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Publications (10)19.04 Total impact

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    ABSTRACT: Adaptation of skin barrier function and interleukin-1α (IL-1α) content in diapered and nondiapered skin are poorly characterized in newborns receiving standard skin care. In a monocentric, prospective pilot study 44 healthy, full-term neonates were randomly assigned to skin care with baby wipes (n = 21) or water-moistened washcloth (n = 23) at each diaper change. Transepidermal water loss (TEWL), skin hydration, skin-pH, IL-1α, and epidermal desquamation were measured on days 2, 14, and 28 postpartum. Microbiological colonization was evaluated at baseline and on day 28. Significantly lower TEWL was found on the buttock in the group using baby wipes compared to water. IL-1α and skin hydration significantly increased and pH decreased independent of skin care regimen. IL-1α was significantly higher in diapered skin compared to nondiapered skin. Although skin care with wipes seems to stabilize TEWL better than using water, the skin condition and microbiological colonization were comparable using both cleansing procedures. Increase of epidermal IL-1α may reflect postnatal skin barrier maturation. These data suggest that neither of the two cleansing procedures harms skin barrier maturation within the first four weeks postpartum. Longer observations on larger populations could provide more insight into postnatal skin barrier maturation.
    Pediatric Dermatology 01/2012; 29(3):270-6. · 1.04 Impact Factor
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    ABSTRACT: The bioelectrical phase angle has shown predictive potential in various diseases, but general cutoffs are lacking in the clinical setting. This study evaluated the prognostic value of the fifth percentile of sex-, age-, and body mass index-stratified phase angle reference values in patients with cancer with respect to nutritional and functional status, quality of life, and 6-mo mortality. In a second step, we also studied the effect of the standardized phase angle (with a z score to determine individual deviations from the population average) on these variables. A total of 399 patients with cancer were studied. Phase angle was obtained with bioelectrical impedance analysis; muscle function was assessed by handgrip strength and peak expiratory flow. Quality of life was determined by the European Organization for Research and Treatment of Cancer questionnaire. Nutritional status was assessed by using Subjective Global Assessment. Survival of patients was documented after 6 mo. Patients with a phase angle of less than the fifth reference percentile had significantly lower nutritional and functional status, impaired quality of life (P lt 0.0001), and increased mortality (P lt 0.001). The standardized phase angle emerged as a significant predictor for malnutrition and impaired functional status in generalized linear model regression analyses. It was also a stronger indicator of 6-mo survival than were malnutrition and disease severity in the Cox regression model (P lt 0.0001) and according to the receiver operating characteristic curve. The standardized phase angle is an independent predictor for impaired nutritional and functional status and survival. The fifth phase angle reference percentile is a simple and prognostically relevant cutoff for detection of patients with cancer at risk for these factors.
    American Journal of Clinical Nutrition 09/2010; 92(3):612-9. · 6.50 Impact Factor
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    ABSTRACT: Decreased functionality and muscle weakness are prominent features in cancer patients. We investigated determinants of muscle function assessed by hand grip and knee extension strength as well as functional status in cancer patients. 189 consecutively admitted cancer patients (age 60.8 ± 12.7 years, 96 male) were recruited. Muscle function was assessed by hand grip and knee extension strength, and percentage of anticipated peak expiratory flow (%PEF). Functional status was determined by the EORTC questionnaire of quality of life. Nutritional status was assessed with Subjective Global Assessment (SGA). Age, gender, SGA, body mass index, clinical variables such as cancer location, presence of distant metastases, tumour burden according to TNM stage, UICC stage, number of drugs per day, number of comorbidities, type of treatment and depression were investigated as potential risk factors for muscle weakness and impaired functional status in a multiple regression analysis. 80 patients (39 male) were classified moderately or severely malnourished. Malnutrition also emerged as an independent determinant for hand grip (estimated effect size 11%, p < 0.01), knee extension strength (estimated effect size 12%, p < 0.001), and peak expiratory flow (estimated effect size 30%, p < 0.008) and functional status (estimated effect size 19.4%, p < 0.001) next to age and gender, which were the strongest predictors. Among the disease parameters, only amount of daily medication exhibited a significant influence on knee extension strength. Malnutrition is a disease independent risk factor for reduced muscle strength and functional status in cancer patients. Treatment of malnutrition might therefore also restore muscle strength.
