Publications by authors named "Claudia Schulz"

86 Publications

Enteric Ganglioneuritis, a Common Feature in a Subcutaneous TBEV Murine Infection Model.

Microorganisms 2021 Apr 18;9(4). Epub 2021 Apr 18.

Department of Infectious Diseases, Institute for Parasitology, University of Veterinary Medicine, Buenteweg 17, 30559 Hanover, Germany.

Tick-borne encephalitis (TBE) is a severe neurologic disease in Europe and Asia. Disease expression ranges from asymptomatic to severe neurological clinical pictures, involving meningitis, encephalitis, meningoencephalitis and potentially fatal outcome. Humans mostly become infected with TBE virus (TBEV) by the bite of an infected tick. Gastrointestinal (GI) symptoms in humans are mainly attributed to the first viremic phase of TBEV infection with unspecific symptoms and/or resulting from severe neurological impairment of the central nervous system (CNS). We used the subcutaneous TBEV-infection of C57BL/6 mice as a model to analyze GI complications of TBE. We observed the acute distension and segmental dilation of the intestinal tract in 10 of 22 subcutaneously infected mice. Histological analysis revealed an intramural enteric ganglioneuritis in the myenteric and submucosal plexus of the small and large intestine. The numbers of infiltrating macrophages and CD3 T lymphocytes correlated with the severity of ganglioneuritis, indicating an immune-mediated pathogenesis due to TBEV-infection of the enteric plexus. Our study demonstrates that the inflammation of enteric intramural ganglia presents to be a common feature in TBEV-infected mice. Accordingly, the results of this mouse model emphasize that GI disease manifestation and consequences for long-term sequelae should not be neglected for TBEV-infections in humans and require further investigation.
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http://dx.doi.org/10.3390/microorganisms9040875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074024PMC
April 2021

Postoperativer Verlauf von 150 Patienten nach Wächterlymphknotenbiopsie in Tumeszenz-Lokalanästhesie.

J Dtsch Dermatol Ges 2021 Apr;19(4):536-544

Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen.

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http://dx.doi.org/10.1111/ddg.14351_gDOI Listing
April 2021

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data.

Eur J Health Econ 2021 Apr 4. Epub 2021 Apr 4.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Background: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients.

Methods: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves.

Results: 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective.

Conclusion: Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.
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http://dx.doi.org/10.1007/s10198-021-01295-zDOI Listing
April 2021

Local Recurrence Rates of Skin Tumors After Resection With Complete Circumferential Peripheral and Deep Margin Assessment-Identification of High-Risk Entities.

Dermatol Surg 2021 02;47(2):e31-e36

All authors are affiliated with the Department of Dermatology, Eberhard-Karls-UniversityTübingen, Tübingen, Germany.

Background: The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found.

Objective: The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification.

Patients And Methods: We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed.

Results: Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease.

Conclusion: Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.
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http://dx.doi.org/10.1097/DSS.0000000000002431DOI Listing
February 2021

Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia.

J Dtsch Dermatol Ges 2021 04 9;19(4):536-543. Epub 2021 Feb 9.

Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.

Background: Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients.

Patients And Methods: We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA.

Results: 32 % of the patients reported post-operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA.

Conclusions: SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.
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http://dx.doi.org/10.1111/ddg.14351DOI Listing
April 2021

Multi-species ELISA for the detection of antibodies against SARS-CoV-2 in animals.

Transbound Emerg Dis 2020 Nov 15. Epub 2020 Nov 15.

Friedrich-Loeffler-Institut, Greifswald - Insel Riems, Germany.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic with millions of infected humans and hundreds of thousands of fatalities. As the novel disease - referred to as COVID-19 - unfolded, occasional anthropozoonotic infections of animals by owners or caretakers were reported in dogs, felid species and farmed mink. Further species were shown to be susceptible under experimental conditions. The extent of natural infections of animals, however, is still largely unknown. Serological methods will be useful tools for tracing SARS-CoV-2 infections in animals once test systems are evaluated for use in different species. Here, we developed an indirect multi-species ELISA based on the receptor-binding domain (RBD) of SARS-CoV-2. The newly established ELISA was evaluated using 59 sera of infected or vaccinated animals, including ferrets, raccoon dogs, hamsters, rabbits, chickens, cattle and a cat, and a total of 220 antibody-negative sera of the same animal species. Overall, a diagnostic specificity of 100.0% and sensitivity of 98.31% were achieved, and the functionality with every species included in this study could be demonstrated. Hence, a versatile and reliable ELISA protocol was established that enables high-throughput antibody detection in a broad range of animal species, which may be used for outbreak investigations, to assess the seroprevalence in susceptible species or to screen for reservoir or intermediate hosts.
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http://dx.doi.org/10.1111/tbed.13926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753575PMC
November 2020

Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data.

BMC Geriatr 2020 10 31;20(1):439. Epub 2020 Oct 31.

Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Background: A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality.

Methods: In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality.

Results: The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2.

Conclusion: This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).
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http://dx.doi.org/10.1186/s12877-020-01847-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603768PMC
October 2020

Differences in Self-Esteem Between Cat Owners, Dog Owners, and Individuals Without Pets.

Front Vet Sci 2020 2;7:552. Epub 2020 Sep 2.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Pet ownership may provide an additional source of social support and may contribute to the owner's self-esteem. Self-esteem is considered a basic human need and is associated with psychological conditions such as depressive symptoms. To date, there is limited knowledge on the association between keeping a pet and self-esteem. The aim of this study was to determine whether cat owners, dog owners, and individuals without pets differ in terms of self-esteem (total sample and stratified by sex). Data were taken from the German Aging Survey (wave 5; nationally representative sample of individuals residing in private households ≥40 years). In this survey, the widely used and well-established Rosenberg scale was used to quantify self-esteem. Socioeconomic, lifestyle, and health-related factors were adjusted for in the regression analysis ( = 5,485). Multiple linear regressions showed that dog owners reported higher self-esteem scores compared to individuals without pets (β = 0.04, < 0.05). Similarly, male dog owners reported higher self-esteem scores compared to men without pets (β = 0.07, < 0.01). In contrast, female cat owners reported lower self-esteem scores compared to women without pets (β = -0.07, < 0.01). Study findings showed a link between owning a cat and lower self-esteem (women), as well as between owning a dog and higher self-esteem (total sample; men). Future studies should concentrate on investigating the underlying mechanisms. Furthermore, longitudinal studies are needed to better understand the link between animal ownership and self-esteem.
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http://dx.doi.org/10.3389/fvets.2020.00552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492270PMC
September 2020

[Surgical techniques in the treatment of basal cell carcinoma-a prospective investigation].

Hautarzt 2020 Dec;71(12):960-968

Universitätshautklinik, Eberhard-Karls Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.

Background: Basal cell carcinomas are the most frequent epithelial skin tumors and a frequent indication for dermatological interventions. Despite the establishment of drug treatment options, surgery is still the treatment of choice. Various options are available ranging from curettage to complex dermatosurgical procedures. In addition to the main aspect of low local recurrence rates, esthetic factors and the number of procedures are also important for the choice of treatment.

Methods: In this study 347 patients with 398 basal cell carcinomas (nodular type, diameter up to 10 mm) were prospectively examined. The patients were randomized into two treatment arms: in one group the tumor was treated by ring curettage and in the other group the tumor was excised. Patients who underwent 3D histologically controlled surgery due to basal cell carcinoma during the same investigation period served as controls.

Results: The highest local recurrence rate was observed after curettage (14.0%), whereas the group with 3D histology had the lowest recurrence rate (0.9%, p < 0.001). In the 3D group, more re-excisions were required to achieve complete tumor clearance compared to the group who underwent excisions with serial section histology. Patients rated the esthetic outcome best after curettage. The median follow-up was 3.9 years.

Conclusion: The choice of surgical treatment for small nodular basal cell carcinomas depends on individual circumstances. Excisions controlled by 3D histology with wound closure after complete tumor clearance showed the lowest recurrence rate in our study; however, curettage is also a possible surgical treatment option with minimal effort and an acceptable recurrence rate, which can lead to good esthetic results.
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http://dx.doi.org/10.1007/s00105-020-04685-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686215PMC
December 2020

Scent dog identification of samples from COVID-19 patients - a pilot study.

