Deutsches Arzteblatt international最新文献

Background: Multiple sclerosis (MS) is a neuroinflammatory disease of presumed autoimmune origin. A combination of genetic susceptibility and exposure to certain environmental and lifestyle factors might trigger the onset of MS. The currently known risk factors include a genetic predisposition, infection with the Epstein-Barr virus (EBV), smoking, and an increased body mass index.

Methods: In 2021-22, we carried out a case-control study nested within the German National Cohort (NAKO) to investigate associations of potential risk factors with MS.

Results: The subjects included 576 persons with MS (cases) and 895 without MS (controls). Beyond the known risk factors, we observed associations between MS and the cumulative number of common childhood infections (odds ratio (OR) 1.14 per additional infection, 95% confidence interval (CI): [1.03; 1.25]), major stressful life events (SLE) (OR 1.25 per additional event, [1.06; 1.48]), being the firstborn child of a mother aged 30 or older (OR 2.11, [1.08; 4.13]); higher amounts of physical activity in the teenage years were associated with a lower risk of MS (OR 0.82 per unit increase in activity level, [0.71; 0.95]).

Conclusion: We confirmed known risk factors for MS and found associations with a number of new ones, e.g., the cumulative number of common childhood infections. These findings may shed light on the etiology of MS and merit further study.

Background: Cleft lip and palate deformities (CLPD) constitute one of the more common types of congenital malformation. In Germany, the prevalence is more than 1 in 500 births. The treatment is complex; multistep interdisciplinary treatment is needed for full recovery. In this S3-level clinical practice guideline, we provide evidence- and consensus-based recommendations for the treatment of patients with CLPD.

Methods: A systematic literature search based on key questions was carried out. All recommendations and statements were formulated by specialists from multiple disciplines and were adopted in a formal consensus procedure.

Results: Despite the epidemiological and clinical importance of CLPD, no clear treatment recommendations are available; the major treatments for it are debated and variably provided. If a fetus is at elevated risk of CLPD, ultrasonography in the second or third trimester of pregnancy is recommended. For a newborn child with CLPD, adequate food intake must be ensured. Orthodontic treatment is carried out in an interdisciplinary manner and in multiple developmental phases. Controversy surrounds the timing and sequence of reconstructive procedures for defor mities that affect all structures. In children who have them, normal ventilation of the middle ear is impaired or obviated, making tympanic effusions and hearing loss more likely. In all children with CLPD, speech can be impaired and there can be a secondary impairment of language acquisition.

Conclusion: Most of the evidence concerning the treatment of CLPD is of low level. Standardization of the treatment approach should improve long-term outcomes and quality of life in patients with CLPD. Standardized, long-term, multicenter data acquisition would help increase the yield of useful information from future studies.

Background: General practitioners are the main mediators of rehabilitation and prevention services for their patients, yet many who could benefit from such services do not receive them because there has not, to date, been any structured means of detecting need. We studied the efficacy of a work-related health check for persons aged 45 and over ("check-up 45+") to identify the need for rehabilitation and preventive care in general practice.

Methods: In a pragmatic, multicenter, 1:1 randomized controlled trial (registration no. DRKS00028303), the participating patients (aged 45 to 59) received, in addition to usual care, either a short questionnaire alone (695 patients) or, additionally, the "check-up 45+" (706 patients), in which the need for rehabilitation or prevention services was assessed with a validated "screening 45+" questionnaire and subsequent evaluation by the general practitioner. The primary endpoint was the number of applications for rehabilitation and prevention services, as determined from routine data derived from the German Pension Insurance (Deutsche Rentenversicherung). The secondary endpoints were approvals of services, actual provision of services, and needs identified by the "check-up 45+".

Results: Applications for rehabilitation and prevention services were four times more common for patients who received the "check-up 45+" than for those who did not (12.0% vs. 2.9%; p<0.001). The percentages of approved and completed services were higher as well (8.4% vs. 2.4%; 7.2% vs. 2.3%; p<0.001 for both). The "checkup 45+" identified a need for rehabilitation in 17.7% of patients and a need for preventive services in 26.3%.

Conclusion: These findings indicate that the use of the "check-up 45+" in primary care increases the number of applications for rehabilitation and prevention services. The "check-up 45+" can improve needs-based access to rehabilitation and prevention services through early, structured recognition of the patient's needs and ensuing application for these services.