BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:Allergic diseases of the respiratory tract are common atopic diseases in the population. Pollen of plants are one of their main causes. Pollen of trees, grasses, and weeds like mugwort are of particular importance in this context. The purpose of the present study was to determine the association between typical respiratory symptoms due to pollen allergens and the sensitization to pollen of ragweed and mugwort in adults. METHODS:1039 participants (18 to 66 years) from Southwest Germany were included in this cross-sectional study. Complains typically for aeroallergens were recorded by questionnaire. In-vitro existing sensitizations were determined for grasses/early bloomer (gx1), trees (tx6), mugwort (w6 and Art-v1) and ragweed (w1 and Amb-a1) by testing for specific IgE-antibodies. RESULTS:In a screening test with a mixed allergen sample (sx1) 36.0 % of the participants showed an aeroallergen sensitization. Consecutive investigations of these 374 positive samples revealed a sensitization to grasses/early bloomer, trees, ragweed (w1), mugwort (w6) and the major allergens ragweed (Amb-a1) and mugwort (Art-v1) in 61.8 %, 54.5 %, 29.9 %, 24.3 %, 1.9 %, and 12.3 %, respectively. This corresponds to 22.2 %, 19.6 %, 10.8 %, 8.7 %, 0.7 % and 4.4 %, respectively, in the whole study population. The participants tested positively stated significantly more disorders. On average, 51.1 % had known hay fever, 65.2 % sneezing without cold and 41.5 % sneezing due to contact with grasses or flowers. In contrast, participants tested negatively stated disorders in only 4.4 %, 32.5 %, and 3.9 %, respectively. CONCLUSION:In Southwest Germany, sensitizations to plant pollen mainly are still caused by grasses, trees, and weeds like mugwort. A sensitization to pollen of ragweed alone is rare until now. However, in case of continuous allergic disorders of the respiratory tract in late summer, a sensitization to ragweed can be important for differential diagnostics.

背景与目标： 背景与目的：呼吸道过敏性疾病是人群中常见的特应性疾病。植物的花粉是其主要原因之一。在这种情况下，树木，草和像艾蒿这样的杂草的花粉尤为重要。本研究的目的是确定成人花粉过敏原引起的典型呼吸道症状与豚草和艾蒿对花粉的敏感性之间的关系。
方法：来自德国西南部的1039名参与者（18至66岁）被纳入本横断面研究。通过问卷调查记录了典型的气源性过敏原投诉。通过测试特定的IgE抗体，确定了草/早bloom（gx1），树木（tx6），艾蒿（w6和Art-v1）和豚草（w1和Amb-a1）的体外现有致敏性。
结果：在混合过敏原样品（sx1）的筛查测试中，有36.0％的参与者表现出了空气过敏原致敏性。对这374个阳性样品的连续调查显示，对草/早熟花，树木，豚草（w1），艾蒿（w6）和豚草的主要过敏原（Amb-a1）和艾蒿（Art-v1）的致敏性分别为61.8％，54.5％。 ，29.9％，24.3％，1.9％和12.3％。在整个研究人群中，这分别对应于22.2％，19.6％，10.8％，8.7％，0.7％和4.4％。参与者进行了积极测试，表明明显更多的疾病。平均而言，有51.1％的人患有花粉症，有65.2％的人不接触感冒打喷嚏，以及41.5％的人因接触草或花而打喷嚏。相比之下，参与者仅以4.4％，32.5％和3.9％的比率对负面陈述的疾病进行了测试。
结论：在德国西南部，对植物花粉的致敏作用仍然主要是由草，树木和艾蒿等杂草引起的。迄今为止，仅对豚草的花粉进行敏化是罕见的。但是，在夏末持续出现呼吸道过敏性疾病的情况下，对豚草过敏可能对鉴别诊断很重要。

BACKGROUND & AIMS: :Breast cancer is the most common malignant disease among women in Germany. There are more than 50,000 new cases of breast cancer diagnosed each year in the country. As breast cancer is a complex disease it necessitates an interdisciplinary treatment, therefore it is very likely that patients with breast cancer will benefit from treatment in special centers, either a "breast cancer centre" or "tumor centre". In recent years certifying programs for the above mentioned centers have been introduced, which guarantee standards of the quality of treatment for breast cancer all over the country. In this article we report on the development and role of tumor centers in oncology healthcare in Germany, which nowadays have a very good international reputation. Moreover, they may be a good example to other countries to found similar centers in order to improve standards of the management in oncology healthcare.

