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Listl S, van Ardenne O, Grytten J, Gyrd-Hansen D, Lang H, Melo P, Nemeth O, Tubert-Jeannin S, Vassallo P, van Veen E, Vernazza C, Waitzberg R, Winkelmann J, Woods N. Prioritization, Incentives, and Resource Use for Sustainable Dentistry: The EU PRUDENT Project. JDR Clin Trans Res 2024; 9:180-184. [PMID: 37486021 PMCID: PMC10943613 DOI: 10.1177/23800844231189485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT The EU PRUDENT project aims to enhance the financing of oral health systems through novel evidence and implementation of better financing solutions together with citizens, patients, providers, and policy makers. The multicountry nature of the project offers unique windows of opportunity for rapid learning and improving within and across various contexts. PRUDENT is anticipated to strengthen capacities for better oral care financing in the EU and worldwide.
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Affiliation(s)
- S. Listl
- Radboud University Medical Center, Radboud Institute of Health Sciences (RIHS), Department of Dentistry, Quality and Safety of Oral Healthcare, Nijmegen, Gelderland, the Netherlands
| | | | - J. Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway
| | - D. Gyrd-Hansen
- Danish Center for Health Economics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - H. Lang
- Estonian Dental Association, Tallinn, Estonia
| | - P. Melo
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - O. Nemeth
- Department of Community Dentistry, Semmelweis University, Budapest, Hungary
| | - S. Tubert-Jeannin
- University of Clermont-Auvergne, UFR d’Odontologie, Clermont-Ferrand, France
| | - P. Vassallo
- Ministry for Health, Health Promotion and Disease Prevention Directorate, Valetta, Malta
| | | | - C. Vernazza
- Newcastle University, School of Dental Sciences, Newcastle, Tyne and Wear, UK
| | - R. Waitzberg
- Department of Health Care Management, Technische Universität Berlin, Faculty of Economics & Management, Berlin, Germany
| | - J. Winkelmann
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - N. Woods
- University College Cork, Cork University Business School, Centre for Policy Studies, Cork, Ireland
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Pavelekova P, Necpal J, Jech R, Havrankova P, Svantnerova J, Jurkova V, Gdovinova Z, Lackova A, Han V, Winkelmann J, Zech M, Skorvanek M. Predictors of whole exome sequencing in dystonic cerebral palsy and cerebral palsy-like disorders. Parkinsonism Relat Disord 2023:105352. [PMID: 36997436 DOI: 10.1016/j.parkreldis.2023.105352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of permanent disorders attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Cerebral palsy-like (CP-like) disorders may clinically resemble CP but do not fulfill CP criteria and have often a progressive course and/or neurodevelopmental regression. To assess which patients with dystonic CP and dystonic CP-like disorder should undergo Whole Exome Sequencing (WES), we compared the rate of likely causative variants in individuals regarding their clinical picture, co-morbidities, and environmental risk factors. METHOD Individuals with early onset neurodevelopmental disorder (ND) manifesting with dystonia as a core feature were divided into CP or CP-like cohorts based on their clinical picture and disease course. Detailed clinical picture, co-morbidities, and environmental risk factors including prematurity, asphyxia, SIRS, IRDS, and cerebral bleeding were evaluated. RESULTS A total of 122 patients were included and divided into the CP group with 70 subjects (30 males; mean age 18y5m±16y6m, mean GMFCS score 3.3 ± 1.4), and the CP-like group with 52 subjects (29 males; mean age 17y7m±1y,6 m, mean GMFCS score 2,6 ± 1,5). The WES-based diagnosis was present in 19 (27.1%) CP patients and 30 CP-like patients (57.7%) with genetic conditions overlap in both groups. We found significant differences in diagnostic rate in CP individuals with vs. without risk factors (13.9% vs. 43.3%); Fisher's exact p = 0.0065. We did not observe the same tendency in CP-like (45.5% vs 58.5%); Fisher's exact p = 0.5. CONCLUSION WES is a useful diagnostic method for patients with dystonic ND, regardless of their presentation as a CP or CP-like phenotype.
