PURPOSE: The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. METHODS: In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. RESULTS: We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. CONCLUSION Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.
Accidents ; classification ; Adult ; Age Factors ; Blood Transfusion ; Data Analysis ; Emergency Medical Services ; Female ; Fluid Therapy ; Germany ; epidemiology ; Hemoglobins ; Humans ; International Normalized Ratio ; Intubation ; statistics & numerical data ; Male ; Matched-Pair Analysis ; Multiple Organ Failure ; Registries ; Sex Factors ; Survival Rate ; Trauma Severity Indices ; Wounds and Injuries ; mortality

PURPOSE: To investigate the potential benefits of testosterone administration to elderly men (>65 years) with late-onset hypogonadism (LOH) in comparison with younger men and to assess the safety of testosterone administration to elderly men. MATERIALS AND METHODS: A total of 561 hypogonadal men from two registry studies were divided into age groups of < or =65 years (group Y, n=450; range, 32-65 years) and >65 years (group O, n=111; range, 66-84 years). Following an initial 6-week interval, all men were treated with 3-month injections of parenteral testosterone undecanoate for up to 6 years. RESULTS: Over the 6 years, there was a progressive decrease of body weight and waist circumference. Beneficial effects on lipids and other metabolic factors and on psychological and sexual functioning progressed over the first 24 to 42 months and were sustained. Rather than a deterioration, there was an improvement of urinary parameters. Prostate volume and prostate-specific antigen increased moderately. Hematocrit levels increased but remained within safe margins. CONCLUSIONS: The benefits of restoring serum testosterone in men with LOH were not significantly different between men older than 65 years of age and younger men. There were no indications that side effects were more severe in elderly men. The effects on prostate and urinary function and hematocrit were within safe margins. Age itself need not be a contraindication to testosterone treatment of elderly men with LOH.
Age Factors ; Age of Onset ; Aged ; Androgens/administration & dosage ; Anthropometry/methods ; Drug Monitoring/methods ; Germany ; Humans ; *Hypogonadism/diagnosis/drug therapy/epidemiology/physiopathology/psychology ; Male ; Middle Aged ; Organ Size ; *Prostate/drug effects/pathology ; Prostate-Specific Antigen/analysis ; Registries ; *Sexual Behavior/drug effects/psychology ; Testosterone/administration & dosage/*analogs & derivatives ; Treatment Outcome

OBJECTIVETo evaluate the effects of occupational stress intervention in the workplaces abroad by systematic review and to provide a reference for domestic research.

METHODSThe Medline database was searched to collect the literature on occupational stress intervention published from January 1 in 2000 to September 4 in 2014, Using standardized forms, the methods, contents, subjects, study design, result indicator, effectiveness and evidence of the intervention were extracted and analyzed.

RESULTSThirty studies met the inclusion criteria, with a total sample size of 5699 participants, including 20 randomized trials and 10 non-randomized or self-controlled studies from 12 countries, such as Germany, Japan, and Britain. The course of intervention ranged from 4 to 16 weeks. Six types of intervention were identified, i.e., cognitive-behavioral treatment (CBT), relaxation technique, physical activity, organization-focused intervention, combined intervention, and multilevel intervention, among which CBT was used most frequently. The outcome variables mainly included social psychological variable and work-related variable. Occupational stress intervention could significantly improve the occupational stress and depressive symptoms, and also had some effects on the work-related outcomes. The effectiveness of the intervention might vary between the subjects with different occupational stress levels before intervention. The effectiveness of the intervention was better at an organizational level than at an individual level, but the effectiveness at a multiple level was not necessarily better than that at a single level.

CONCLUSIONOccupational stress intervention is an effective method to improve the occupational stress at workplace. However, the occupational stress level before intervention, the duration and frequency of intervention, measures and level of intervention, and follow-up period have certain influence on the effectiveness of intervention. Future research should pay attention to methodology, focus on organizational level and network-based intervention, and increase the cost-benefit analysis.

