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。

BACKGROUND & AIMS: :Phenylketonuria (PKU) is an important error of amino acid metabolism which results in most patients from phenylalanine hydroxylase (PAH) deficiency. PKU displays a marked genotypic heterogeneity both within and between different populations. The aim of this study was to establish the genotypic spectrum of PKU in eastern Germany, and to compare this to the distribution of mutations in western Germany. The study population included 302 patients in 290 families who were followed at treatment centers in Berlin, Leipzig and Jena. The study showed marked genotypic variability with a total of 75 mutations, including 15 that have so far not been described (eleven missense mutations, one splicing mutation, and three small deletions). One of these novel mutations, E183Q, occurred in cis to a R408W mutation. In the non-immigrant eastern German population, the frequency of R408W accounted for 40.1% of the PKU alleles. In the immigrant Turkish population of the former West Berlin, the most prevalent mutation was IVS10-11G>A (57%). There was a marked difference of the genotypic spectrum between the population studied here and the data reported from the western part of the country.

背景与目标： ：苯丙酮尿症（PKU）是氨基酸代谢的重要错误，导致大多数患者患有苯丙氨酸羟化酶（PAH）缺乏症。北大在不同人群之内和之间都显示出明显的基因型异质性。这项研究的目的是在德国东部建立PKU的基因型谱，并将其与德国西部的突变分布进行比较。研究人群包括290个家庭的302名患者，并在柏林，莱比锡和耶拿的治疗中心进行了随访。这项研究显示出明显的基因型变异，共有75个突变，包括迄今尚未描述的15个突变（11个错义突变，1个剪接突变和3个小缺失）。这些新突变之一E183Q顺式出现在R408W突变中。在非移民的德国东部人口中，R408W的频率占北卡罗来纳等位基因的40.1％。在前西柏林的土耳其移民人口中，最普遍的突变是IVS10-11G> A（57％）。在此研究的人群与该国西部报道的数据之间，基因型谱存在显着差异。

BACKGROUND & AIMS: BACKGROUND:The HÖRSTAT study conducted in Northwest Germany found hearing impairment in approximately 16% of adults when applying the World Health Organization (WHO) criterion. However, the robustness of extrapolations to a national level might be questioned, as the epidemiological data were collected on a regional level. METHODS:Independently from HÖRSTAT, the "Hearing in Germany" study examined adult hearing in Aalen, a town located in Southwest Germany. Both cross-sectional studies were based on stratified random samples from the general population. The average pure-tone threshold shift at 0.5, 1, 2, and 4 kHz (PTA4), the prevalence of hearing impairment (WHO criterion: PTA4 in the better ear >25), and hearing aid uptake were compared. Data from the Aalen and HÖRSTAT studies were pooled (n = 3105) to extrapolate to the prevalence and the degree of hearing impairment for the years 2015, 2020, and 2025. RESULTS:Both studies yielded very similar results for PTA4. Weighted for official population statistics, the prevalence of hearing impairment according to the WHO criterion is 16.2% in adults, thus affecting 11.1 million persons in Germany. Owing to demographic changes, the prevalence is expected to increase in the medium term by around 1% per 5‑year period. With a similar degree of hearing loss, hearing aid provision differs from place to place. CONCLUSION:When adjusted for gender and age to the European Standard Population, the prevalence of hearing impairment observed both in HÖRSTAT and the Aalen sample is considerably lower than reported for international studies. Since the analysis refers to cross-sectional data only, possible cohort effects are not considered in the prevalence projection.