BMC Infect Dis 2020 Jul 23;20(1):536. Epub 2020 Jul 23.

Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany.

Background: As the COVID-19 pandemic continues to spread, early, ideally real-time, identification of SARS-CoV-2 infected individuals is pivotal in interrupting infection chains. Volatile organic compounds produced during respiratory infections can cause specific scent imprints, which can be detected by trained dogs with a high rate of precision.

Methods: Eight detection dogs were trained for 1 week to detect saliva or tracheobronchial secretions of SARS-CoV-2 infected patients in a randomised, double-blinded and controlled study.

Results: The dogs were able to discriminate between samples of infected (positive) and non-infected (negative) individuals with average diagnostic sensitivity of 82.63% (95% confidence interval [CI]: 82.02-83.24%) and specificity of 96.35% (95% CI: 96.31-96.39%). During the presentation of 1012 randomised samples, the dogs achieved an overall average detection rate of 94% (±3.4%) with 157 correct indications of positive, 792 correct rejections of negative, 33 incorrect indications of negative or incorrect rejections of 30 positive sample presentations.

Conclusions: These preliminary findings indicate that trained detection dogs can identify respiratory secretion samples from hospitalised and clinically diseased SARS-CoV-2 infected individuals by discriminating between samples from SARS-CoV-2 infected patients and negative controls. This data may form the basis for the reliable screening method of SARS-CoV-2 infected people.
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http://dx.doi.org/10.1186/s12879-020-05281-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376324PMC
July 2020

Sentinel lymph node biopsy for high-thickness cutaneous squamous cell carcinoma.

Arch Dermatol Res 2021 Mar 8;313(2):119-126. Epub 2020 May 8.

Department of Dermatology and Center for Dermatologic Surgery, Eberhard-Karls University of Tuebingen, Liebermeisterstraße 25, 72076, Tübingen, Germany.

Squamous cell carcinomas are among the most common skin tumors and show a risk of metastasis depending on various factors such as tumor thickness, localization, histological subtype and immune status of the patient. Sentinel lymph node biopsy (SLNB) SLNB represents a possibility for assessing the locoregional lymph node status. In this study, the role of the SLNB in lymph node status and survival was analyzed. Retrospectively, 720 patients with high-risk squamous cell carcinoma (tumor thickness > 5 mm) were examined. 150 patients agreed to SLNB, 570 patients did not undergo histologic confirmation of lymph node status and were included directly in follow-up. In 101 patients, a sentinel lymph node was successfully marked and extirpated, followed by regular follow-up examinations.A total of 11.11% of the patients showed lymph node metastasis in the course of their treatment, with no difference in the proportion of patients in the SLNB group (11.9%) and the observation group (11.4%) (p = 0.873). The proportion of distant metastasis also did not differ between the groups (p = 0.898). In 3.96% of the patients in the SLNB group, a metastasis was found in the sentinel lymph node. Tumor-specific death was observed in 7.14% of the patients in the SLNB group and 4.74% in the observation group (p = 0.269). Although SLNB is a principally suitable method for determining lymph node status, the available data do not provide any benefit regarding further metastasis or tumor-specific survival.
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http://dx.doi.org/10.1007/s00403-020-02082-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864829PMC
March 2021

Eradication of Peste des Petits Ruminants Virus and the Wildlife-Livestock Interface.

Front Vet Sci 2020 13;7:50. Epub 2020 Mar 13.

FAO-OIE GEP PPR Secretariat, Food and Agriculture Organization of the United Nations, Rome, Italy.