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Harrer P, Folberth J, Zhao C, Schormair B, Tilch E, Gieger C, Peters A, Oexle K, Schwaninger M, Winkelmann J. Methylglyoxal – a central metabolic factor in restless legs syndrome? Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
With growing awareness of the large burden of oral diseases and how limited coverage affects both access and affordability, oral health policy has been receiving increased attention in recent years. This culminated in the adoption of the WHO resolution on Oral Health in 2021, which urges Member States to better integrate oral health into their universal health coverage and noncommunicable disease agendas. This study investigates major patterns and developments in oral health status, financing, coverage, access, and service provision of oral health care in 31 European countries. While most countries cover oral health care for vulnerable population groups, the level of statutory coverage varies widely across Europe resulting in different coverage and financing schemes for the adult population. On average, one third of dental care spending is borne by public sources and the remaining part is paid out-of-pocket or by voluntary health insurance. This has important ramifications for financial protection and access to care, leaving many dental problems untreated. Overall, unmet needs for dental care are higher than for other types of care and particularly affect low-income groups. Dental care is undergoing various structural changes. The number of dentists is increasing, and the composition of the health workforce is starting to change in many countries. Dental care is increasingly provided in group practices and by practices that are part of private equity firms. Although there are early signs of a shift towards more prevention of oral diseases, dental care overall remains focused on treatment. A lack of data affects all areas of oral health care and impede to inform policy-making on the underlying causes and the prevalence of oral disease, as well as the effectiveness of community preventive activities and oral health services.
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Affiliation(s)
- J Winkelmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | | | - J Gomez Rossi
- Oral Health Diagnostics, Charité University, Berlin, Germany
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5
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Maier C, Winkelmann J, Wismar M. Overview of innovative skill-mix changes in nursing across Europe. Eur J Public Health 2022. [PMCID: PMC9593714 DOI: 10.1093/eurpub/ckac129.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Many countries in Europe and worldwide have implemented new professional for nurses or are in the process of implementation, yet, an overview of the evidence on skill-mix changes has been missing. This study has analysed skill-mix innovations in nursing, evidence on outcomes and lessons for implementation. Methods An overview of systematic reviews, following a protocol plus country case studies, as part of an international study. The literature search was performed in six databases, with search terms covering skill-mix whereby the nursing profession played a key role. Screening was performed by three researchers after high interrater reliability rates were achieved. Analyses were performed for the nursing professions, a typology of skill-mix changes (task-shifting and role expansion) and evidence on outcomes. Results A total of 42 systematic reviews were identified on nurses working in new roles. The roles varied considerably, ranging from nurse prescribing to advanced practice nursing and nurse-led clinics. Nurse-led chronic care programmes were frequently identified, with overall positive outcomes on several health outcomes, e.g., for patients with diabetes or cardiovascular diseases. Nurses were also working in advanced roles in health promotion and prevention, e.g., performing screening programmes, showing equivalent quality of care compared with doctors if adequately trained. Several skill-mix models to enhance care coordination and integration were identified, suggesting that when tailored to the needs of specific population groups, particularly for vulnerable groups, may improve health outcomes or access to services. Conclusions The roles of nurses are increasingly diversifying and expanding internationally. Sharing country experiences on how to effectively educate the workforce to be prepared for these new roles and ensure smooth integration is critical.
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Affiliation(s)
- C Maier
- Department of Healthcare Management, Technische Universität Berlin , Berlin, Germany
- European Observatory on Health Systems and Policies , Brussels, Belgium
| | - J Winkelmann
- Department of Healthcare Management, Technische Universität Berlin , Berlin, Germany
- European Observatory on Health Systems and Policies , Brussels, Belgium
| | - M Wismar
- European Observatory on Health Systems and Policies , Brussels, Belgium
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6
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Grofik M, Cibulka M, Olekšáková J, Turčanová Koprušáková M, Galanda T, Necpál J, Jungová P, Kurča E, Winkelmann J, Zech M, Jech R. A case of novel DYT6 dystonia variant with serious complications after deep brain stimulation therapy: a case report. BMC Neurol 2022; 22:344. [PMID: 36096774 PMCID: PMC9465909 DOI: 10.1186/s12883-022-02871-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene. Case presentation We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far. Conclusions DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.
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Affiliation(s)
- M Grofik
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Cibulka
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia.
| | - J Olekšáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - M Turčanová Koprušáková
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - T Galanda
- Department of Neurosurgery, Slovak Medical University and Roosevelt Hospital, Banska Bystrica, Slovakia
| | - J Necpál
- Department of Neurology, Zvolen Hospital, Zvolen, Slovakia
| | - P Jungová
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia
| | - E Kurča
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovakia
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - M Zech
- Department of Molecular and Biochemical Genetics - Centre of Rare Genetic Diseases, Faculty of Medicine & Comenius University, University Hospital Bratislava, Bratislava, Slovakia.,Institute of Neurogenomics, Helmholtz Centrum, Munich, Germany
| | - R Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
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Schmidt A, Winkelmann J, Merkur S. Social Health Insurance country responses to the COVID-19 pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pandemic response is largely also driven by organization and governance of health systems. In countries with social health insurance (SHI) systems, pluralism of actors and decentralisation may represent a particular challenge in crisis times.
Objectives
We aim to present a comprehensive analysis of the health system responses during the COVID-19 pandemic of eight SHI countries: Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland. The question at the centre of the analysis is how SHI funds and defining characteristics of SHI systems have shaped pandemic response and which lessons to draw from the experiences of the first wave (spring to autumn 2020).