背景与目标： 乳腺癌是德国女性中最常见的恶性疾病。该国每年诊断出超过50,000例新的乳腺癌病例。由于乳腺癌是一种复杂的疾病，因此有必要进行跨学科治疗，因此，乳腺癌患者很有可能会受益于“乳腺癌中心”或“肿瘤中心”等特殊中心的治疗。近年来，针对上述中心的认证计划已经出台，从而保证了全国乳腺癌治疗质量的标准。在本文中，我们报告了肿瘤中心在德国肿瘤医疗保健领域的发展和作用，如今，该中心在国际上享有很高的声誉。而且，它们对于其他国家建立类似的中心以提高肿瘤医疗保健管理标准可能是一个很好的例子。

BACKGROUND & AIMS: :We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

背景与目标： ：我们以德国有独立麻醉科的医院为例，检查手术室的生产力。链接到麻醉学小组文献，我们使用ln（手术时间总计/麻醉师的总工资）作为手术室生产力的替代指标。我们根据来自87家医院的调查数据，测试了手术室生产力与不同结构，组织和管理特征之间的关联。我们的经验分析将改善的手术室生产率与更大的手术室容量，适当的调度行为和管理方法联系起来，以重新调整利益。根据此分析，强制执行管辖权和避免提前过度安排似乎是提高手术室生产率的可实施工具。

BACKGROUND & AIMS: :We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case-control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.

背景与目标： ：我们报告说，自2016年12月以来，德国持续，长期且在地理上分散的溶血性尿毒症综合征和胃肠炎暴发，涉及30例。该暴发是由志贺毒素生产（STEC）埃希氏菌的山梨醇发酵型不育变体引起的。大肠杆菌O157。分子分型显示14例分离株之间密切相关。一名HUS患者死亡。病例对照研究的结果表明，肉末包装是最有可能的食物载体。食品安全调查正在进行中。

BACKGROUND & AIMS: BACKGROUND:The legal framework for fluid management in the palliative care setting varies between continents and even between countries. OBJECTIVES:What legal implications must be taken into account in Germany in dealing with "terminal" dehydration? MATERIALS AND METHODS:Relevant publications in English and German have been identified. Notably, German recommendations and guidelines were reviewed, whereas national mindsets were contrasted with those of other countries like the United Kingdom and Canada. RESULTS:Our legal considerations are in line with the recommendations of the German Federal Medical Association. Key components are "patient autonomy", "best possible symptom control" and a "steady therapeutic risk-benefit assessment". Dehydration should then continue to be regarded as a "symptom" that must be "controlled" as long as it can be improved by therapeutic means and as long as the patient is not opposed to this approach. However, if dehydration remains therapeutically refractory, it is justified either not to initiate clinically assisted hydration (CAH) or to stop the ongoing therapy. The "shared decision-making model" practiced in Canada is diametrically opposed to this approach, where paternalistic decision-making is possible, provided that patients or relatives appear to be ill-informed and unprepared to decide "correct" according to expert opinion. CONCLUSIONS:A "non-refractory" state of dehydration at the end of life must not be left untreated under German law and must not be used as an option to hasten the death process if the development of dehydration does not correspond to the patient's will or if this will cannot be determined.

