GMS German Medical Science最新文献

{"title":"Automated sleep stage classification based on tracheal body sound and actigraphy.","authors":"Christoph Kalkbrenner,&nbsp;Rainer Brucher,&nbsp;Tibor Kesztyüs,&nbsp;Manuel Eichenlaub,&nbsp;Wolfgang Rottbauer,&nbsp;Dominik Scharnbeck","doi":"10.3205/000268","DOIUrl":"https://doi.org/10.3205/000268","url":null,"abstract":"<p><p>The current gold standard for assessment of most sleep disorders is the in-laboratory polysomnography (PSG). This approach produces high costs and inconveniences for the patients. An accessible and simple preliminary screening method to diagnose the most common sleep disorders and to decide whether a PSG is necessary or not is therefore desirable. A minimalistic type-4 monitoring system which utilized tracheal body sound and actigraphy to accurately diagnose the obstructive sleep apnea syndrome was previously developed. To further improve the diagnostic ability of said system, this study aims to examine if it is possible to perform automated sleep staging utilizing body sound to extract cardiorespiratory features and actigraphy to extract movement features. A linear discriminant classifier based on those features was used for automated sleep staging using the type-4 sleep monitor. For validation 53 subjects underwent a full-night screening at Ulm University Hospital using the developed sleep monitor in addition to polysomnography. To assess sleep stages from PSG, a trained technician manually evaluated EEG, EOG, and EMG recordings. The classifier reached 86.9% accuracy and a Kappa of 0.69 for sleep/wake classification, 76.3% accuracy and a Kappa of 0.42 for Wake/REM/NREM classification, and 56.5% accuracy and a Kappa of 0.36 for Wake/REM/light sleep/deep sleep classification. For the calculation of sleep efficiency (SE), a coefficient of determination r² of 0.78 is reached. Additionally, subjects were classified into groups of SEs (SE≥40%, SE≥60% and SE≥80%). A Cohen's Kappa >0.61 was reached for all groups, which is considered as substantial agreement. The presented method provides satisfactory performance in sleep/wake and wake/REM/NREM sleep staging while maintaining a simple setup and offering high comfort. This minimalistic approach may address the need for a simple yet reliable preliminary sleep screening in an ambulatory setting.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"17 ","pages":"Doc02"},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6449867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37162253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relapse of typhoid fever following delayed response to meropenem: A case report and review of previously published cases indicating limited clinical efficacy of meropenem for the treatment of typhoid fever.","authors":"Christian G Blumentrath,&nbsp;Gernot Müller,&nbsp;Dieter Teichmann,&nbsp;Jens Tiesmeier,&nbsp;Jasmina Petridou","doi":"10.3205/000267","DOIUrl":"https://doi.org/10.3205/000267","url":null,"abstract":"<p><p>In times of emerging multi-drug resistance among Gram-negative bacteria (including <i>Salmonella enterica</i>, Serovar Typhi), we observed relapse of typhoid fever following delayed response to treatment with meropenem, suggestive for limited clinical efficacy of the drug. Three previously published cases supported our suspicion. Within this context, we discuss the case details with a focus on potential explanations for insufficient clinical response to meropenem (e.g. limited intracellular penetration, phenomena of tolerance and persistence). Meropenem is a last-resort antimicrobial agent for the treatment of multi-drug resistant Gram-negative infections. Reliable clinical data evaluating the efficacy of meropenem for the treatment of typhoid fever are urgently needed. Future clinical studies evaluating typhoid fever outcome should also investigate the impact of (i) intracellular penetration of antibiotics, and (ii) tolerance and persistence on outcome.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"17 ","pages":"Doc01"},"PeriodicalIF":0.0,"publicationDate":"2019-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/000267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37188300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) program in Ethiopia.","authors":"Matiwos Soboka,&nbsp;Kristina Adorjan,&nbsp;Sandra Dehning,&nbsp;Tsedeke Asaminew,&nbsp;Mubarek Abera,&nbsp;Matthias Siebeck,&nbsp;Markos Tesfaye,&nbsp;Andrea Jobst","doi":"10.3205/000266","DOIUrl":"https://doi.org/10.3205/000266","url":null,"abstract":"<p><p><b>Introduction:</b> The shortage of trained manpower in the field of mental health remains a significant obstacle to the treatment of people with mental illnesses in low and middle-income countries. In 2010, a new <i>Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH)</i> program for non-physician clinicians was established at Jimma University to address this shortage in Ethiopia. This study aimed to assess the competency, satisfaction, and involvement level of graduates of the program. <b>Methods:</b> A cross-sectional study was conducted among the graduates of the program. Data were collected with a semi-structured, self-administered questionnaire that was developed for the study. Responses were recorded on a Likert scale to assess graduates' competency