Results
Our analysis highlights key characteristics driving pandemic response common across SHI countries, particular the level of (de)centralization of responsibilities and providers and the role of SHI funds (compared to other actors). Five key themes emerged: governance, SHI fund sustainability, the role of GPs, surveillance strategies and (essential) health service provision. We found that SHI funds were not represented in crisis management teams during the pandemic in the majority of countries analysed. Responsibility partly shifted towards central government and away from the SHI funds.
Conclusions
Decentralization may pose significant challenges among local authorities with regard to the coordination of policies and information system flows. At the same time, decentralized pandemic management may be favourable as it supports bottom-up self-organization of ambulatory care providers. In fact, coordinated ambulatory care often helped avoid overburdening hospitals in the countries analysed.
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Affiliation(s)
- A Schmidt
- Austrian National Public Health Institute, Vienna, Austria
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - J Winkelmann
- Technical University of Berlin, Department of Healthcare Management, Berlin, Germany
| | - S Merkur
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
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Pavelekova P, Jech R, Zech M, Krepelova A, Han V, Mosejova A, Liba Z, Urgosik D, Gdovinova Z, Havrankova P, Fecikova A, Winkelmann J, Skorvanek M. Atypical presentations of DYT1 dystonia with acute craniocervical onset. Parkinsonism Relat Disord 2021; 83:54-55. [PMID: 33476878 DOI: 10.1016/j.parkreldis.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
DYT1 gene mutations lead to early-onset dystonia that begins with focal limb onset and spreads to other body regions within 5 years, with typical sparing of the oromandibular muscles. In the present study, we describe two patients with an unusual presentation of the disease.
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Affiliation(s)
- P Pavelekova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.
| | - R Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - M Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute for Human Genetics, Technische Universität München, Munich, Germany
| | - A Krepelova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - V Han
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - A Mosejova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Z Liba
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - D Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Z Gdovinova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - P Havrankova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - A Fecikova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute for Human Genetics, Technische Universität München, Munich, Germany; Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - M Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
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9
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Winkelmann J, Henschke C, Scarpetti S, Panteli D. Dental care in Europe: financing, coverage and provision. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In Europe, countries have adopted very different approaches to providing publicly subsidized dental insurance coverage. However, little attention has been paid on these variations in the coverage, financing and provision of oral health care and its implications. This cross-country Health Systems in Transition (HiT) Review aims to fill this gap in the field of comparison of oral health systems.
Methods
The comparative HiT draws on multiple data sources. It builds on detailed country information from national HiTs and other international sources (MISSOC, OECD/OBS country profiles). International databases (Eurostat, OECD, EHIS, EU-SILC) are used as main sources to compare available oral health related indicators. National and international policy documents and information by country experts complement this information. The HiT covers all EU members states and countries belonging to the EU's single market (UK, Iceland, Norway, Switzerland).
Results
In almost all countries, dental care is funded to a greater extent by private patient payments than other health care sectors. Overall, contribution of voluntary health insurances (VHI) to dental spending is low, while out-of-pocket spending is substantial in many countries leading to high levels of unmet needs for dental care for financial reasons, mainly for poor households. Comparison of coverage reveals that most countries commit to a minimum scope of basic dental care (emergency care, children), but there is large variation in terms of restriction of service packages ranging from countries with very limited, partial to comprehensive coverage.
Conclusions
Dental care has become a priority for European policy makers as countries extend statutory dental care coverage recognising the importance of prevention of oral diseases. However, there remain wide variations in the level of coverage resulting in differences of likelihood of dental care use.
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Affiliation(s)
- J Winkelmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - C Henschke
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - S Scarpetti
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - D Panteli
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
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10
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Fattore G, Winkelmann J, Panteli D, Allin S. An extended comparative analysis using vignettes of dental care coverage. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Virtually all European countries state to guarantee universal healthcare coverage to their citizens. However, there is evidence, although scarce, that dental care is a special case as coverage is very limited in some countries and there are major differences across national jurisdictions. This comparative study tries to better understand how dental care is covered in Europe and Canada through the use of five vignettes presenting dental services for specific patients.
Methods
Experts from each country were asked to state whether the following situations were covered by their statutory systems: a) scaling and polishing to remove plaque deposits and calculus for an adult; b) treatment for caries including fillings and root canal treatment for an adult; c) prosthetic rehabilitation for an elderly; d) fillings and repairs for a seven-year old girl with serious tooth decay; e) orthodontic treatment for a 13 old boy.
Results
Preliminary analysis of the vignettes from 10 countries show that there is a large variation between countries in who delivers dental care, how much it costs and who pays for it.