背景与目标： 背景：在姑息治疗环境中进行液体管理的法律框架在各大洲之间，甚至在国家之间也有所不同。
目标：在德国处理“终端”脱水时必须考虑哪些法律含义？
材料与方法：已经确定了英文和德文的相关出版物。值得注意的是，对德国的建议和指南进行了审查，而将国家的思维方式与英国和加拿大等其他国家的思维方式进行了对比。
结果：我们的法律考虑符合德国联邦医学协会的建议。关键组成部分是“患者自主权”，“最佳可能的症状控制”和“稳定的治疗风险效益评估”。脱水应继续被视为“症状”，只要可以通过治疗手段加以改善并且只要患者不反对这种方法，就必须加以“控制”。但是，如果脱水仍在治疗上难以治疗，则有理由不启动临床辅助水合作用（CAH）或停止正在进行的治疗。在加拿大实行的“共同决策模型”与这种方法截然相反，这种方法可以实行家长式决策，但前提是患者或亲属似乎不了解情况并且不准备根据专家意见做出“正确”的决定。
结论：根据德国法律，生命终了的“非难治性”脱水状态必须保持不变，并且如果脱水的发展与患者的意愿或意愿不符，则不得将其用作加速死亡过程的选择。如果无法确定。

BACKGROUND & AIMS: :This study investigates the susceptibility to cefditoren of penicillin-susceptible strains of invasive Streptococcus pneumoniae (n = 312) and of penicillin-intermediate strains of S. pneumoniae (n = 30) isolated mainly from patients with respiratory tract infections. The MIC(90)s of penicillin-susceptible and -intermediate isolates were as follows: cefditoren, < or =0.06 and 1 mg/L; penicillin G, < or =0.06 and 0.5 mg/L. Cefditoren showed the highest activity against the penicillin-intermediate strains investigated compared with the other beta-lactam antibiotics and is therefore considered to be a promising agent for the treatment of infections caused by pneumococci with reduced penicillin susceptibility.

背景与目标： ：这项研究调查了主要从呼吸道感染患者中分离出的侵袭性肺炎青霉素敏感菌株（n = 312）和肺炎链球菌青霉素中间菌株（n = 30）对头孢托仑的敏感性。青霉素易感和中度分离株的MIC（90）值如下：头孢托仑，<或= 0.06和1 mg / L； Cefditoren，<或= 0.06和1 mg / L。青霉素G，≤0.06和0.5 mg / L。与其他β-内酰胺类抗生素相比，头孢托仑对所研究的青霉素中间菌株表现出最高的活性，因此被认为是治疗青霉素敏感性降低的肺炎球菌感染的有前途的药物。

BACKGROUND & AIMS: BACKGROUND:Increasing numbers of aging individuals with chronic co-morbidities travel to regions where falciparum malaria is endemic. Non-communicable diseases are now leading risk factors for death in such countries. Thus, the influence of chronic diseases on the outcome of falciparum malaria is an issue of major importance. Aim of the present study was to assess whether non-communicable diseases increase the risk for severe imported falciparum malaria. METHODS:A retrospective observational study of all adult cases with imported falciparum malaria hospitalized between 2001 and 2015 in the tertiary care Charité University Hospital, Berlin, was performed. RESULTS:A total of 536 adult patients (median age 37 years; 31.3% female) were enrolled. Of these, 329 (61.4%) originated from endemic countries, 207 patients (38.6%) from non-endemic regions. Criteria for severe malaria were fulfilled in 68 (12.7%) cases. With older age, lack of previous malaria episodes, being a tourist, and delayed presentation, well-characterized risk factors were associated with severe malaria in univariate analysis. After adjustment for these potential confounders hypertension (adjusted odds ratio aOR, 3.06 95% confidence interval, CI 1.34-7.02), cardiovascular diseases (aOR, 8.20 95% CI 2.30-29.22), and dyslipidaemia (aOR, 6.08 95% CI 1.13-32.88) were individual diseases associated with severe disease in multivariable logistic regression. Hypertension proved an independent risk factor among individuals of endemic (aOR, 4.83, 95% CI 1.44-16.22) as well as of non-endemic origin (aOR, 3.60 95% CI 1.05-12.35). CONCLUSIONS:In imported falciparum malaria hypertension and its related diseases are risk factors for severe disease.