背景与目标： 背景：在德国西北部进行的HÖRSTAT研究发现，在应用世界卫生组织（WHO）标准时，大约16％的成年人存在听力障碍。但是，由于流行病学数据是在区域级别收集的，因此可能会质疑外推到国家级别的鲁棒性。
方法：独立于HÖRSTAT，“德国听力”研究对位于德国西南部小镇Aalen的成人听力进行了检查。两项横断面研究均基于来自一般人群的分层随机样本。比较了分别在0.5、1、2和4 kHz处的平均纯音阈值移位（PTA4），听力障碍的患病率（WHO标准：更好的耳朵中PTA4> 25）和助听器吸收。汇总Aalen和HÖRSTAT研究的数据（n = 3105）以推断2015年，2020年和2025年的患病率和听力障碍程度。
结果：两项研究均对PTA4产生了非常相似的结果。根据官方的人口统计数据加权，根据WHO的标准，听力障碍的患病率在成年人中为16.2％，从而影响德国的1,110万人。由于人口变化，预计中期流行率每5年增加1％左右。对于相似程度的听力损失，助听器的提供因地而异。
结论：按照欧洲标准人群的性别和年龄进行调整后，在HÖRSTAT和Aalen样本中观察到的听力障碍患病率大大低于国际研究报告的水平。由于分析仅涉及横截面数据，因此在患病率预测中未考虑可能的队列效应。

BACKGROUND & AIMS: OBJECTIVE:According to recent surveys, outpatient antibiotic prescribing in Germany has been comparatively low among European countries. We assessed regional variation in outpatient antibiotic use within Germany both for overall use as well as for specific antibiotic drug classes. METHODS:Prescription data for the year 2003 covering approximately 90% of the total population were analysed using the ATC/WHO defined daily dose (DDD) methodology. Data were expressed in DDD per 1,000 persons covered by the insurance and day (DID). RESULTS:Outpatient antibiotic prescribing in 2003 was 13.6 DID and ranged between 9.2 and 17.9 DID in the different regions examined. Low consumption regions were eastern and southern states. High consumption areas were in the west near the French and Belgian border. This regional prescribing pattern was similar for children and adults. Penicillins were the most frequent prescribed drugs, but their use density showed a relatively large regional variation (factor 3.5), with relatively low prescription frequency in the eastern states. In almost all regions quinolones were used more often than trimethoprim-sulfamethoxazole. CONCLUSION:The regional variation in recent outpatient antibiotic prescribing in Germany is substantial. The relatively high antibiotic use in the western part of the country is remarkable, remains unexplained and requires further study.

背景与目标： 目的：根据最近的调查，德国的门诊抗生素处方在欧洲国家中相对较低。我们评估了德国境内整体使用以及特定抗生素类药物在门诊使用抗生素方面的地区差异。
方法：使用ATC / WHO规定的日剂量（DDD）方法分析了2003年的处方数据，涵盖了约90％的总人口。数据以DDD表示，每千人保险和日数（DID）。
结果：2003年门诊抗生素处方的DID为13.6 DID，在所检查的不同区域范围为9.2-17.9 DID。低耗地区是东部和南部各州。高消费地区位于法国和比利时边境附近的西部。对于儿童和成人，这种区域性处方模式是相似的。青霉素是最常用的处方药，但其使用密度显示出较大的区域差异（系数3.5），而东部各州的处方频率相对较低。在几乎所有地区，喹诺酮类药物的使用都比甲氧苄氨嘧啶-磺胺甲基恶唑要多。
结论：德国近期门诊抗生素处方的地区差异很大。该国西部地区的抗生素使用量相对较高，仍然无法解释，需要进一步研究。