and satisfaction level. The quantitative data were summarized by descriptive statistics, including means, standard deviations, and frequencies. Qualitative data were transcribed and analyzed thematically. <b>Result:</b> Until June 2015, 32 trainees had graduated from the MSc ICCMH program; 87.5% (n=28) of these graduates participated in the study. Almost all (96.4%, n=27) graduates were working in public institutions. The majority (75%, n=21) were directly engaged in the clinical care of patients. Also, two-thirds of the graduates (67.9%, n=19) were involved in mental health research. All of the graduates felt confident in conducting psychiatric assessments of adults and identifying and managing common mental disorders (100%, n=28). Similarly, 100% (n=28) of the graduates reported that they felt confident in identifying and managing severe mental illnesses. <b>Conclusions:</b> The outcome of the program is a considerable workforce of skilled mental health professionals. The majority of graduates were retained within the public mental health service. Brain drain does not appear to be a challenge among non-physician mental health specialists. The findings on the self-perceived competencies mirror the amount of clinical exposure during the training. With a minimal revision of the curriculum, the level of satisfaction and competencies can be enhanced.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"16 ","pages":"Doc04"},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36893815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and treatment of sexually transmitted infections in men followed by urologists in Germany - a cross sectional study with 347,090 men.","authors":"Louis Jacob,&nbsp;Dragos Andrei Duse,&nbsp;Karel Kostev","doi":"10.3205/000265","DOIUrl":"https://doi.org/10.3205/000265","url":null,"abstract":"<p><p><b>Aim:</b> The goal of this retrospective analysis was to study the prevalence and treatment of the most common sexually transmitted infections (STI) in men followed by urologists in Germany. <b>Methods:</b> This study included a total of 347,090 men followed in 71 urology practices in Germany between 2013 and 2015. The first outcome was the prevalence of individuals diagnosed with STI between 2013 and 2015. The following eight types of STI infections were included in the analysis: chlamydial infection, gonococcal infection, anogenital warts, anogenital herpes infection, trichomoniasis, ulcus molle, phthiriasis, and syphilis. The second outcome was the prevalence of individuals with STI who received an appropriate therapy within 90 days of their initial STI diagnosis. <b>Results:</b> The most frequent STI was anogenital warts (0.64%), whereas the least frequent STI was syphilis (0.03%). The median age at diagnosis ranged from 30.3 years for chlamydia infection to 47.5 years for trichomoniasis. The proportion of individuals receiving treatment was the highest for trichomoniasis (90.6%) and the lowest for anogenital warts (49.9%). <b>Conclusions:</b> Overall, approximately 1.25% of men followed in urology practices in Germany between 2013 and 2015 were diagnosed with at least one STI. Further research is needed to gain a better understanding of the factors potentially associated with the risk of being diagnosed with STI in this setting in Germany. Moreover, there is a need for enabling higher rates of diagnosis and thus treatment of infected persons.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"16 ","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36521465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of ambulant patients by a general practitioner within a university hospital's emergency department - follow-up study of patients' behaviour shortly afterwards.","authors":"Olaf Krause,&nbsp;Tanja Schleef,&nbsp;Maria Raker,&nbsp;Nils Schneider,&nbsp;Jutta Bleidorn","doi":"10.3205/000264","DOIUrl":"https://doi.org/10.3205/000264","url":null,"abstract":"<p><p><b>Aims:</b> Hospital emergency departments (ED) face an increasing number of outpatient cases. Therefore, Hannover Medical School employs general practitioners for the treatment of walk-in patients within the ED. Up to now, little has been reported on how these patients behave after treatment in the ED. This study aims to assess these patients' behaviour after attending the ED, to find out how many patients consult a physician subsequently, and to explore patients' utilisation of health care in case of similar health problems. <b>Methods:</b> For this follow-up study, patients treated at Hannover Medical School's ED during daytime (Monday - Friday) by a general practitioner (GP) within a period of six weeks in 2016 were subsequently followed up by phone interviews 10-15 days after their consultation. Main topics in the semi-structured interview guide were patients' behaviour after leaving the ED, subsequent contacts with medical care, and how patients would behave in the future given similar symptoms. Data were transferred to a SPSS database, and descriptive data analyses were performed. <b>Results:</b> In total, 171 patients were screened for inclusion, and 91 participated in the study. About half (n=48; 53%) of them were male, and the mean age was 46.6 years. After visiting the GP in the ED, 62 patients (68%) went directly home. Another 14 (15%) took up regular activities (e.g. work, university), while eight patients visited their usual GP practice. Within 10-15 days, 52 patients (57%) had had an appointment with a physician. In most cases this was a GP (n=34; 37%); 12 patients visited a specialist and six patients visited both a GP and a specialist. Physician appointments took place within an average of 3.4 days after treatment in the ED. In case of similar complaints, 37 patients (41%) would visit the ED again rather than visiting the GP, whereas 36% would consult the GP first, and 11% would visit a specialist first. <b>Conclusion:</b> A noteworthy number of patients considered visiting the ED again with similar symptoms instead of visiting a GP in ambulatory care. Consequently our findings suggest that the ED itself plays a minor role in navigating patients' utilisation of medical treatment.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"16 ","pages":"Doc02"},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36325640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real world data in health technology assessments in kidney transplants in Germany: use of routinely collected data to address epidemiologic questions in kidney transplants in the AMNOG process in Germany.","authors":"Kirsten H Herrmann,&nbsp;Ulf Meier-Kriesche,&nbsp;Aljoscha S Neubauer","doi":"10.3205/000263","DOIUrl":"https://doi.org/10.3205/000263","url":null,"abstract":"<p><p><b>Introduction:</b> It is discussed whether real world data can be used in health technology assessment. Following it is of interest whether routinely collected data for quality assurance (QA) in the hospital sector is feasible to address epidemiologic questions in kidney transplantation in the AMNOG process in Germany. <b>Objectives:</b> To investigate the proportion of kidney transplants classified as from so-called standard criteria donors (SCD) and from expanded criteria donors (ECD) in Germany and to study the age distribution. <b>Methods:</b> After granted use by the Federal Joint Committee (G-BA), the data analysis was carried out by the AQUA institute, and a SPSS code was developed. Special challenge was the complex definition of SCD/ECD criteria that, in addition to donor age, takes into account combinations of donor diagnoses, creatinine, and cold ischemia time. <b>Results:</b> Age analyses could be performed in all patients. Median age of the adult transplant recipients in Germany was 54 years in 2012 as well as in 2013, range 18-85 and 18-82 years and a mean (SD) of 53 (14) and 52 (14) years, respectively. 63.5% (2012) and 62.5% (2013) of recipients were male. Classification in SCD/ECD transplants could be performed for 2,083 of 2,461 patients (85%; 2012) and for 1,795 of 2,079 patients (86%; 2013). Of all classifiable transplants 61.4% (2012) and 66.5% (2013) were SCD transplants. Total project time from the request to results was <6 months. <b>Conclusions:</b> The use of data routinely collected for QA in the hospital sector is feasible to address epidemiologic questions in kidney transplantation in the AMNOG process in Germany, which is basically following the systematic of an HTA process. All patients with kidney transplants are represented thus avoiding sampling error. Limitations include the availability of all necessary data in the QA data set. Within <6 months' time with reasonable resources it was possible to meet timelines. The analyses were accepted by the authorities.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"16 ","pages":"Doc01"},"PeriodicalIF":0.0,"publicationDate":"2018-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/000263","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35856508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parathyroid carcinoma: an unusual presentation of a rare neoplasm.","authors":"Sharma Shruti,&nbsp;Fouzia Siraj","doi":"10.3205/000262","DOIUrl":"https://doi.org/10.3205/000262","url":null,"abstract":"<p><p>Parathyroid carcinoma is an extremely rare malignant endocrine neoplasm that is very challenging in its diagnosis as well as its treatment. Clinically the disease is detected earlier in patients who present with hyperparathyroidism with signs of profound hypercalcemia. Differentiation between benign and malignant disease of the parathyroid is challenging both for the clinician and for the pathologist. Complete surgical resection at the time of first operation offers the best chance of cure. Even after radical excision which is the standard management, local recurrence and metastases are frequent. The disease usually has a slow indolent course and most patients suffer from complications of hypercalcemia rather than tumor invasion or metastasis. We report a case of a 31-year-old woman who presented with renal colic. Various hematological, biochemical and radiological investigations were performed and a slightly enlarged right parathyroid was found. A clinical diagnosis of parathyroid adenoma was made and a right parathyroidectomy was done. Intraoperatively the surgeon had no suspicion of malignancy but microscopically the lesion was malignant and a final diagnosis of parathyroid carcinoma was rendered based on the criteria of invasion. Since there is no gold standard, a multidisciplinary approach, including the entire clinical, biochemical, radiological and pathological profile of the disease aids in an accurate diagnosis. Here we are reporting a case of a functional parathyroid carcinoma presenting in a relatively young patient with all the biochemical and radiological investigations and intraoperative findings pointing towards a benign parathyroid disease.