背景与目标： 背景：越来越多的具有慢性合并症的衰老个体前往恶性疟疾流行的地区。在这些国家，非传染性疾病目前是导致死亡的主要危险因素。因此，慢性疾病对恶性疟疾后果的影响是一个非常重要的问题。本研究的目的是评估非传染性疾病是否会增加严重输入性恶性疟疾的风险。
方法：对2001年至2015年在柏林Charité大学医院的三级医院住院的所有输入性恶性疟原虫进行回顾性观察研究。
结果：共纳入536名成年患者（中位年龄37岁；女性31.3％）。其中，329例（61.4％）来自地方病国家，207例患者（38.6％）来自非地方病地区。 68例（12.7％）符合严重疟疾标准。随着年龄的增长，缺乏先前的疟疾发作，成为旅游者以及出现病情延迟，在单因素分析中，特征明确的危险因素与严重的疟疾有关。在对这些潜在的混杂因素进行调整后，高血压（调整后的优势比aOR，3.06 95％置信区间，CI 1.34-7.02），心血管疾病（aOR，8.20 95％CI 2.30-29.22）和血脂异常（aOR，6.08 95％CI 1.13- 32.88）是多变量Logistic回归中与重症相关的个别疾病。高血压被证明是地方性（aOR，4.83，95％CI 1.44-16.22）和非地方性起源（aOR，3.60 95％CI 1.05-12.35）个体的独立危险因素。
结论：在输入的恶性疟疾中，高血压及其相关疾病是严重疾病的危险因素。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:Treatment of hip fractures is a major challenge for the German health-care system due to the increasing incidence, high mortality rate, and need for long-term care. The purpose of this study was to determine the present and future economic burden of hip fractures in Germany. METHODS:Annual costs of hip fractures were determined from a societal perspective, by multiplying individual lifetime costs at different ages by the incidence of hip fractures (incidence-based cost-of-illness study). To calculate individual lifetime costs, a Markov decision model was developed. Secondary data were used. RESULTS:Total annual costs related to hip fractures were euro 2.77 billion. Due to population aging, costs of hip fractures may increase to euro 3.85 billion in 2030. CONCLUSION:The result implies the need to identify effective prevention strategies for hip fractures and evaluate their cost-effectiveness.

背景与目标： 背景与目的：髋部骨折的治疗是德国医疗保健系统面临的主要挑战，原因是其发病率不断增加，死亡率较高且需要长期护理。这项研究的目的是确定德国髋部骨折的当前和未来经济负担。
方法：从社会角度确定每年的髋部骨折成本，方法是将不同年龄段的个体终生成本乘以髋部骨折的发生率（基于发病率的疾病成本研究）。为了计算个人终生成本，开发了一个马尔可夫决策模型。使用了辅助数据。
结果：与髋部骨折相关的年度总成本为27.7亿欧元。由于人口老龄化，到2030年，髋部骨折的费用可能增加到38.5亿欧元。
结论：该结果暗示需要确定有效的髋部骨折预防策略并评估其成本效益。

BACKGROUND & AIMS: PURPOSE:Adolescence marks a transition period in the development of gender experience and expression. Although there is growing awareness about various gender identities in health research, only limited data on the prevalence of adolescent gender variance in the general population exist. METHODS:German female and male adolescents (n = 940) aged 10-16 years participating in the nationally representative "Health Behaviour in School-aged Children" Hamburg survey were asked to report their current gender experience (identification as both feminine and masculine) and gender expression (gender role as a girl or boy). Two overall categories and five subcategories on gender experience and expression were established based on previous research. RESULTS:In total, 4.1% of the adolescents' responses were rated as variant in gender experience and 3.0% as nonconforming in expression. Both variant experiences and nonconforming expression together were present in only .9% of adolescents. Gender variance was more strongly present in girls and in younger age groups. In detail, 1.6% reported an incongruent, 1.1% an ambivalent, and 1.5% no gender identification. Another 8.0% of the responses could be rated as only somewhat congruent. CONCLUSIONS:Fluidity between clearly congruent or incongruent pathways is present in adolescence, including variant as well as possibly still developing (only somewhat clear) gender experiences, whereas clearly incongruent identification and nonconforming expression were less frequent. Understanding adolescent gender development as multidimensional is important to identify the needs of those who do not fit into the current understanding of either female or male.