Growing evidence suggests that multiple wildlife species can be infected with peste des petits ruminants virus (PPRV), with important consequences for the potential maintenance of PPRV in communities of susceptible hosts, and the threat that PPRV may pose to the conservation of wildlife populations and resilience of ecosystems. Significant knowledge gaps in the epidemiology of PPRV across the ruminant community (wildlife and domestic), and the understanding of infection in wildlife and other atypical host species groups (e.g., camelidae, suidae, and bovinae) hinder our ability to apply necessary integrated disease control and management interventions at the wildlife-livestock interface. Similarly, knowledge gaps limit the inclusion of wildlife in the FAO/OIE Global Strategy for the Control and Eradication of PPR, and the framework of activities in the PPR Global Eradication Programme that lays the foundation for eradicating PPR through national and regional efforts. This article reports on the first international meeting on, "Controlling PPR at the livestock-wildlife interface," held in Rome, Italy, March 27-29, 2019. A large group representing national and international institutions discussed recent advances in our understanding of PPRV in wildlife, identified knowledge gaps and research priorities, and formulated recommendations. The need for a better understanding of PPRV epidemiology at the wildlife-livestock interface to support the integration of wildlife into PPR eradication efforts was highlighted by meeting participants along with the reminder that PPR eradication and wildlife conservation need not be viewed as competing priorities, but instead constitute two requisites of healthy socio-ecological systems.
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http://dx.doi.org/10.3389/fvets.2020.00050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082352PMC
March 2020

Regional variation of care dependency after hip fracture in Germany: A retrospective cohort study using health insurance claims data.

PLoS One 2020 23;15(3):e0230648. Epub 2020 Mar 23.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objective: To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance.

Data Sources/study Setting: Patient-level statutory health and long-term care insurance claims data from 2009-2011 and official statistical data from Germany.

Study Design: We performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics.

Principal Findings: The study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency.

Conclusions: Several characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230648PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7089542PMC
June 2020

Uptake of an exercise class and use of bone density measurement after advice by the health insurance fund: results from the osteoporotic fracture prevention program in rural areas (OFRA).

Aging Clin Exp Res 2020 Jul 7;32(7):1255-1262. Epub 2020 Mar 7.

Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany.

Background: OFRA is a large health insurance fund-driven program which aims to reduce the risk of falls and fractures in older people living in rural areas. The programme offered specific mobility and falls prevention classes and bone density measurement by a DXA scan free of charge to more than 10,000 people, and was promoted by staff of the health insurance fund either by a visit at home, or a phone call, or a visit at home and a subsequent phone call. The aim of this study was to analyse the uptake of an exercise class and the use of a DXA scan after advice.

Methods: Telephone interviews were conducted in a randomly selected subgroup of 780 persons 9 months after first contact. Rates of uptake of an exercise class or use of a DXA scan were calculated. Predictors of uptake and use were analysed applying logistic regression models.

Results: The rate of uptake after advice for specific mobility and fall prevention class was 29.6%. For DXA scan, the rate of use after advice was 16.7%. Rates of uptake and use increased if the first contact by a visit at home or a phone call was followed by an additional subsequent phone call.

Conclusion: A direct motivational approach in older people by a health insurance fund is feasible and results in relevant participation and utilization rates in exercise classes and DXA scans.
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http://dx.doi.org/10.1007/s40520-020-01506-2DOI Listing
July 2020

Treatment utilization and treatment barriers in individuals with body dysmorphic disorder.

BMC Psychiatry 2020 02 18;20(1):69. Epub 2020 Feb 18.

Institute of Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany.

Background: Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics.

Methods: German individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively.

Results: Only 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight.

Conclusions: The results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.
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http://dx.doi.org/10.1186/s12888-020-02489-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027080PMC
February 2020

The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture.

Dtsch Arztebl Int 2020 01;117(4):53-59

Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart; School of Health Sciences, University of Manchester, and Manchester Academic Health Sciences Centre, and Manchester University NHS Foundation Trust, Manchester, UK; Institute of Epidemiology and Medical Biom etry, Ulm University, Ulm; Center for Trauma Research, Ulm University, Ulm; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart; Department of Orthopedics and Trauma Surgery, Diakonissen Hospital Karlsruhe-Rüppurr, Karlsruhe.

Background: To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany.

Methods: This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses.

Results: The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management.

Conclusion: A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.
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http://dx.doi.org/10.3238/arztebl.2020.0053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036469PMC
January 2020

Gazing rituals in body dysmorphic disorder.

J Behav Ther Exp Psychiatry 2020 09 4;68:101522. Epub 2019 Nov 4.

Institute of Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany. Electronic address:

Background And Objectives: Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflection in the mirror) with regard to effects on dissociation, attractiveness evaluations and perceptual uncertainty. The aim of this study was to examine the hypothesized causal effects of gazing rituals on appearance preoccupation.