BACKGROUND & AIMS: :Antimicrobial drugs in livestock farming are not used for therapeutic purposes, only, but also to conceal deficiencies in animal husbandry and management. Use of antibiotic drugs should be restricted by specific regulations, since some veterinarians seem to have an interest in increasing their income by treatment of diseases instead of performing health management. The above-mentioned requirements have been fulfilled by section 56 a (2) of German Pharmaceuticals Act, which regulates the usage and dispensary of pharmaceuticals according to the current standards of veterinary science. These current standards of veterinary science are described by common scientific positions and specific opinions of certain relevant committees. There is no single institutional committee available at present. Therefore, members of the German Federal Chamber of Veterinarians and members of the Committees of the German Federal States, which are responsible for the compliance with regulations and acts, defined a common position on current standards of veterinary science, concerning correct treatment with antibiotic drugs within a Working Group of the Federal States for Veterinary Pharmaceuticals (former ArgeVet, now AG TAM), the so-called "antibiotic guidelines". These antibiotic guidelines should help veterinary practitioners to use and prescribe those substances only, which are accurate for treatment of the diagnosed disease concerning the used class of antibiotic, amount, and duration of usage. The responsible authorities have to proof the prudent and proper use of antibiotic drugs in the range of their surveillance. The surveillance by the authorities is complicated, since the burden of proof of improper usage of antimicrobial drugs lies within the responsibility of the authorities. Prevention can primarily be conducted by informing the responsible veterinarians of the proper forms of treatment and by strict regulations for registration of pharmacologically active substances. Every additional label use and the usage of existing old registrations may undermine the surveillance of improper usage of pharmacologically active substances in livestock animals. The responsible authorities of the German Federal States, which may vary in their organization among the states, have to administrate the following duties: (1) Surveillance of manufacture and distribution of pharmaceuticals. (2) Inspection and control of proper usage of pharmaceuticals. Thus, the surveillance of distribution of veterinary pharmaceuticals has a broader range of requirements in comparison to surveillance of human pharmaceuticals. It is necessary to record and to control the amount of used drugs as well as their ways of distribution to perform a sufficient surveillance. The legal authorization was created by the 11th Amendment of the German Pharmaceuticals Act, but these specifications are still too imprecise to support the surveillance in the current process. Hence, the actual surveillance process is more focussed on usage and dispensary of pharmaceuticals and less focussed on manufacture and distribution. Therefore, the current surveillance with the aim to limit unnecessary usage of pharmacologically active substances according to the current legislation is limited. It is necessary to change legislation with regard to control of distribution of pharmaceuticals as well as integration of self-control of livestock owners for a sustainable increase of efficacy.

背景与目标： ：畜牧业中使用的抗菌药物不仅用于治疗目的，而且还可以掩盖畜牧业和管理方面的不足。抗生素的使用应受到特定法规的限制，因为一些兽医似乎有兴趣通过治疗疾病而不是进行健康管理来增加收入。上述要求已通过《德国药品法》第56a（2）节得到满足，该节根据当前的兽医科学标准对药品的使用和分配进行了规范。这些现行的兽医科学标准由共同的科学立场和某些相关委员会的特定见解来描述。目前没有单一的机构委员会。因此，负责遵守法规和行为的德国联邦兽医商会成员和德国联邦国家委员会的成员，在当前兽医科学标准中就使用正确的抗生素治疗产生了共同的立场。联邦兽药国家工作小组（前ArgeVet，现为AG TAM），即所谓的“抗生素指南”。这些抗生素指南应帮助兽医从业人员仅使用和开处方那些对于所诊断疾病的治疗准确无误的物质，涉及所使用的抗生素种类，用量和使用期限。主管当局必须在其监视范围内证明对抗生素药物的审慎和正确使用。当局的监督十分复杂，因为证明不当使用抗菌药物的举证责任在当局的责任之内。预防主要可以通过向负责的兽医告知适当的治疗方式以及严格的药理活性物质注册规定来进行。每增加一次标签使用和使用现有的旧注册信息，可能会破坏对家畜动物药理活性物质使用不当的监视。德国联邦各州的主管当局（在各州之间的组织可能有所不同）必须执行以下职责：（1）药品生产和分销的监督。 （2）检查和控制药品的合理使用。因此，与对人类药品的监视相比，对兽药分布的监视具有更广泛的要求。有必要记录和控制使用过的药物的数量及其分配方式，以进行充分的监视。法律授权是由《德国药品法》第11条修正案创建的，但是这些规范仍然不够精确，无法支持当前流程中的监视。因此，实际的监视过程更多地侧重于药品的使用和分配，而较少侧重于制造和分销。因此，旨在限制根据现行法规不必要地使用药理活性物质的当前监视受到限制。有必要改变有关药物分配控制以及牲畜所有者自我控制整合的立法，以实现效力的可持续增长。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: -2

背景与目标： -2