背景与目标： 目的：青春期是性别经验和表达发展的过渡时期。尽管在健康研究中人们对各种性别认同的认识不断提高，但仅存在关于普通人群中青少年性别差异患病率的有限数据。
方法：要求参加全国代表性的“学龄儿童健康行为”汉堡调查的10-16岁的德国男女青少年（n = 940），报告他们目前的性别经历（识别为女性和男性），并性别表达（作为女孩或男孩的性别角色）。在以前的研究的基础上，建立了关于性别经验和表达的两个总体类别和五个子类别。
结果：总计，青少年回答中有4.1％被评定为性别经历变异，而3.0％被评为表达不合格。仅有0.9％的青少年同时存在变异经历和不合格表达。性别差异在女孩和较年轻的年龄组中更为明显。详细地说，有1.6％的人表示不相符，有1.1％的人表示矛盾，有1.5％的人没有性别认同。可以将另外8.0％的回答评为完全一致。
结论：青春期存在明显一致或不一致的途径之间的混乱，包括变异以及可能仍在发展中（只是有些清晰）的性别经历，而明显不一致的识别和不一致的表达则较少。将青春期的性别发展理解为多维的，对于确定那些不适合当前对女性或男性理解的人的需求很重要。

BACKGROUND & AIMS: :Analyses of data from the first National Health Examination Survey undertaken from 1984-1986 within the framework of the German Cardiovascular Prevention Study, show the following risk factor prevalences in 25-69 year-old men and women: overweight (BMI males: greater than 25, females greater than 24) or obese (BMI greater than 30): men 65.0%, women 57.6%; total serum cholesterol (less than 5.17 mmol/dl): men 73.7%, women 74.0%; normal blood pressure (according to JNC definitions): men 45.0%, women 59.1%; hypertension according to WHO criteria: men 26.0%, women 21.1%; controlled hypertensives (WHO criteria): men 19.9%, women 33.9%; current smoking: men 40.8%, women 26.1%. For most of the cardiovascular risk factors there is a clear negative association between prevalence and length of school education. Three myocardial infarction (MI) registries (WHO MONICA Project) are operating in the Federal Republic of Germany. Incidence and case-fatality data are within comparable ranges. Coronary heart disease (CHD) mortality has been relatively stable in both sexes from 1970 to 1986 with a minor peak in 1976 and a slight downward trend since then. A study of the reliability of coding procedures in West German state statistical offices revealed major disagreements so that trends derived from national mortality data as aggregate data of the federal states might be spurious. An ecological correlation of regional smoking prevalences (1978) and regional CHD mortality rates (1977-9) showed significant coefficients in men, but not in women.

背景与目标： ：对1984-1986年在德国心血管预防研究框架内进行的首次国家健康检查调查的数据进行的分析显示，在25-69岁的男性和女性中，以下危险因素患病率：超重（BMI男性：大于25，女性（24岁以上）或肥胖（BMI大于30）：男性65.0％，女性57.6％；血清总胆固醇（低于5.17 mmol / dl）：男性73.7％，女性74.0％；正常血压（根据JNC定义）：男性45.0％，女性59.1％；根据WHO标准，高血压：男性26.0％，女性21.1％；控制性高血压（WHO标准）：男性19.9％，女性33.9％；目前吸烟：男性40.8％，女性26.1％。对于大多数心血管疾病危险因素，患病率与受教育年限之间存在明显的负相关关系。德意志联邦共和国正在运营三个心肌梗塞（MI）注册表（WHO MONICA项目）。发病率和病死率数据在可比较的范围内。从1970年到1986年，男女的冠心病（CHD）死亡率一直相对稳定，1976年出现轻微高峰，此后略有下降。对西德州统计局的编码程序的可靠性进行的研究表明，存在重大分歧，因此，由国家死亡率数据（作为联邦州的汇总数据）得出的趋势可能是虚假的。区域吸烟率（1978年）和区域冠心病死亡率（1977-9年）之间的生态相关性在男性中表现出显着的系数，而在女性中却没有。