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"15 ","pages":"Doc21"},"PeriodicalIF":0.0,"publicationDate":"2017-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/000262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35753211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla.","authors":"Abdalmalik O Ghandourah,&nbsp;Ashkan Rashad,&nbsp;Max Heiland,&nbsp;Badr M Hamzi,&nbsp;Reinhard E Friedrich","doi":"10.3205/000261","DOIUrl":"https://doi.org/10.3205/000261","url":null,"abstract":"<p><p>The aim of this study was to assess the frequency, location and width of accessory canals (AC) of canalis sinuosus (CS) using cone beam computed tomography and compare our findings with recent literature. Additionally, intraosseous canals (IOC) in the sinus wall other than the CS were noted. A retrospective analysis of 219 scans from our university department was conducted. The registered parameters were age, sex, location and width of canals. Group A consisted of 201 (85 males and 116 females) adults ranged from 19 to 99 years of age (mean age = 47.5 years). A total of 136 patients (67.6%) presented at least 1 AC, of which 55 cases showed a foramen width greater than 1 mm (27.4%). Group B had a sample size of 18 adolescents (7 males and 11 females) with a range of age from 7 to 18 years (mean age = 15.8 years). Eight cases (44.4%) presented at least one AC, of which only 3 had a foramen width greater than 1 mm (3.6%). ACs were found to occur predominantly at central incisors region (Group A) and the left lateral incisor and canine as well as the central incisors regions (Group B). Adolescents showed a lower prevalence of accessory canals compared to adults. These findings supplement earlier reports on the anatomical variations of the intraosseous vessel and nerve conduits of the maxilla. Surgical interventions in this area can be planned more precisely, taking into account the three-dimensional imaging, thus possibly protecting these sensitive structures.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"15 ","pages":"Doc20"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35715210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition from in-hospital ventilation to home ventilation: process description and quality indicators.","authors":"Marc Kastrup,&nbsp;Benjamin Tittmann,&nbsp;Tanja Sawatzki,&nbsp;Martin Gersch,&nbsp;Charlotte Vogt,&nbsp;Max Rosenthal,&nbsp;Simone Rosseau,&nbsp;Claudia Spies","doi":"10.3205/000259","DOIUrl":"https://doi.org/10.3205/000259","url":null,"abstract":"<p><p>The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory) ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process. This project describes an ideal sequence of processes (process chain), based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment. The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"15 ","pages":"Doc18"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/000259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35715207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients.","authors":"Louis Jacob,&nbsp;Matthias Kalder,&nbsp;Karel Kostev","doi":"10.3205/000260","DOIUrl":"https://doi.org/10.3205/000260","url":null,"abstract":"<p><p><b>Aim:</b> The goal of this study was to identify potential risk factors for ectopic pregnancy in women followed in German gynecological practices. <b>Methods:</b> The present study included pregnant women diagnosed with ectopic pregnancy and pregnant women without ectopic pregnancy followed in 262 gynecological practices between January 2012 and December 2016. The effects of demographic and clinical variables on the risk of developing ectopic pregnancy were estimated using a multivariate logistic regression model. <b>Results:</b> This study included 3,003 women with ectopic pregnancy and 97,194 women without ectopic pregnancy. The mean age was 31.4 years (SD=5.9 years) in ectopic pregnancy patients and 31.1 years (SD=5.6 years) in non-ectopic pregnancy patients. Women aged 36-40 (OR=1.12) and 41-45 years (OR=1.46) were at a higher risk of ectopic pregnancy than women aged 31-35 years. Prior ectopic pregnancy was strongly associated with a risk of recurring ectopic pregnancy (OR=8.17). Prior genital surgery (OR=2.67), endometriosis (OR=1.51), and eight other gynecological diseases were also positively associated with ectopic pregnancy (ORs ranging from 1.19 to 2.06). Finally, there was a 1.80-fold increase in women previously diagnosed with psychiatric disorders. <b>Conclusions:</b> Prior ectopic pregnancy and prior genital surgery were strongly associated with ectopic pregnancy in women followed in German gynecological practices. Psychiatric diseases had an additional impact on the risk of ectopic pregnancy.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"15 ","pages":"Doc19"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3205/000260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35715208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}