Conclusions
Full coverage of dental care is rare in Europe and the extent of coverage varies greatly across countries in Europe and also in comparison to Canada.
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Affiliation(s)
- G Fattore
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - J Winkelmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - D Panteli
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - S Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Winkelmann J, Maier CB. Time trends in the geographical distribution of physicians, nurses and midwives in Europe. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Data on the supply of health professionals show large variations in the health workforce density among European countries based on national-level data. However, little attention has been paid to the comparison of health professional density at the regional level. This study aimed to analyse the density of physicians, nurses and midwives at regional level, using a cross-country comparative design and examine time trends.
Methods
Descriptive analysis of Eurostat data on the rate of health professionals per population at national and regional levels (NUTS 2 regions) for 2017 and time trends (2005-2017) and comparison to population density. To improve the cross-country comparability of data a set of criteria was applied, resulting in 15 European countries covered on physicians and eight for nurses and midwives. Changes over time in the regional distribution were analysed, using percentage change and compound annual growth rate (CAGR).
Results
We found a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria: 513, Poland 241.6 per 100.000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483). Differences by regions across Europe were higher and varied up to 4.5-fold both for physicians and nurses/midwives and did not improve over time. Results show that in all countries physician density levels are highest in densely populated regions, with capitals and/or major cities, while density of nurses and midwives tends to be higher in less populated areas. Overall, physician rates grew at a faster rate than the density levels of nurses and midwives.
Conclusions
International data should not only cover supply indicators at national level, but routinely collect regional data on the number of health professionals to demonstrate regional differences in workforce supply and to improve monitoring and workforce planning at regional levels.
Key messages
Despite increases in the density levels of physicians, nurses and midwives, time trends over a ten-year period showed no improvement in the geographical distribution within countries. The study is the first of its kind to descriptively analyse geographical density levels and time trends among health professionals across a selection of European countries using Eurostat data.
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Affiliation(s)
- J Winkelmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - C B Maier
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
- European Observatory on Health Systems and Policies, Berlin, Germany
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Abstract
There is a growing interest in cylindrical structures of hard and soft particles. A promising new method to assemble such structures has recently been introduced by Lee et al. [Lee, Gizynski, and Grzybowski, Adv. Mater. 29, 1704274 (2017)ADVMEW0935-964810.1002/adma.201704274]. They used rapid rotations around a central axis to drive spheres of lower density than the surrounding fluid towards the axis. This resulted in different structures as the number of spheres is varied. Here, we present comprehensive analytic energy calculations for such self-assembled structures, based on a generic soft sphere model, from which we obtain a phase diagram. It displays interesting features, including peritectoid points. These analytic calculations are complemented by preliminary numerical simulations for finite sample sizes with soft spheres. A similar analytic approach could be used to study packings of spheres inside cylinders of fixed dimensions, but with a variation in the number of spheres.
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Affiliation(s)
- J Winkelmann
- School of Physics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - A Mughal
- Institute of Mathematics, Physics and Computer Science, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, Wales SY23, United Kingdom
| | - D B Williams
- School of Physics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - D Weaire
- School of Physics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - S Hutzler
- School of Physics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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13
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Van den Broucke S, Wismar M, Kroezen M, Winkelmann J, Budde H, Maier CB. Skill-mix innovations to keep people healthy and well: health promotion and disease prevention. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - M Kroezen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - H Budde
- Technical University Berlin, Berlin, Germany
| | - CB Maier
- Technical University Berlin, Berlin, Germany
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14
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Maier CB, Budde H, Kroezen M, Winkelmann J, Wismar M. Overview of systematic reviews: outcomes of health workforce skill-mix changes in ambulatory care. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- CB Maier
- Technical University Berlin, Berlin, Germany
| | - H Budde
- Technical University Berlin, Berlin, Germany
| | - M Kroezen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Winkelmann J, Budde H, Maier CB, Kroezen M, Wismar M. The potential of skill-mix innovations for chronic care and multimorbidity. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - H Budde