BACKGROUND & AIMS: OBJECTIVES:To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease. DESIGN:A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices. SETTING:UK and German healthcare perspectives were considered. PARTICIPANTS:Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment. METHODS:UK and German healthcare perspectives were considered, as were different strategies for re-intervention. INTERVENTIONS:Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents). PRIMARY OUTCOME MEASURES:The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs). RESULTS:Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs. CONCLUSIONS:All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA.

背景与目标： 目的：评估5种用于治疗股浅动脉疾病的血管内干预措施的终生成本和成本效益。
设计：基于模型的健康经济评估。使用现有的决策分析模型，从文献中获取更新的有效性数据，并根据购买价格更新成本。
地点：考虑了英国和德国的医疗保健观点。
对象：符合条件的股dication动脉间歇性lau行的患者。
方法：考虑英国和德国的医疗保健观点，以及不同的重新干预策略。
干预措施：经皮腔内血管成形术（PTA）与纾困裸金属支架（假定代表现有的医疗标准，以及4种替代方法：主要的裸金属支架，药物洗脱支架，药物洗脱球囊（DEB）和仿生支架） 。
主要观察指标：两种治疗之间的增量成本-效果比，定义为增量成本除以增量质量调整生命年（QALYs）。
结果：仿生支架BioMimics 3D的使用始终被估计占主导地位，据QALYs测算，该仿生支架具有较低的生命周期成本和更高的有效性。在其余的干预措施中，DEB总是最有效的，而PTA效果最差。成本效益结果存在不确定性，主要驱动因素是仿生支架的成本和有效性以及DEB的成本。
结论：PTA的所有4种替代方案均更有效，其中仿生支架最为经济。由于结果存在不确定性，并且所有干预措施均具有不同的作用机制，因此可以认为所有这四种干预都是PTA的替代方案。

BACKGROUND & AIMS: BACKGROUND:Modifiable health risk factors (MHRFs) significantly affect morbidity and mortality rates and frequently occur in specific combinations or risk clusters. Using five MHRFs (smoking, high-risk alcohol consumption, physical inactivity, low intake of fruits and vegetables, and obesity) this study investigates the extent to which risk clusters are observed in a representative sample of women aged 65 and older in Germany. Additionally, the structural composition of the clusters is systematically compared with data and findings from other countries. METHODS:A pooled data set of Germany's representative cross-sectional surveys GEDA09 and GEDA10 was used. The cohort comprised 4,617 women aged 65 and older. Specific risk clusters based on five MHRFs are identified, using hierarchical cluster analysis. The MHRFs were defined as current smoking (daily or occasionally), risk alcohol consumption (according to the Alcohol Use Disorders Identification Test, a sum score of 4 or more points), physical inactivity (less active than 5 days per week for at least 30 min and lack of sports-related activity in the last three months), low intake of fruits and vegetables (less than one serving of fruits and one of vegetables per day), and obesity (a body mass index equal to or greater than 30). A total of 4,292 cases with full information on these factors are included in the cluster analysis. Extended analyses were also performed to include the number of chronic diseases by age and socioeconomic status of group members. RESULTS:A total of seven risk clusters were identified. In a comparison with data from international studies, the seven risk clusters were found to be stable with a high degree of structural equivalency. CONCLUSION:Evidence of the stability of risk clusters across various study populations provides a useful starting point for long-term targeted health interventions. The structural clusters provide information through which various MHRFs can be evaluated simultaneously.

