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Background and Objective: From the perspective of welfare economics, institutionalised long-term care (ILTC) is expensive and thus requires key figures. This article provides the population-based mean length of stay in ILTC, which is a meaningful measure for monitoring purposes. Method: The Sullivan method was applied to official statistics on population and long-term care between 1999 and 2011. This method splits up the life expectancy at birth into one part in and one part out of ILTC. The part in ILTC can be interpreted as length of stay. Results: In 2011, males in Germany experienced 5.5 months in ILTC, females 14.4 months. In 1999, the length of stay was 3.8 and 11.8 months, respectively. Thus, the length of stay in ILTC has increased over time. However, the increase regarding women stopped in 2007. Furthermore, the onset of ILTC has been protracted. In 2011, the mean age at the start of ILTC was 77.6 years (males) and 81.7 years (females). In 1999 the mean age was 74.5 years (males) and 79.9 years (females). In 2011, males spent 0.6% of their life expectancy in ILTC, females 1.4%. In 1999, this share was 0.4% (males) and 1.2% (females). Conclusions: The utilisation of ILTC needs to be monitored by meaningful key figures over time. The length of stay, as proposed here, provides information on life expectancy and ILTC prevalence collapsed into one measure. This article reports the length of stay and substantiates its increase over time (in women, the increase ended in 2007). It is recommended to regularly update the time series by using official statistics. © Georg Thieme Verlag KG.


Heiligenhaus A.,University of Duisburg - Essen | Heinz C.,University of Duisburg - Essen | Edelsten C.,Ipswich Hospital | Kotaniemi K.,University of Helsinki | Minden K.,Deutsches Rheuma Forschungszentrum
Ocular Immunology and Inflammation | Year: 2013

Juvenile idiopathic arthritis (JIA) is the most common systemic disease associated with uveitis in childhood. The frequency of JIA-associated uveitis (JIAU) varies geographically, and between ethnicities. Uveitis risk is high in JIA associated with oligoarthritis, young age at arthritis onset and ANA positivity. Gender alters risk for the incidence of JIA and the severity of JIAU. Familial cases support the possible role of genetic influences in the pathogenesis. Arthritis typically precedes the uveitis, but uveitis may occur up to seven years following the arthritis onset. Although complications still occur, the frequency of bilateral blindness has dropped, probably by both improved screening of high-risk patients with JIA, and the increased use of early immunosuppression. However, there is still continuing persistence of JIAU into adulthood. For improvement of epidemiological knowledge of this complicated disease, large, well-defined, long-term population-based registries are needed with the application of universally agreed case definitions and outcome measures. © 2013 Informa Healthcare USA, Inc. All rights reserved.


Minden K.,Charite - Medical University of Berlin | Niewerth M.,Deutsches Rheuma Forschungszentrum
Aktuelle Rheumatologie | Year: 2015

The most common chronic inflammatory rheumatic disease of childhood and adolescence, juvenile idiopathic arthritis (JIA), often persists into adulthood. About half of the patients are in need of rheumatological care beyond adolescence. Most of these patients have polyarticular JIA or spondylarthritis and present with rather unusual articular and extra-articular manifestations, such as asymmetric oligoarthritis, hardly elevated inflammatory laboratory parameters and asymptomatic uveitis, to adult rheumatologists. For young people with JIA, the transition to adulthood is a challenging process. The patients have to complete the normal developmental tasks, but have also to manage the transfer to adult care. The latter works in only 2 of 3 cases. Of those young people who reach adult rheumatology care, a significant proportion is not able to cope with the new setting of care and is accordingly unsatisfied. Therefore, specific measures and programmes have been established to support the young people in the transition process according to their individual medical, psychosocial and educational/vocational needs and to organise a continuous medical care. However, the implementation of such youth-friendly services including transitional care has been frustratingly slow. Many structural and psychosocial barriers do exist and prevent the widespread implementation of health transition supports. Transition is resource consuming. It requires a reorganisation of workstreams to accommodate a clear, well-documented transitional pathway, including among other things, sufficiently long consultation times, an age-appropriate communication, addressing of age-specific topics and a close cooperation between paediatric and adult rheumatologists. There is a need to evaluate the effectiveness of such measures. That could be a precondition to recognise transition services as part of regular health care. © Georg Thieme Verlag KG Stuttgart.


Romagnani C.,Deutsches Rheuma Forschungszentrum
Immunotherapy | Year: 2010

Scientists interested in the field of immunomodulation meet every 2 years to discuss new regulatory mechanisms and targets of intervention for the treatment of autoimmunity and transplant rejection. This article highlights the 9th International Conference on New Trends in Immunosuppression and Immunotherapy, which was held in February 2010 in Geneva, Switzerland. © 2010 Future Medicine Ltd.


Bros H.,Charite - Medical University of Berlin | Bros H.,Max Delbruck Center for Molecular Medicine | Millward J.M.,Charite - Medical University of Berlin | Millward J.M.,Max Delbruck Center for Molecular Medicine | And 5 more authors.
Experimental Neurology | Year: 2014

Oxidative stress and mitochondrial dysfunction appear to contribute to axon degeneration in numerous neurological disorders. However, how these two processes interact to cause axonal damage-and how this damage is initiated-remains unclear. In this study we used transected motor axons from murine peripheral roots to investigate whether oxidative stress alters mitochondrial dynamics in myelinated axons. We show that the nodes of Ranvier are the initial sites of mitochondrial damage induced by oxidative stress. There, mitochondria became depolarized, followed by alterations of the external morphology and disruption of the cristae, along with reduced mitochondrial transport. These mitochondrial changes expanded from the nodes of Ranvier bidirectionally towards both internodes and eventually affected the entire mitochondrial population in the axon. Supplementing axonal bioenergetics by applying nicotinamide adenine dinucleotide and methyl pyruvate, rendered the mitochondria at the nodes of Ranvier resistant to these oxidative stress-induced changes. Importantly, this inhibition of mitochondrial damage protected the axons from degeneration. In conclusion, we present a novel ex vivo approach for monitoring mitochondrial dynamics within axons, which proved suitable for detecting mitochondrial changes upon exogenous application of oxidative stress. Our results indicate that the nodes of Ranvier are the site of initial mitochondrial damage in peripheral axons, and suggest that dysregulation of axonal bioenergetics plays a critical role in oxidative stress-triggered mitochondrial alterations and subsequent axonal injury. These novel insights into the mechanisms underlying axon degeneration may have implications for neurological disorders with a degenerative component. © 2014 Elsevier Inc.

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