- Technical University Berlin, Berlin, Germany
| | - CB Maier
- Technical University Berlin, Berlin, Germany
| | - M Kroezen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Kroezen M, Wismar M, Budde H, Winkelmann J, Maier CB. Implementation strategies for skill-mix innovations. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Kroezen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - H Budde
- Technical University Berlin, Berlin, Germany
| | | | - CB Maier
- Technical University Berlin, Berlin, Germany
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Berger E, Maier CB, Winkelmann J, Budde H, Kroezen M, Wismar M. Skill-mix innovations in long-term and palliative care. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Berger
- Technical University Berlin, Berlin, Germany
| | - CB Maier
- Technical University Berlin, Berlin, Germany
| | | | - H Budde
- Technical University Berlin, Berlin, Germany
| | - M Kroezen
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Schormair B, Kemlink D, Mollenhauer B, Fiala O, Machetanz G, Roth J, Berutti R, Strom TM, Haslinger B, Trenkwalder C, Zahorakova D, Martasek P, Ruzicka E, Winkelmann J. Diagnostic exome sequencing in early-onset Parkinson's disease confirms VPS13C as a rare cause of autosomal-recessive Parkinson's disease. Clin Genet 2018; 93:603-612. [PMID: 28862745 DOI: 10.1111/cge.13124] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 12/18/2022]
Abstract
Parkinson's disease (PD) is a genetically heterogeneous disorder and new putative disease genes are discovered constantly. Therefore, whole-exome sequencing could be an efficient approach to genetic testing in PD. To evaluate its performance in early-onset sporadic PD, we performed diagnostic exome sequencing in 80 individuals with manifestation of PD symptoms at age 40 or earlier and a negative family history of PD. Variants in validated and candidate disease genes and risk factors for PD and atypical Parkinson syndromes were annotated, followed by further analysis for selected variants. We detected pathogenic variants in Mendelian genes in 6.25% of cases and high-impact risk factor variants in GBA in 5% of cases, resulting in overall maximum diagnostic yield of 11.25%. One individual was compound heterozygous for variants affecting canonical splice sites in VPS13C, confirming the causal role of protein-truncating variants in this gene linked to autosomal-recessive early-onset PD. Despite the low diagnostic yield of exome sequencing in sporadic early-onset PD, the confirmation of the recently discovered VPS13C gene highlights its advantage over using predefined gene panels.
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Affiliation(s)
- B Schormair
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - D Kemlink
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - B Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Institute of Neuropathology and Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - O Fiala
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic.,Institute of Neuropsychiatric Care (INEP), Prague, Czech Republic
| | | | - J Roth
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - R Berutti
- Institute of Human Genetics, Helmholtz Zentrum München, Munich, Germany
| | - T M Strom
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Munich, Germany
| | - B Haslinger
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - D Zahorakova
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - P Martasek
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - E Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany.,Institute of Human Genetics, Technische Universität München, Munich, Germany.,Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Winkelmann J, Dunne F, Langlois V, Möbius M, Weaire D, Hutzler S. 2D foams above the jamming transition: Deformation matters. Colloids Surf A Physicochem Eng Asp 2017. [DOI: 10.1016/j.colsurfa.2017.03.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Winkelmann J, Haffner B, Weaire D, Mughal A, Hutzler S. Simulation and observation of line-slip structures in columnar structures of soft spheres. Phys Rev E 2017; 96:012610. [PMID: 29347149 DOI: 10.1103/physreve.96.012610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/07/2022]
Abstract
We present the computed phase diagram of columnar structures of soft spheres under pressure, of which the main feature is the appearance and disappearance of line slips, the shearing of adjacent spirals, as pressure is increased. A comparable experimental observation is made on a column of bubbles under forced drainage, clearly exhibiting the expected line slip.
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Affiliation(s)
- J Winkelmann
- Foams and Complex Systems, School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - B Haffner
- Foams and Complex Systems, School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - D Weaire
- Foams and Complex Systems, School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - A Mughal
- Institute of Mathematics, Physics and Computer Science, Aberystwyth University, Penglais, Aberystwyth, Ceredigion, Wales SY23, United Kingdom
| | - S Hutzler
- Foams and Complex Systems, School of Physics, Trinity College Dublin, Dublin 2, Ireland
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Winkelmann J, Haffner B, Weaire D, Mughal A, Hutzler S. Corrected Article: Simulation and observation of line-slip structures in columnar structures of soft spheres [Phys. Rev. E 96, 012610 (2017)]. Phys Rev E 2017; 97:059902. [PMID: 29906839 DOI: 10.1103/physreve.97.059902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/07/2022]
Abstract
This corrects the article DOI: 10.1103/PhysRevE.96.012610.