Methods: We asked 115 females to complete a face gazing paradigm with three different facial stimuli and, depending on the condition, different gazing durations. We also examined the influence of BDD symptom severity on the reactions to different facial stimuli.

Results: Five minutes of gazing significantly increased dissociation. Participants rated the attractiveness of self-relevant stimuli, especially the own photographed face, below average and lower than the unfamiliar face.

Limitations: Limitations with regard to sample characteristics and experimental design are discussed.

Conclusions: Our findings support cognitive-behavioral models for BDD and indicate that therapists may extend therapeutic interventions like mirror retraining by specific perceptual retraining with photographs of the patients.
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http://dx.doi.org/10.1016/j.jbtep.2019.101522DOI Listing
September 2020

Camelids and Cattle Are Dead-End Hosts for Peste-des-Petits-Ruminants Virus.

Viruses 2019 12 8;11(12). Epub 2019 Dec 8.

Institute of Diagnostic Virology, Friedrich-Loeffler-Institut, 17493 Greifswald-Insel Riems, Germany.

Peste-des-petits-ruminants virus (PPRV) causes a severe respiratory disease in small ruminants. The possible impact of different atypical host species in the spread and planed worldwide eradication of PPRV remains to be clarified. Recent transmission trials with the virulent PPRV lineage IV (LIV)-strain Kurdistan/2011 revealed that pigs and wild boar are possible sources of PPRV-infection. We therefore investigated the role of cattle, llamas, alpacas, and dromedary camels in transmission trials using the Kurdistan/2011 strain for intranasal infection and integrated a literature review for a proper evaluation of their host traits and role in PPRV-transmission. Cattle and camelids developed no clinical signs, no viremia, shed no or only low PPRV-RNA loads in swab samples and did not transmit any PPRV to the contact animals. The distribution of PPRV-RNA or antigen in lymphoid organs was similar in cattle and camelids although generally lower compared to suids and small ruminants. In the typical small ruminant hosts, the tissue tropism, pathogenesis and disease expression after PPRV-infection is associated with infection of immune and epithelial cells via SLAM and nectin-4 receptors, respectively. We therefore suggest a different pathogenesis in cattle and camelids and both as dead-end hosts for PPRV.
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http://dx.doi.org/10.3390/v11121133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950723PMC
December 2019

Detrimental Role of Neutrophil Extracellular Traps during Dengue Virus Infection.

Trends Immunol 2020 01 5;41(1):3-6. Epub 2019 Dec 5.

Research Center for Emerging Infections and Zoonosis, University of Veterinary Medicine, Hannover, Germany; Department of Physiological Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany. Electronic address:

A recent article by Sung et al. identified the CLEC2 platelet receptor as an important factor of lethal dengue virus infection. Formation of neutrophil extracellular traps via crosstalk with CLEC5A and TLR2 neutrophils were ascribed a causative role in DENV infection. This provides new insights for the development of candidate broad-spectrum therapies against hemorrhagic virus infections.
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http://dx.doi.org/10.1016/j.it.2019.11.010DOI Listing
January 2020

Acute care models for hip fracture treatment vs post-acute rehabilitation services in older adults after hip fracture: A comparative claims data analysis from Germany.

J Rehabil Med 2020 Feb 27;52(2):jrm00024. Epub 2020 Feb 27.

Department of Clinical Gerontology, Robert-Bosch-Hospital , , Stuttgart, Germany.

Objective: Acute geriatric care (geriatric early rehabilitative treatment) and sub-acute (inpatient) geriat-ric rehabilitation are delivered to geriatric patients in Germany after hip fracture. The aim of this study was to compare patients' outcomes after hip fracture between 3 German federal states (Hesse, Bavaria, and Baden-Wuerttemberg) that nearly exclusively offered one of the two geriatric care systems.

Design: Retrospective cohort study with patient-related health insurance claims data.

Patients: Analyses were performed with data from 2009-2012 of over 30,000 patients aged ≥80 years with incident hip fracture.

Methods: Primary outcomes: "increase in care dependency", "nursing home admission"; secondary outcomes: "rehospitalization", "mortality". Multivariate regression models were applied.

