in a total of 40 patients and 11 healthy controls. Concomitantly, cognitive impairment was evaluated using the symbol digit modalities test and fatigue was assessed by different fatigue severity scales.When comparing patient subpopulations to healthy subjects, Dex-CRH stimulation tests indicated an HPA hyperactivity in primary and secondary progressive MS, while relapsing-remitting patients had response patterns similar to controls. However, results were only significant for one of the six analysed parameters, i.e. area under the curve calculations of ACTH stimulation. Within the patient sample, clear-cut differences emerged between groups of different cognitive impairment, being significant for all ACTH response parameters. Our results suggest an HPA hyperactivation related to increased cognitive impairment. Indicators of HPA axis activation further correlated substantially with neurologic disability, but only moderately with duration of disease and even less with depressive symptoms and fatigue. We conclude that the observed dysregulation is more likely a secondary effect of the extent of brain damage rather than primarily involved in the pathogenesis of MS.     

Prim?re Katheterablation von Vorhofflimmern

Hintergrund: Die primäre Katheterablation von Vorhofflimmern stellt eine neue, kurative Behandlungsoption für Patienten mit therapieresistentem Vorhofflimmern dar. Sie hat den langfristig stabilen Sinusrhythmus zum Ziel, mit daraus folgernder koordinierter Vorhofkontraktion. Ablationsmethoden: Zwei verschiedene Ablationsstrategien haben sich in den letzten Jahren etabliert: Die Triggerelimination versucht auslösende atriale Extrasystolen (meistens innerhalb der Pulmonalvenen) zu identifizieren und durch fokale Hochfrequenzstromapplikation auszuschalten oder innerhalb der Pulmonalvenen zu isolieren. Durch die Substratmodifikation sollen mittels Anlage langer Ablationslinien die Eigenschaften des Vorhofmyokards so verändert werden, dass Vorhofflimmern nicht mehr aufrechterhalten werden kann. Bewertung: Beide Behandlungskonzepte müssen ihre Effektivität noch im Rahmen von sorgfältigen Nachbeobachtungsstudien unter Beweis stellen, bevor sie für den generellen Einsatz bei Patienten mit Vorhofflimmern empfohlen werden können. Background: Primary catheter ablation of atrial fibrillation is a new and curative option for the treatment of patients with drug-refractory atrial fibrillation. It is aiming at a long-term restoration of sinus rhythm and thereby causing a coordinated atrial contraction. Ablation Methods: Two different ablation strategies have been established: The "trigger elimination" tries to identify triggering atrial extrasystoles (mostly within the pulmonary veins), followed by focal ablation or isolation within the pulmonary veins. The "substrate modification" changes by long linear radiofrequency-induced lesions the ability of the atrial myocardium to sustain atrial fibrillation. Valuation: Both treatment options still have to prove their effectiveness in carefully monitored follow-up, before they can be offered to the general patient population with atrial fibrillation.     

Population-based incidence estimates of uveal melanoma in Germany. Supplementing cancer registry data by case-control data.

Valid incidence rates of uveal melanoma (UM) from German population-based cancer registries are currently not available due to under-reporting. We conducted two case-control studies on UM at a reference centre for eye tumours and show the influence on population-based incidences of UM when data from case-control studies are linked with a cancer registry. The first case-control study (1996-1998) recruited 13 UM cases aged 35-74 years and the second case-control study (2002-2003) recruited 20 UM cases aged 20-74 residing within the population covered by the Münster Cancer Registry. After record linkage, age-truncated and standardized (World Standard Population) incidences with and without the record linkage were compared. Incidence rates based on routine cancer registration increased by a factor of 1.7 (1996-1998, age group 35-74 years) and 3.7 (2002-2003, age group 20-74 years) after record linkage with the case-control data. The supplemented age-standardized incidence of UM is 8.6 per million (20-74 years, 2002-2003) compared with the unsupplemented incidence of 2.3 per million. UM unknown to the registry were less often morphologically verified than those known to the registry. Cancer registries relying on pathology reports underestimate UM incidences if eye-preserving treatments are introduced. Close co-operation between cancer referral centres and cancer registries can substantially improve the completeness of registration.     

Gender differences of symptom reporting and medical health care utilization in the German population

Aim: Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence. Methods: We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years. Results: The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p 0.001) and in the healthy subsample (n = 906, p 0.01). Also, female utilization of medical services was higher (p 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55–59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001). Conclusions: The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health.     

In Vivo quantitative mapping of cardiac perfusion in rats using a noninvasive MR spin-labeling method

Measurement of myocardial perfusion is important for the functional assessment of heart in vivo. Our approach is based on the modification of the longitudinal relaxation time T1 induced by magnetic spin labeling of endogenous water protons. Labeling is performed by selectively inverting the magnetization within the detection slice, and longitudinal relaxation is measured using a fast gradient echo MRI technique. As a result of blood flow, nonexcited spins enter the detection slice, which leads to an acceleration of the relaxation rate. Incorporating this phenomenon in a mathematical model that describes tissue as two compartments yields a simple expression that allows the quantification of perfusion from a slice-selective and a global inversion recovery experiment. This model takes into account the difference between T1 in blood and T1 in tissue. Our purpose was to evaluate the feasibility and reproducibility of this technique to map quantitatively myocardial perfusion in vivo in rats. Quantitative maps of myocardial blood flow were obtained from nine rats, and the reproducibility of the technique was evaluated by repeating the whole perfusion experiment four times. Evaluation of regions of interest within the myocardium yielded a mean perfusion value of 3.6 ± .5 ml min^?1 g^-1 over all animals, which is in good agreement with previously reported literature values.     

Inhibitors of Type IV Phosphodiesterases Reduce the Toxicity of MPTP in Substantia Nigra Neurons In Vivo

The neuropathology of Parkinson's disease is characterized by the degeneration of dopaminergic neurons in the substantia nigra. We have recently shown that the activation of protein kinase A improves the survival of dopaminergic neurons in culture and, furthermore, protects them from the dopaminergic neurotoxin, 1-methyl-4-phenylpyridinium ion (MPP⁺) in vitro. We have now analysed the potential of phosphodiesterase inhibitors to increase cAMP levels in dopaminergic neurons, to improve their survival in culture and to protect them from the toxicity of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in vivo. Increasing intracellular cAMP with phosphodiesterase type IV-specific inhibitors enhanced the survival of dopaminergic neurons in culture. Inhibitors of other phosphodiesterase types were not active. In vivo , phosphodiesterase type IV inhibitors reduced the MPTP-induced dopamine depletion in the striatum of C57BL/6 mice. Furthermore, the loss of tyrosine hydroxylase-immunopositive neurons in the substantia nigra of these animals was diminished. After Nissl staining, a similar reduction of the MPTP-induced loss of neurons was observed in the substantia nigra. The protective effect of protein kinase A activation did not appear to be due to the blocking of MPP⁺ uptake into dopaminergic neurons. This was not decreased after treatment with forskolin or 8-(4-chlorophenylthio)-cAMP. Thus, protein kinase A regulates the survival and differentiation of dopaminergic substantia nigra neurons in vivo , implicating a therapeutic potential for substances which regulate cAMP turnover in these neurons.