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Affiliation(s)
- J Winkelmann
- School of Physics, Trinity College Dublin, The University of Dublin, Ireland
| | - B Haffner
- School of Physics, Trinity College Dublin, The University of Dublin, Ireland
| | - D Weaire
- School of Physics, Trinity College Dublin, The University of Dublin, Ireland
| | - A Mughal
- Department of Mathematics, Aberystwyth University, Aberystwyth SY23 3BZ, UK
| | - S Hutzler
- School of Physics, Trinity College Dublin, The University of Dublin, Ireland
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Döring N, Doupi P, Glonti K, Winkelmann J, Warren E, McKee M, Knai C. Electronic discharge summaries in cross-border care in the European Union: How close are we to making it happen? International Journal of Care Coordination 2014. [DOI: 10.1177/2053435414540614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The political drive for cross-border care within the European Union and an increasing focus on integrated care both have implications for electronic health records. The hospital discharge summary is a critical component of systems to ensure quality and continuity of care, and in a cross-border setting would particularly benefit from an electronic version. We have explored the extent to which European Union level policy and practice on electronic health records address issues pertinent to the development and implementation of electronic discharge summaries for patients treated outside their own country. Methods We approached the topic by analysing data from two different sources: European Union policy documents on topics relevant to electronic health records and deliverables of European Union-funded electronic health record-focused research and development projects. Elements pertinent to different aspects of interoperability – legal, semantic and technical – were extracted from both sources and their content compared to assess the degree of consistency between policy and implementation targets. Results We identified 25 policy documents and 14 European Union-funded projects. Our results show that European legislation is increasingly aligned with projects funded through European Union sources and substantial progress has been accomplished in achieving electronic communication across European health systems. Nevertheless, the achievement of a European level interoperable discharge summary is still a distant goal, while inadequate attention has been paid to the coordination of current discharge summary practices in Member States. Discussion If the harmonized European Union patient summary is also to function as an electronic discharge summary, further specific steps are needed that address issues of both content and processes related to communication.
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Affiliation(s)
- N Döring
- Maastricht University, The Netherlands
- Karolinska Institutet, Sweden
| | - P Doupi
- National Institute for Health and Welfare – THL, Finland
| | - K Glonti
- London School of Hygiene & Tropical Medicine, UK
| | - J Winkelmann
- European Centre for Social Welfare Policy and Research, Austria
| | - E Warren
- London School of Hygiene & Tropical Medicine, UK
| | - M McKee
- London School of Hygiene & Tropical Medicine, UK
| | - C Knai
- London School of Hygiene & Tropical Medicine, UK
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24
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Kohnen R, Bosse B, Hopp M, Winkelmann J, Allen R, Trenkwalder C. No augmentation during opioid treatment in restless legs syndrome – Results from a 1 year long-term trial. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trenkwalder C, Benes H, Grote L, Högl B, Winkelmann J, Allen R, Hopp M, Bosse B, Kohnen R. Opioid treatment is effective in patients with severe RLS after failure of previous medications —/INS; Results of a 1-year study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Knier B, Boeckh-Behrens T, Murgan I, Wörtler K, Hemmer B, Winkelmann J. [Crowned dens syndrome: a rare differential diagnosis of acute neck pain]. Nervenarzt 2012; 83:1308-11. [PMID: 22843028 DOI: 10.1007/s00115-012-3599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buck D, Albrecht E, Aslam M, Hauenstein N, Jochim A, Cepok S, Grummel V, Berthele A, Lichtner P, Gieger C, Winkelmann J, Hemmer B. Genetic Determinants of IgG Synthesis in the Cerebrospinal Fluid of Patients with Multiple Sclerosis (S20.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s20.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schulte EC, Knauf F, Kemlink D, Schormair B, Lichtner P, Gieger C, Meitinger T, Winkelmann J. Variant screening of the coding regions of MEIS1 in patients with restless legs syndrome. Neurology 2011; 76:1106-8. [PMID: 21422461 DOI: 10.1212/wnl.0b013e318211c366] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E C Schulte
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Ahmad B, Vigliotta I, Tatini F, Campioni S, Mannini B, Winkelmann J, Tiribilli B, Chiti F. The induction of α-helical structure in partially unfolded HypF-N does not affect its aggregation propensity. Protein Eng Des Sel 2011; 24:553-63. [PMID: 21518735 DOI: 10.1093/protein/gzr018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The conversion of proteins into structured fibrillar aggregates is a central problem in protein chemistry, biotechnology, biology and medicine. It is generally accepted that aggregation takes place from partially structured states of proteins. However, the role of the residual structure present in such conformational states is not yet understood. In particular, it is not yet clear as to whether the α-helical structure represents a productive or counteracting structural element for protein aggregation. We have addressed this issue by studying the aggregation of pH-unfolded HypF-N. It has previously been shown that the two native α-helices of HypF-N retain a partial α-helical structure in the pH-unfolded state and that these regions are also involved in the formation of the cross-β structure of the aggregates. We have introduced mutations in such stretches of the sequence, with the aim of increasing the α-helical structure in the key regions of the pH-unfolded state, while minimizing the changes of other factors known to influence protein aggregation, such as hydrophobicity, β-Sheet propensity, etc. The resulting HypF-N mutants have higher contents of α-helical structure at the site(s) of mutation in their pH-unfolded states, but such an increase does not correlate with a change of aggregation rate. The results suggest that stabilisation of α-helical structure in amyloidogenic regions of the sequence of highly dynamic states does not have remarkable effects on the rate of protein aggregation from such conformational states. Comparison with other protein systems indicate that the effect of increasing α-helical propensity can vary if the stabilised helices are in non-amyloidogenic stretches of initially unstructured peptides (accelerating effect), in amyloidogenic stretches of initially unstructured peptides (no effect) or in amyloidogenic stretches of initially stable helices (decelerating effect).