Cognitive Therapy ; Exercise ; Germany ; Humans ; Japan ; Randomized Controlled Trials as Topic ; Relaxation Therapy ; Stress, Psychological ; epidemiology ; United Kingdom ; Workplace

Metallo-beta-lactamase-producing Pseudomonas aeruginosa (MPPA) is an important nosocomial pathogen that shows resistance to all beta-lactam antibiotics except monobactams. There are various types of metallo-beta-lactamases (MBLs) in carbapenem-resistant P. aeruginosa including Imipenemase (IMP), Verona integron-encoded metallo-beta-lactamase (VIM), Sao Paulo metallo-beta-lactamase (SPM), Germany imipenemase (GIM), New Delhi metallo-beta-lactamase (NDM), Florence imipenemase (FIM). Each MBL gene is located on specific genetic elements including integrons, transposons, plasmids, or on the chromosome, in which they carry genes encoding determinants of resistance to carbapenems and other antibiotics, conferring multidrug resistance to P. aeruginosa. In addition, these genetic elements are transferable to other Gram-negative species, increasing the antimicrobial resistance rate and complicating the treatment of infected patients. Therefore, it is essential to understand the epidemiology, resistance mechanism, and molecular characteristics of MPPA for infection control and prevention of a possible global health crisis. Here, we highlight the characteristics of MPPA.
Anti-Bacterial Agents ; Carbapenems ; Drug Resistance, Multiple ; Epidemiology* ; Germany ; Humans ; Infection Control ; Integrons ; Monobactams ; Plasmids ; Pseudomonas aeruginosa*

Sensitivity to commercial teat dips (nonoxinol-9 iodine complex and chlorhexidine digluconate) of 56 Staphylococcus (S.) aureus strains isolated from quarter milk samples of various German dairy herds treated with different teat dipping schemes was investigated in this study. The minimum inhibitory concentration was determined using a broth macrodilution method according to the German Veterinary Association guidelines. The main objective of the current study was to induce in vitro resistance induction of S. aureus to chemical disinfectants. Ten different strains were repeatedly passed ten times in growth media with sub-lethal concentrations of disinfectants. Nine strains showed a significant reduction in susceptibility to the nonoxinol-9 iodine complex but only one strain developed resistance to chlorhexidine digluconate. Stability of the acquired resistance was observed in all S. aureus strains adapted to the nonoxinol-9 iodine complex and chlorhexidine digluconate. In contrast, simultaneous resistance to different antibiotics was not observed in any of the ten investigated S. aureus strains. However, the isolates exhibited a high degree of resistance to penicillin G. Based on these results, resistance of S. aureus to chemical disinfectants may be more likely to develop if the chemicals are used at concentrations lower than that required for an optimal biocidal effect.
Animals ; Anti-Bacterial Agents/pharmacology ; Cattle ; Chlorhexidine/*pharmacology ; Disinfectants/pharmacology ; Dose-Response Relationship, Drug ; Drug Resistance, Bacterial ; Female ; Germany/epidemiology ; Iodine/chemistry/*pharmacology ; Mastitis, Bovine/epidemiology/*microbiology ; Nonoxynol/*pharmacology ; Staphylococcal Infections/epidemiology/microbiology/*veterinary ; Staphylococcus aureus/classification/*drug effects

Enterohemorrhagic Escherichia coli ; Escherichia coli Infections ; epidemiology ; Germany ; epidemiology ; Humans

