ObjectiveTo examine the impact of type 2 diabetes on direct and indirect costs and to describe the effect of relevant diabetes-related factors, such as type of treatment or glycaemic control on direct costs.DesignBottom-up excess cost analysis from a societal perspective based on population-based survey data.Participants9160 observations from 6803 individuals aged 31–96 years (9.6% with type 2 diabetes) from the population-based KORA (Cooperative Health Research in the Region of Augsburg) studies in Southern Germany.Outcome measuresHealthcare usage, productivity losses, and resulting direct and indirect costs.MethodsInformation on diabetes status, biomedical/sociodemographic variables, medical history and on healthcare usage and productivity losses was assessed in standardised interviews and examinations. Healthcare usage and productivity losses were costed with reference to unit prices and excess costs of type 2 diabetes were calculated using generalised linear models.ResultsIndividuals with type 2 diabetes had 1.81 (95% CI 1.56 to 2.11) times higher direct (€3352 vs €1849) and 2.07 (1.51 to 2.84) times higher indirect (€4103 vs €1981) annual costs than those without diabetes. Cardiovascular complications, a long diabetes duration and treatment with insulin were significantly associated with increased direct costs; however, glycaemic control was only weakly insignificantly associated with costs.ConclusionsThis study illustrates the substantial direct and indirect societal cost burden of type 2 diabetes in Germany. Strong effort is needed to optimise care to avoid progression of the disease and costly complications.

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BackgroundAlthough the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers’ (PCPs) perspectives, needs, and attitudes regarding vertigo management.The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions.MethodsA theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs’ perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure.ResultsTwelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions.ConclusionsFrom the PCPs’ perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and targeted patient management.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0716-y) contains supplementary material, which is available to authorized users.

Objective: To determine the incidence of Harris lines in two medieval populations which inhabited the Canton of Berne, in Central Switzerland, and to compare the results with those of a contemporary population living in the same geographical area. A simplified method is described for measuring the age of the individual at the time of formation of Harris lines, with possible future applications. Design and patients: Radiographs of 112 wellpreserved tibiae of skeletons of two medieval populations from the eighth to fifteenth centuries were reviewed for the incidence of Harris lines. The results were compared with those of 138 current patients living in the same geographic location in Central Switzerland. Age and gender of the medieval individual were determined using known anthropological methods. Age of bone at the time of formation of Harris lines was estimated according to the method of Maat. Results: Harris lines were found in 88 of 112 (80%) of the examined medieval skeletons and in 28 of 138 (20%) of the living individuals. Higher incidences of Harris lines were found at the age of 2 years and at ages between 8 and 12 years in both populations. No gender difference was found regarding the incidence of Harris lines. In both populations the occurrence of Harris lines was associated with certain diseases such as degenerative bone disease, trauma, osteoporosis, rheumatoid arthritis, peripheral vascular diseases, rickets and bony deformities. Conclusion: A high incidence of Harris lines was found in the medieval population, perhaps reflecting difficult living and hygienic conditions, but also the poor care and neglect of the children population. Measuring the age of the individual at the time of formation of Harris lines is simple and may have future clinical applications in the paediatric population for medico-legal purposes. The application of Harris lines as a marker in follow-up of osteoporosis may need further evaluation.

Zusammenfassung. Die Kumulation von Risikofaktoren ist ein gängiges Kriterium zur Indikation eines frühen Hilfebedarfs. Über die Anzahl und das Ausmaß der psychosozial belasteten Familien in Deutschland ist bislang nur wenig bekannt. Mit Daten von N=7 549 Familien der Studie Kinder in Deutschland – KiD 0 – 3 und einem Inventar aus 25 Risikofaktoren wurde die Klassifizierung der Familien in Risikogruppen anhand einfacher Summenindizes mit den Ergebnissen einer Latenten Klassenanalyse (LCA) verglichen. Während einfache Summenindizes 24 – 30 % der Familien als belastet identifizierten, erzeugte die inhaltlich überlegene LCA eine Vier-Klassen-Lösung mit 59 % unbelasteten und 5 % hochbelasteten Familien. Im mittleren Belastungsbereich unterscheidet sich die Gruppe der sozioökonomisch belasteten Familien (19 %) von Familien mit hohem elterlichem Stress und Konfliktpotenzial (17 %). Die Ergebnisse liefern wichtige Hinweise für die Versorgungsforschung zu Frühen Hilfen.