背景与目标： 背景：可调节的健康风险因素（MHRF）会显着影响发病率和死亡率，并经常以特定的组合或风险类别发生。本研究使用五个MHRF（吸烟，高风险饮酒，缺乏运动，水果和蔬菜的摄入量少以及肥胖）研究了在德国65岁及以上的代表性女性样本中观察到的风险簇的程度。此外，将集群的结构组成与其他国家的数据和调查结果进行了系统比较。
方法：使用德国代表性断面调查GEDA09和GEDA10的汇总数据集。该队列包括4,617名65岁以上的女性。使用分层聚类分析，基于五个MHRF的特定风险聚类得以识别。 MHRF的定义为当前吸烟（每天或偶尔吸烟），饮酒风险（根据酒精使用障碍识别测试，总分为4分或更高分），缺乏运动（每周活动少于5天，至少30天）过去三个月内最少且缺乏与运动有关的活动），水果和蔬菜的摄入量较低（每天少于一份水果和一种蔬菜）和肥胖症（体重指数等于或大于30） 。聚类分析总共包括4,292例有关这些因素的完整信息。还进行了扩展的分析，以包括按年龄和小组成员的社会经济地位划分的慢性病的数量。
结果：总共确定了七个风险类别。与来自国际研究的数据进行比较，发现七个风险类别是稳定的，具有高度的结构等效性。
结论：各种研究人群中风险群的稳定性的证据为长期的有针对性的健康干预措施提供了有用的起点。结构簇提供了可以同时评估各种MHRF的信息。

BACKGROUND & AIMS: BACKGROUND AND AIMS:Overall obesity has recently been established as an independent risk factor for critical illness in patients with coronavirus disease 2019 (COVID-19). The role of fat distribution and especially that of visceral fat, which is often associated with metabolic syndrome, remains unclear. Therefore, this study aims at investigating the association between fat distribution and COVID-19 severity. METHODS:Thirty patients with COVID-19 and a mean age of 65.6 ± 13.1 years from a level-one medical center in Berlin, Germany, were included in the present cross-sectional analysis. COVID-19 was confirmed by polymerase chain reaction (PCR) from nasal and throat swabs. A severe clinical course of COVID-19 was defined by hospitalization in the intensive care unit (ICU) and/or invasive mechanical ventilation. Fat was measured at the level of the first lumbar vertebra on routinely acquired low-dose chest computed tomography (CT). RESULTS:An increase in visceral fat area (VFA) by ten square centimeters was associated with a 1.37-fold higher likelihood of ICU treatment and a 1.32-fold higher likelihood of mechanical ventilation (adjusted for age and sex). For upper abdominal circumference, each additional centimeter of circumference was associated with a 1.13-fold higher likelihood of ICU treatment and a 1.25-fold higher likelihood of mechanical ventilation. CONCLUSIONS:Our proof-of-concept study suggests that visceral adipose tissue and upper abdominal circumference specifically increase the likelihood of COVID-19 severity. CT-based quantification of visceral adipose tissue and upper abdominal circumference in routine chest CTs may therefore be a simple tool for risk assessment in COVID-19 patients.

背景与目标： 背景与目的：总体肥胖最近已被确定为2019年冠状病毒病（COVID-19）患者严重疾病的独立危险因素。脂肪分布的作用，尤其是内脏脂肪的作用，通常与代谢综合征有关，目前尚不清楚。因此，本研究旨在研究脂肪分布与COVID-19严重程度之间的关系。
方法：本断面分析包括来自德国柏林一级医疗中心的30例COVID-19患者，平均年龄为65.6±13.1岁。通过聚合酶链反应（PCR）从鼻和咽拭子中确认了COVID-19。重症监护病房（ICU）的住院和/或有创机械通气定义了COVID-19的严重临床病程。在常规获得的低剂量胸部计算机断层扫描（CT）上测量第一个腰椎水平的脂肪。
结果：内脏脂肪面积（VFA）增加10平方厘米与ICU治疗的可能性高1.37倍，机械通气的可能性高1.32倍（根据年龄和性别调整）。对于上腹围，每增加一厘米的围，ICU治疗的可能性高1.13倍，机械通气的可能性高1.25倍。
结论：我们的概念验证研究表明，内脏脂肪组织和上腹围特别增加了COVID-19严重程度的可能性。因此，常规胸部CT中基于CT的内脏脂肪组织和上腹围的量化可能是COVID-19患者进行风险评估的简单工具。