Results: Compared with Hesse, the state with acute geriatric care, the risks of an "increase in care dependency" were lower in Bavaria (adjusted ratio = 0.84; 95% confidence interval (95% CI) 0.81-0.87) and Baden-Wurttemberg (0.88; 0.85-0.92), the 2 federal states with sub-acute geriatric rehabilitation. A reduction in the risk of nursing home admission was observed in Baden-Wuerttemberg (0.77; 95% CI 0.69-0.87), but not in Bavaria. Rehospitalization rates were lower in Bavaria and Baden-Wuerttemberg compared with Hesse. There was no difference in mortality.

Conclusion: Some, but not all, outcomes were more favourable in the federal states with sub-acute geriatric rehabilitation than in the federal state with acute geriatric care.
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http://dx.doi.org/10.2340/16501977-2630DOI Listing
February 2020

The German National Registry of Primary Immunodeficiencies (2012-2017).

Front Immunol 2019 19;10:1272. Epub 2019 Jul 19.

Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1-25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0-88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%-subcutaneous; 29%-intravenous; 1%-unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.
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http://dx.doi.org/10.3389/fimmu.2019.01272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659583PMC
October 2020

First Isolation and Phylogenetic Analyses of Tick-Borne Encephalitis Virus in Lower Saxony, Germany.

Viruses 2019 05 21;11(5). Epub 2019 May 21.

Institute for Parasitology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559 Hanover, Germany.

Tick-borne encephalitis (TBE) is the most important tick-borne arboviral disease in Europe. Presently, the main endemic regions in Germany are located in the southern half of the country. Although recently, sporadic human TBE cases were reported outside of these known endemic regions. The detection and characterization of invading TBE virus (TBEV) strains will considerably facilitate the surveillance and assessment of this important disease. In 2018, ticks were collected by flagging in several locations of the German federal state of Lower Saxony where TBEV-infections in humans (diagnosed clinical TBE disease or detection of TBEV antibodies) were reported previously. Ticks were pooled according to their developmental stage and tested for TBEV-RNA by RT-qPCR. Five of 730 (0.68%) pools from spp. ticks collected in the areas of "Rauher Busch" and "Barsinghausen/Mooshuette" were found positive for TBEV-RNA. Phylogenetic analysis of the whole genomes and E gene sequences revealed a close relationship between the two TBEV isolates, which cluster with a TBEV strain from Poland isolated in 1971. This study provides first data on the phylogeny of TBEV in the German federal state of Lower Saxony, outside of the known TBE endemic areas of Germany. Our results support the hypothesis of an east-west invasion of TBEV strains in Western Europe.
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http://dx.doi.org/10.3390/v11050462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563265PMC
May 2019

Combination of bilateral advancement flap and mucosal-island-pedicle flap for reconstruction of an upper lip defect.

G Ital Dermatol Venereol 2019 Apr;154(2):210-212

Division of Dermatosurgery, Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany.

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http://dx.doi.org/10.23736/S0392-0488.17.05629-2DOI Listing
April 2019

Neglected Hosts of Small Ruminant Morbillivirus.

Emerg Infect Dis 2018 12;24(12):2334-2337

Eradication of small ruminant morbillivirus (PPRV) is targeted for 2030. PPRV lineage IV is found in much of Asia and Africa. We used PPRV lineage IV strain Kurdistan/2011 in transmission trials to investigate the role of pigs, wild boar, and small ruminants as PPRV reservoirs. Suids were a possible source of infection.
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http://dx.doi.org/10.3201/eid2412.180507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256395PMC
December 2018

Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany.

J Am Med Dir Assoc 2019 04 14;20(4):451-455.e3. Epub 2018 Nov 14.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objectives: Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.

Design: Retrospective cohort study.

Setting And Participants: Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011.

Measures: The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome.

Results: Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level.

Conclusions/implications: This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
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http://dx.doi.org/10.1016/j.jamda.2018.09.029DOI Listing
April 2019

Evaluation of an IGM-specific ELISA for early detection of bluetongue virus infections in domestic ruminants sera.

Transbound Emerg Dis 2019 Jan 23;66(1):537-545. Epub 2018 Nov 23.