When we think of our family and friends, we probably know someone who is good at finding their way and someone else that easily gets lost. We still know little about the biological and environmental factors that influence our navigational ability. Here, we investigated the frequency and sociodemographic determinants of wayfinding and their association with vestibular function in a representative cross-sectional sample (N = 783) of the adult German-speaking population. Wayfinding was assessed using the Wayfinding Strategy Scale, a self-report scale that produces two scores for each participant representing to what degree they rely on route-based or orientation (map-based) strategies. We were interested in the following research questions: (1) the frequency and determinants of wayfinding strategies in a population-based representative sample, (2) the relationship between vestibular function and strategy choice and (3) how sociodemographic factors influence general wayfinding ability as measured using a combined score from both strategy scores. Our linear regression models showed that being male, having a higher education, higher age and lower regional urbanization increased orientation strategy scores. Vertigo/dizziness reduced the scores of both the orientation and the route strategies. Using a novel approach, we grouped participants by their combined strategy scores in a multinomial regression model, to see whether individuals prefer one strategy over the other. The majority of individuals reported using either both or no strategy, instead of preferring one strategy over the other. Young age and reduced vestibular function were indicative of using no strategy. In summary, wayfinding ability depends on both biological and environmental factors; all sociodemographic factors except income. Over a third of the population, predominantly under the age of 35, does not successfully use either strategy. This represents a change in our wayfinding skills, which may result from the technological advances in navigational aids over the last few decades.

sychosocial stress, especially adverse childhood experiences, is disproportionately likely to influence child development in negative ways and often leads to risky health behavior, such as substance abuse, increased burden of disease and increased healthcare costs (1). In Germany, a retrospective survey showed that difficulties in the parental home as well as violence and deprivation experiences were associated with an increased likelihood of depression, anxiety, physical aggression, and low life satisfaction as an adult (2). While international studies identified several additional types of psychosocial stress associated with an increased risk of developmental abnormalities (3-8), reliable prevalence estimates for Germany are available only for a few of these stressors and risks (9).Knowledge of the significance of individual adverse psychosocial factors in the highly sensitive first period of life may be useful to develop approaches to prevention strategies. Currently, there is no reliable data on how many of the families with children who participate in the statutory child development checks suffer from psychosocial stress. On the side of the child, these characteristics can, for example, include negative emotionality, and on the side of the parents, parenting stress or, with regard to the family, frequent quarrels. In terms of targeting prevention services to young parents, this is important information. Parents' subjective experience of psychosocial stress is a key criterion when it comes to taking the initiative for participating in prevention programs; thus, prevalence rates can be used to estimate the need for prevention. Over 99% of parents attend the child development checks (10), reflecting their high level of trust in pediatricians. Therefore, child development checks do not only provide an opportunity to detect biomedical diseases and monitor progress in the child's development, but also to gain a first impression of the overall situation in the family (11)(12)(13)(14). While in the United States an overall concept for pediatricians has already been developed and evaluated which is designed to enable early identification and support of families experiencing psychosocial stress (15), in Germany a pediatric assessment form for the evaluation of psychosocial support needs ("pädiatrischer Anhaltsbogen") is available to be used during the U3 to U6 child development checks SummaryBackground: Psychosocial stress in early childhood can impair children's health and development. Data on the prevalence of psychosocial stress in families with infants and toddlers in Germany are lacking. Such data could be used to determine the need for prevention and to plan the appropriate preventive measures.Methods: In 2015, a representative cross-sectional study called Kinder in Deutschland-KiD 0-3 was conducted by questionnaire in pediatricians' practices across Germany. Parents taking their children to the U3-U7a child development checks were asked to self-report information about stress in their families. The data were an...