BACKGROUND & AIMS: :In late 2011, the insect-transmitted Schmallenberg virus (SBV) emerged in Europe. In this study, a cattle farm located in the core region of the epidemic was closely monitored between May 2011 and January 2012. Up to the end of September every tested serum sample was negative by an SBV-specific antibody ELISA, suggesting the absence of an infection before autumn 2011. Around the end of September/beginning of October SBV genome was detected in blood samples of some animals, and a few cows exhibited fever during that period. Starting at the end of September the first cows seroconverted; the within-herd prevalence reached 100% within barely 1 month. Consequently, SBV spread rapidly in the tested herd during the vector season of 2011.

背景与目标： ：2011年底，昆虫传播的Schmallenberg病毒（SBV）在欧洲出现。在这项研究中，对2011年5月至2012年1月之间位于该流行病核心地区的一个养牛场进行了密切监视。截至9月底，每个测试的血清样本均通过SBV特异性抗体ELISA呈阴性，表明没有感染是在2011年秋天之前。在9月底/ 10月初左右，在一些动物的血液样本中检测到SBV基因组，在此期间，一些母牛表现出发烧。从9月底开始，第一批母牛进行了血清学转化。在短短1个月内，畜群内的患病率达到了100％。因此，SBV在2011年媒介季节在受试牛群中迅速传播。

BACKGROUND & AIMS: :Until now, existing remuneration of environmental services has not sufficiently supported the goals of spending money more effectively on the environment and of motivating farmers. Only a small share of the budgets for agriculture in the EU, as well as in US and other countries, is available for buying environmental goods and services beyond the level of good farming practice (GFP). This combined with the insufficient targeting of compensation payments to areas where special measures are needed leads to an unsatisfactorily low impact of agri-environment measures compared to other driving forces that stimulate the intensification of farming. The goal of this paper is to propose a management concept that enhances the ecological and cost efficiency of agri-environment measures. Components of the concept are a comprehensive environmental information base with prioritised goals and targets (available in Germany from landscape planning) and new remuneration models, which complement conventional compensation payments that are based upon predetermined measures and cost. Comprehensive landscape planning locates and prioritises areas which require environmental action. It contains the information that authorities need to prioritise funding for environmental services and direct measures to sites which need environmental services beyond the level of GFP. Also appropriate remuneration models, which can enhance the cost efficiency of public spending and the motivation of the farmers, can be applied on the base of landscape planning. Testing of the planning methodology and of one of the remuneration models (success-oriented remuneration) in a case study area ("Fuhrberger Feld" north of Hanover, Germany) demonstrated the usability of the concept and led to proposals for future development of the methodology and its application in combination with other approaches.

背景与目标： ：直到现在，现有的环境服务报酬还不足以支持更有效地在环境上花钱和激励农民的目标。欧盟以及美国和其他国家/地区的农业预算中只有一小部分可用于购买超出良好农业规范（GFP）水平的环境商品和服务。与其他补偿措施未能充分针对需要采取特殊措施的地区相比，导致农业环境措施的影响与刺激农业集约化的其他驱动力相比，令人满意地较低。本文的目的是提出一种管理概念，以提高农业环境措施的生态和成本效率。该概念的组成部分是一个全面的环境信息库，具有优先级的目标和指标（在德国可从景观规划中获得）和新的薪酬模型，这些模型可补充基于预定措施和成本的传统补偿金。全面的景观规划可以对需要采取环境行动的区域进行定位并确定其优先级。它包含当局需要优先考虑为环境服务提供资金的信息，以及针对需要超出GFP范围的环境服务的地点采取直接措施的信息。此外，可以在景观规划的基础上采用适当的薪酬模型，以提高公共支出的成本效率和农民的动机。在案例研究区（德国汉诺威以北的“ Fuhrberger Feld”）中对计划方法论和一种薪酬模型（以成功为导向的薪酬）进行了测试，证明了该概念的实用性，并为该方法的未来发展提出了建议及其与其他方法结合使用。