Factors affecting bacteriological cure rates (BCR) and new intramammary infections (IMI) during the dry period as well as clinical mastitis (CM) during early lactation were investigated in 414 German Holstein dairy cows receiving dry cow therapy. Cows were treated with either benethamine benzylpenicillin (300,000 IU), penethamate hydriodide (100,000 IU), and framycetin sulphate (100 mg, n = 136), or cefquinome (150 mg, n = 135), or benzathine cloxacillin (1,280 mg, n = 143). Overall BCR, IMI, and CM at parturition were 86.4%, 20.7%, and 4.3%, respectively. The three antibiotic treatments differed only in BCR, with cloxacillin yielding better results than the others. Udder quarters from cows with > 4 lactations had a higher risk of IMI and CM at calving. Chronic changes in udder tissues were linked to a lower BCR and were associated with a higher risk of CM during early lactation. The risk of CM at calving was higher in udder quarters with unspecific or subclinical mastitis before drying off. In conclusion, with antibiotic dry cow therapy, age and health status of the udder appear to be major determinants of IMI and CM during the dry period and early lactation, while BCR was associated with the antibiotic type and udder tissue status.
Animals ; Anti-Bacterial Agents/administration & dosage/*therapeutic use ; Bacterial Infections/drug therapy/epidemiology/prevention & control/*veterinary ; Cattle ; Cephalosporins/administration & dosage/therapeutic use ; Female ; Framycetin/administration & dosage/therapeutic use ; Germany/epidemiology ; Incidence ; Lactation ; Mammary Glands, Animal/*microbiology/physiology ; Mastitis, Bovine/drug therapy/*epidemiology/prevention & control ; Penicillins/administration & dosage/therapeutic use ; Risk Factors

OBJECTIVESTo investigate the trends in incidence and long-term recurrence rate of pilonidal sinus disease (PSD) within the German Armed Forces, and analyse the influence of variable factors, such as different surgical methods, body constitution and smoking amount, to incidence and long-term recurrence rate of PSD.

METHODSInformation of all the patients being admitted with primary PSD to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 was collected and analyzed, 500 patients of which were interviewed.

RESULTSTwo of the 500 patients were dead, and every one of the rest 498 patients agreed to take part in the interview. The incidence of PSD rose from 0.3/1000 in 1985 to 2.4/1000 in 2007. The recurrence rates were decreasing within 16 years of treatment from 33% in 1981 via 23% in 1986 to 12% in 1996 (P = 0.01). Recurrence rates of primary open wound healing (16.8%) compared to primary suture (31.0%) differ significantly (P < 0.01). While the mean body weight within the army rose 1 kg per decade, population shows an increase of 1.9 kg per decade though not being an influencing factor on the recurrence rate (P = 0.72). Smoking of more than 20 cigarettes per day proved to be a significant factor on the recurrence rate of PSD (P = 0.015).

CONCLUSIONWhile the recurrence rates-especially of primary open wound treatment-decreased, the incidence of PSD rose nearly tenfold.

Adult ; Factor Analysis, Statistical ; Germany ; epidemiology ; Humans ; Incidence ; Middle Aged ; Military Personnel ; Pilonidal Sinus ; epidemiology ; etiology ; Recurrence ; Smoking ; epidemiology

Escherichia coli ; classification ; Escherichia coli Infections ; epidemiology ; microbiology ; Germany ; epidemiology ; Humans ; Pandemics

AIMThe objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China's deliberations on the introduction of universal dental care for its people. METHODOLOGY A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better.

RESULTSThe epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The main reason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists.

CONCLUSION AND RECOMMENDATIONSIf dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these conditions it can be assumed that modern dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; epidemiology ; Community Dentistry ; Delivery of Health Care ; organization & administration ; Dental Caries ; epidemiology ; Dental Health Services ; organization & administration ; Dentists ; supply & distribution ; Germany ; epidemiology ; Health Care Reform ; Health Policy ; Health Priorities ; Health Transition ; Humans ; Insurance, Health ; Middle Aged ; Mouth, Edentulous ; epidemiology ; Oral Health ; Outcome Assessment (Health Care) ; Periodontal Diseases ; epidemiology ; Philosophy, Dental ; Preventive Dentistry ; Reimbursement Mechanisms ; Tooth Loss ; epidemiology ; Universal Coverage ; organization & administration ; Young Adult