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Affiliation(s)
- B Ahmad
- Dipartimento di Scienze Biochimiche, Università degli Studi di Firenze, Viale Morgagni 50, 50134 Firenze, Italy
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Winkelmann J. Density functional theory: Prediction of ellipsometric parameters and structural behaviour of pure fluid vapour-liquid interfaces. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19940981015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Winkelmann J. Genetik des Restless-Legs-Syndroms. Akt Neurol 2009. [DOI: 10.1055/s-0029-1223407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mätz-Rensing K, Winkelmann J, Becker T, Burckhardt I, van der Linden M, Köndgen S, Leendertz F, Kaup FJ. Outbreak of Streptococcus equi subsp. zooepidemicus infection in a group of rhesus monkeys (Macaca mulatta). J Med Primatol 2009; 38:328-34. [PMID: 19508349 PMCID: PMC7166853 DOI: 10.1111/j.1600-0684.2009.00359.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background A severe upper respiratory tract infection occurred in a breeding group of rhesus monkeys housed together in one of six indoor/outdoor corals of the German Primate Center. The clinical signs of the disease included severe purulent conjunctivitis, rhinitis, pharyngitis, respiratory distress and lethargy. Six of 45 animals died within a few days after developing signs of infection. Methods and results Histopathologic and microbiologic examinations of the dead animals were consistent with a severe fibrinopurulent bronchopneumonia. Microbiology revealed a Lancefield group C streptococcus identified as Streptococcus equi subsp. zooepidemicus as the causative agent of infection. Conclusions The infection was passed on from animal to animal but did not spread to the other five breeding groups nearby. Extensive diagnostic testing failed to reveal the consisting presence of copathogens in individual cases. A visitor with upper respiratory disease was suspected as source of infection.
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Affiliation(s)
- K Mätz-Rensing
- Department of Pathology, German Primate Center, Göttingen, Germany.
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Kemlink D, Polo O, Frauscher B, Gschliesser V, Högl B, Poewe W, Vodicka P, Vavrova J, Sonka K, Nevsimalova S, Schormair B, Lichtner P, Silander K, Peltonen L, Gieger C, Wichmann HE, Zimprich A, Roeske D, Müller-Myhsok B, Meitinger T, Winkelmann J. Replication of restless legs syndrome loci in three European populations. J Med Genet 2009; 46:315-8. [PMID: 19279021 DOI: 10.1136/jmg.2008.062992] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is associated with common variants in three intronic and intergenic regions in MEIS1, BTBD9, and MAP2K5/LBXCOR1 on chromosomes 2p, 6p and 15q. METHODS Our study investigated these variants in 649 RLS patients and 1230 controls from the Czech Republic (290 cases and 450 controls), Austria (269 cases and 611 controls) and Finland (90 cases and 169 controls). Ten single nucleotide polymorphisms (SNPs) within the three genomic regions were selected according to the results of previous genome-wide scans. Samples were genotyped using Sequenom platforms. RESULTS We replicated associations for all loci in the combined samples set (rs2300478 in MEIS1, p = 1.26 x 10(-5), odds ratio (OR) = 1.47, rs3923809 in BTBD9, p = 4.11 x 10(-5), OR = 1.58 and rs6494696 in MAP2K5/LBXCOR1, p = 0.04764, OR = 1.27). Analysing only familial cases against all controls, all three loci were significantly associated. Using sporadic cases only, we could confirm the association only with BTBD9. CONCLUSION Our study shows that variants in these three loci confer consistent disease risks in patients of European descent. Among the known loci, BTBD9 seems to be the most consistent in its effect on RLS across populations and is also most independent of familial clustering.
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Affiliation(s)
- D Kemlink
- Helmholtz Zentrum Munich, National Research Center of Environment and Health, Institute of Human Genetics, Munich, Germany
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Plag J, Schormair B, Samtleben W, Müller-Myhsok B, Illig T, Meitinger T, Winkelmann J. The role of MEIS1, BTBD9 and MAP2K5/LBXCOR1 in uraemic RLS – a case-control study in patients with end stage renal disease on maintenance hemodialysis. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Berger K, Broll S, Winkelmann J, Heberlein I, Müller T, Ries V. Untersuchung zur Reliabilität der deutschen Version des PDQ-39: Ein krankheitsspezifischer Fragebogen zur Erfassung der Lebensqualität von Parkinson-Patienten. Akt Neurol 2008. [DOI: 10.1055/s-2007-1017628] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fulda S, Winkelmann J, Wetter TC. Cognitive functions in patients with restless legs syndrome. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Genetic factors affect sleep. Studies in twin pairs demonstrate that the strong hereditary influences on sleep architecture and some sleep disorders are transmitted through families. Evidence like this strongly suggests that sleep regulation receives significant influence from genetic factors. Although recent molecular technologies have revealed evidence that genetic traits or gene products trigger particular changes in sleep electroencephalogram activity, we are still far from finding candidate genes or multiple mutations responsible for individual sleep disorders. Sleep is a very complex phenotype. Genetic susceptibility and environmental factors should be also considered as contributors to sleep phenotype. The aim of this review is to present a current summary and future prospects for genetic studies on sleep and selected sleep-associated disorders.