    Clinical nutrition (Edinburgh, Scotland) 03/2010; 29(5):586-91. · 3.27 Impact Factor
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    ABSTRACT: Pressure ulcers and falls are frequent adverse events with negative impacts for hospital patients. Guidelines recommend risk assessment as the first step in prevention. Care dependency correlates with falls and pressure ulcers and the Care Dependency Scale showed a diagnostic validity comparable to that of specific risk assessment tools. The aim of this study was to establish a simple and valid screening index for the risk of falls and pressure ulcers in hospitals by using the Care Dependency Scale and to evaluate this index within two validation samples from different countries. Quantitative, cross-sectional data from two German surveys and one Dutch survey were analysed. A total of 305 Dutch and German hospitals with 21,880 patients took part. The diagnostic validity of the Care Dependency Scale was evaluated by computing receiver operator characteristics curves, the areas under the curves, sensitivity, specificity and positive and negative predictive values.The Scale demonstrated a good diagnostic validity for pressure ulcer risk screening in Dutch and German hospitals. The diagnostic validity regarding the risk for falls was satisfying in Germany and moderate in the Netherlands. Using the Care Dependency Scale for risk screening could reduce the necessity of further assessment by more than a half. KeywordsAccidental Falls-Hospitals-Nursing Home-Pressure Ulcer-Risk Assessment
    Central European Journal of Medicine 01/2010; 5(5):577-587. · 0.26 Impact Factor
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    ABSTRACT: The effect of topical skin care products on neonatal skin barrier during first 8 weeks of life has not been scientifically evaluated. In a prospective, randomized clinical study, we compared the influence of three skin care regimens to bathing with water on skin barrier function in newborns at four anatomic sites. A total of 64 healthy, full-term neonates (32 boys and 32 girls) aged <48 hours were randomly assigned to four groups receiving twice-weekly: WG, bathing with wash gel (n = 16); C, bathing and cream (n = 16); WG + C, bathing with wash gel plus cream (n = 16); and B, bathing with water (n = 16). Transepidermal water loss, stratum corneum hydration, skin pH, sebum were measured on day 2, week 2, 4, 8 of life on front, abdomen, upper leg, and buttock. Skin condition was scored and microbiologic colonization was documented. After 8 weeks, group WG + C showed significantly lower transepidermal water loss on front, abdomen, and upper leg as well as higher stratum corneum hydration on front and abdomen compared with group B. Similarly, group C showed lower transepidermal water loss and higher stratum corneum hydration on these body regions. Group WG revealed significantly lower pH on all sites compared with group B at week 8. No differences in sebum level, microbiologic colonization and skin condition score were found. Skin care regimens did not harm physiologic neonatal skin barrier adaptation within the first 8 weeks of life. However, significant influence of skin care on barrier function was found in a regional specific fashion.
    Pediatric Dermatology 01/2010; 27(1):1-8. · 1.04 Impact Factor
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    ABSTRACT: Mannose-binding lectin (MBL) mediates important functions within the innate immune system, and its deficiency was associated with infectious complications. However, in adults without concomitant immunodeficiency the clinical relevance of MBL deficiency remains controversial. We analyzed the distribution of MBL deficiency and its association with concomitant immunodeficiency in 228 adult Caucasian patients with a history of recurrent and/or severe infections. Two hundred forty-one unrelated Caucasians without recurrent or severe infections served as control subjects. The frequency of severe MBL deficiency (plasma levels <or= 50 ng/ml) was significantly higher in patients with a history of recurrent and/or severe infections (p < 0.05, odds ratio 2.1, 95% confidence interval 1.1-4.1), and this association was independent of concomitant antibody or cellular immunodeficiency. Our data challenge the view that MBL deficiency in adulthood becomes relevant only in individuals who are immunocompromised for other reasons.
    Human immunology 08/2009; 70(10):809-12. · 2.55 Impact Factor
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    ABSTRACT: Malnutrition is a frequent problem in the elderly and is associated with an impaired functional status and higher morbidity and mortality. In this study we evaluated the effect of a 12-wk nutritional intervention with fortified food on nutritional and functional status in nursing home residents at risk of malnutrition. Nutritional status was assessed with the Mini Nutritional Assessment. Body composition was measured with bioelectrical impedance analysis. Functional status was assessed with handgrip strength, peak flow, the Barthel Index, and the Physical Functioning component of the Short Form 36 questionnaire. The residents were assigned to a group receiving the standard food of the nursing home or a group with a protein- and energy-enriched diet and snacks. Sixty-five nursing home residents were included; 62 were at nutritional risk and 3 were severely malnourished according to the Mini Nutritional Assessment. Protein intake was significantly higher in the group on the enriched diet, whereas energy intake did not differ from the group on the standard diet. Both groups significantly improved most nutritional and body composition parameters during the intervention period. We did not observe convincing improvements in muscle function. Furthermore, the Barthel Index and the Physical Functioning component of the Short Form 36 questionnaire declined in all participants. Standard food in this nursing home provided sufficient energy and macronutrients. Provision of snacks was not effective in increasing energy intake. Although nutritional status improved, functional status did not increase as a consequence. Functional frailty in this study population seems to be influenced more by age-related morbidity and immobilization than by nutritional intake.
    Nutrition 10/2008; 24(11-12):1139-44. · 2.86 Impact Factor
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    ABSTRACT: In view of an increasing necessity for systematic assessments, nursing practice would benefit from a simplification of assessment procedures. These assessments should be scientifically based. To evaluate the possibility of assessing pressure ulcer risk as well as care dependency simultaneously with a standardized instrument for nursing homes and hospitals. Care dependency was measured with the Care Dependency Scale (CDS). The quantitative analyses were accomplished with data from a cross-sectional study that was performed in 2005 in 39 German nursing homes and 37 hospitals with a total of more than 10,000 participants. The scale's construct validity was calculated with Pearson's r, and predictive validity was evaluated by computing sensitivity and specificity values and the area under the curve (AUC). Item-level analyses included calculations of odds ratios, relative risks and logistic regression analyses. Construct validity of the CDS was r = 0.79 (P < 0.01) in nursing homes and r = 0.89 (P < 0.01) in hospitals. AUC was 0.80 in hospitals and 0.65 in nursing homes. Analyses on item level identified 'mobility' as a key item in both settings and additional differing key items for nursing homes and hospitals. The CDS is a well-functioning tool for pressure ulcer risk detection in hospitals. For this purpose, the most appropriate cut-off point is 69 while special regard is given to the items 'continence', 'mobility' and 'hygiene'. In nursing homes the usefulness of the CDS for pressure ulcer risk detection is limited. Here, the most appropriate cut-off point is 41 and attention is given to the items 'mobility', 'getting (un)dressed', 'hygiene' and 'avoidance of danger'.
    Journal of Evaluation in Clinical Practice 03/2008; 14(6):1018-25. · 1.51 Impact Factor
  • Clinical Nutrition Supplements 01/2008; 3:62-62.