Laboratoire de Santé Animale d'Alfort, Université Paris Est, ANSES, ENVA, INRA, UMR 1161 VIROLOGIE, Maisons-Alfort, France.

Competitive-ELISA (c-ELISA) is the most widely used serological test for the detection of Bluetongue virus (BTV) viral protein 7 (VP7) antibodies (Ab). However, these BTV c-ELISAs cannot to distinguish between IgG and IgM. IgM Ab are generated shortly after the primary immune response against an infectious agent, indicating a recent infection or exposure to antigens, such as after vaccination. Because the BTV genome or anti-VP7 Ab can be detected in ruminant blood months after infection, BTV diagnostic tools cannot discriminate between recent and old infections. In this study, we evaluated an IgM-capture ELISA prototype to detect ruminant anti-BTV VP7 IgM on 1,650 serum samples from cattle, sheep, or goats. Animals were BTV-naive, infected, or/and vaccinated with BTV-1, -2, -4, -8, -9, -16, or -27, and we also included 30 sera from cattle infected with the Epizootic haemorrhagic disease virus (EHDV) serotype 6. Results demonstrated that this ELISA kit is specific and can detect the presence of IgM with satisfactory diagnostic specificity and sensitivity from 1 to 5 weeks after BTV infection in domestic ruminants (for goats and cattle; for sheep, at least up to 24 days). The peak of anti-VP7 IgM was reached when the level of infectious viruses and BTV RNA in blood were the highest. The possibility of detecting BTV-RNA in IgM-positive sera allows the amplification and sequencing of the partial RNA segment 2 (encoding the serotype specific to VP2) to determine the causative BTV serotype/strain. Therefore, BTV IgM ELISA can detect the introduction of BTV (or EHDV) in an area with BTV-seropositive domestic animals regardless of their serological BTV status. This approach may also be of particular interest for retrospective epidemiological studies on frozen serum samples.
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http://dx.doi.org/10.1111/tbed.13060DOI Listing
January 2019

Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities.

BMC Geriatr 2018 10 1;18(1):233. Epub 2018 Oct 1.

Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.

Background: Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3-9 years after start of implementation.

Methods: Data from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied.

Results: The program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected.

Conclusions: The program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.
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http://dx.doi.org/10.1186/s12877-018-0924-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167865PMC
October 2018

Long-Range Modulations of Electric Fields in Proteins.

J Phys Chem B 2018 09 28;122(35):8330-8342. Epub 2018 Aug 28.

Institut für Chemie , Technische Universität Berlin , Sekr. PC14, Straße des 17. Juni 135 , D-10623 Berlin , Germany.

Electrostatic interactions are essential for controlling the protein structure and function. Whereas so far experimental and theoretical efforts focused on the effect of local electrostatics, this work aims at elucidating the long-range modulation of electric fields in proteins upon binding to charged surfaces. The study is based on cytochrome c (Cytc) variants carrying nitrile reporters for the vibrational Stark effect that are incorporated into the protein via genetic engineering and chemical modification. The Cytc variants were thoroughly characterized with respect to possible structural perturbations due to labeling. For the proteins in solution, the relative hydrogen bond occupancy and the calculated electric fields, both obtained from molecular dynamics (MD) simulations, and the experimental nitrile stretching frequencies were used to develop a relationship for separating hydrogen-bonding and non-hydrogen-bonding electric field effects. This relationship provides an excellent description for the stable Cytc variants in solution. For the proteins bound to Au electrodes coated with charged self-assembled monolayers (SAMs), the underlying MD simulations can only account for the electric field changes Δ E due to the formation of the electrostatic SAM-Cytc complexes but not for the additional contribution, Δ E, representing the consequences of the potential drops over the electrode/SAM/protein interfaces. Both Δ E and Δ E, determined at distances between 20 and 30 Å with respect to the SAM surface, are comparable in magnitude to the non-hydrogen-bonding electric field in the unbound protein. This long-range modulation of the internal electric field may be of functional relevance for proteins in complexes with partner proteins (Δ E) and attached to membranes (Δ E + Δ E).
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http://dx.doi.org/10.1021/acs.jpcb.8b03870DOI Listing
September 2018