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Affiliation(s)
- M Kimura
- Max Planck Institute of Psychiatry, Munich, Germany.
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Fulda S, Winkelmann J, Wetter T. S25.B Cognitive functions in RLS. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Groß N, Busjahn A, Winkelmann J. Restless Legs Syndrom bei Monozygoten und Dizygoten Zwillingen. Akt Neurol 2007. [DOI: 10.1055/s-2007-987808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plag J, Fulda S, Samtleben W, Wetter T, Winkelmann J. Cognition, mood and anxiety in ESRD-patients with and without restless legs syndrome. Akt Neurol 2007. [DOI: 10.1055/s-2007-987807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Winkelmann J, Lichtner P, Kemlink D, Polo O, Montagna P, Högl B, Stiasny-Kolster K, Hadjigeorgiou G, Pütz B, Trenkwalder C, Strom T, Meitinger T, Müller-Myhsok B. New loci for restless legs syndrome map to chromosome 4q and 17p. Akt Neurol 2006. [DOI: 10.1055/s-2006-952980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Ivanov DA, Winkelmann J. Multiexponential decay autocorrelation function in dynamic light scattering in near-critical ternary liquid mixture. J Chem Phys 2006; 125:104507. [PMID: 16999541 DOI: 10.1063/1.2338312] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The dynamic structure factor of a ternary liquid mixture is calculated from the theory of thermodynamic fluctuations with the help of linearized hydrodynamic equations. The theoretical model allows evaluating and classifying the transport properties near a critical solution point of a ternary mixture. In the vicinity of the critical solution point, experimental dynamic light scattering measurements reveal two hydrodynamic relaxation modes with well-separated characteristic relaxation times. From the autocorrelation functions, we can determine two effective diffusivities D(1) and D(2). As theoretically predicted by a model developed in this work, one of these two modes can be associated with thermal diffusion and the other with mass diffusion. In the special case of an incompressible liquid mixture limit, D(1) and D(2) are decoupled, becoming thermodiffusion coefficient D(T) and mutual mass diffusion coefficient D(ij). A possible physical meaning of D(1) and D(2) for a ternary mixture is discussed.
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Affiliation(s)
- D A Ivanov
- Institut für Physikalische Chemie, Universität Halle-Wittenberg, Mühlpforte 1, D-06108 Halle (Saale), Germany
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Liebetanz KM, Winkelmann J, Trenkwalder C, Pütz B, Dichgans M, Gasser T, Müller-Myhsok B. RLS3: Fine-mapping of an autosomal dominant locus in a family with intrafamilial heterogeneity. Neurology 2006; 67:320-1. [PMID: 16864828 DOI: 10.1212/01.wnl.0000224886.65213.b5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A new locus for restless legs syndrome (RLS3) was identified on chromosome 9p24-22. The authors analyzed transmission disequilibrium tests (TDTs) and affecteds-only linkage analysis in one large family of Bavarian origin, taking into account age at onset. P values were 0.0054 for marker D9S1810 for TDT and 0.0009 for the affecteds-only linkage analysis, providing a confirmation of RLS3. This study narrows the region containing the autosomal dominant RLS3 locus to 11.1 cM (16.6 Mbp).
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Affiliation(s)
- K M Liebetanz
- Department of Clinical Neurophysiology, Georg-August-University, Goettingen, Germany
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Winkelmann J, Lichtner P, Puetz B, Hauk S, Trenkwalder C, Strom T, Meitinger T, Müller-Myhsok B. A new locus for restless legs syndrome maps to chromosome 4q. Akt Neurol 2005. [DOI: 10.1055/s-2005-919219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Friess E, Ambrosius U, Lietzenmayer S, Wichniak A, Winkelmann J, Yassouridis A, Holsboer F. Sleep architecture and sleep continuity in healthy twins. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kortmansky JS, O’Reilly EM, Minsky BD, Puleio SA, Winkelmann J, Kelsen DP, Schwartz GK. A phase I trial of erlotinib, gemcitabine and radiation for patients with locally advanced, unresectable pancreatic cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - B. D. Minsky
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - S. A. Puleio
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - D. P. Kelsen
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
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