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Background In rural regions with a low population density, distances to health care providers as well as insufficient public transport may be barriers for the accessibility of health care. In this analysis it was examined whether the accessibility of gynecologists and GPs, measured as travel time both by car and public transport has an influence on the utilization of health care in the rural region of Western Pomerania in Northern Germany. Methods Utilization data was obtained from the population based Study of Health in Pomerania (SHIP). Utilization was operationalized by the parameter “at least one physician visit during the last 12 months”. To determine travel times by car and by public transport, network analyses were conducted in a Geographic Information System (GIS). Multivariate logistic regression models were calculated to identify determinants for the utilization of gynecologists and GPs. Results There is no significant association between the accessibility by car or public transport and the utilization of gynecologists and GPs. Significant predictors for the utilization of gynecologists in the regression model including public transport are age (OR 0.960, 95% CI 0.950–0.971, p  < 0.0001), social class (OR 1.137, 95% CI 1.084–1.193, p < 0.0001) and having persons ≥18 years in the household (OR 2.315, 95% CI 1.116–4.800, p  = 0.0241). Conclusions In the examined region less utilization of gynecologists is not explainable with long travel times by car or public transport.

Previous predictions of population morbidity consider demographic changes only. To model future morbidity, however, changes in prevalences of risk factors should be considered. We calculated the number of incident cases of first myocardial infarction (MI) in Mecklenburg-Western Pomerania in 2017 considering the effects of demographic changes and trends in the prevalences of major risk factors simultaneously. Data basis of the analysis were two population-based cohorts of the German Study of Health in Pomerania (SHIP-baseline [1997-2001] and the 5-year follow-up and SHIP-Trend-baseline [2008-2011] respectively). SHIP-baseline data were used to calculate the initial coefficients for major risk factors for MI with a Poisson regression model. The dependent variable was the number of incident cases of MI between SHIP-baseline and SHIP-5-year follow-up. Explanatory variables were sex, age, a validated diagnosis of hypertension and/or diabetes, smoking, waist circumference (WC), increased blood levels of triglycerides (TG) and low-density-lipoprotein cholesterol (LDL), and low blood levels of high-density-lipoprotein cholesterol (HDL). Applying the coefficients determined for SHIP baseline to risk factor prevalences, derived from the new cohort SHIP-Trend together with population forecast data, we calculated the projected number of incident cases of MI in 2017. Except for WC and smoking in females, prevalences of risk factors in SHIP-Trend-baseline were lower compared to SHIP-baseline. Based on demographic changes only, the calculated incidence of MI for 2017 compared to the reference year 2006 yields an increase of MI (males: +11.5%, females: +8.0%). However, a decrease of MI (males: -23.7%, females: -17.1%) is shown considering the changes in the prevalences of risk factors in the projection. The predicted number of incident cases of MI shows large differences between models with and without considering changes in the prevalences of major risk factors. Hence, the prediction of incident MI should preferably not only be based on demographic changes.

Purpose The prostate-specific antigen density (PSAD) helps distinguish between benign prostatic hyperplasia (BPH) and prostate cancer. Accurate prostate volume (PV) assessment is necessary for PSAD calculation and both BPH diagnosis and treatment response monitoring; therefore, accurate PV measurement is increasingly becoming an essential step in the urology. Methods Magnetic resonance imaging was used for PV estimation. A new technique based on single-class support-vector machines (S SVM) for accurate PV estimation was realized. Three estimation methods were compared; method 1: planimetry (reference), method 2: S SVM based, and method 3: prolate ellipsoid. Results Method 1 and method 2 depict a strong correlation (Spearman’s rank correlation coefficient ρ  = 0.965, p  > 0.001). The interrater reliability for method 1 and method 2 readings as expressed by the intraclass correlation coefficient (ICC) was 0.975 ( p  > 0.001). Comparison between method 3 and the two other methods shows ρ  = 0.873 ( p  > 0.001), and ρ  = 0.795 ( p  > 0.001), respectively. ICC was 0.54 and 0.505, respectively. The mean difference between method 1 and method 2 was −0.05 ml. The limits of agreement with the 95 % confidence interval were −3.8 to 3.7 ml. Comparing method 3 and the two other methods shows a worse agreement with mean difference of 8.6 ml (95 % confidence interval of 1.0–16.2 ml) and 8.6 ml (95 % confidence interval of −0.7 to 18.0 ml), respectively. Conclusions The prostate volumes obtained by our technique agreed excellently with the planimetry (reference) method. This new technique would be clinically useful for urologists in prostate volumetric analysis.

Die Europäische Gesellschaft für Kardiologie (ESC) präsentiert eine neue Leitlinie für das breite klinische Feld der Kardiomyopathien. Die Leitlinie betont einen phänotypischen Ansatz zur Klassifizierung von Kardiomyopathien und den Einsatz von klinischen Variablen, morphologisch-funktionellen Merkmalen und genetischen Informationen, um eine phänotypbasierte, ätiologisch informierte Diagnose zu ermöglichen. Besonderes Augenmerk wird auf die Risikostratifizierung unter Verwendung validierter Risikokalkulatoren gelegt und klinische Variablen sowie Genotypen integriert, um das tatsächliche Risiko zu bestimmen. Die Bedeutung von Echokardiographie und kardialer Magnetresonanztomographie (MRT) für Diagnose und Monitoring wird betont, wobei Fortschritte in der kardialen MRT eine detaillierte Gewebecharakterisierung ermöglichen, die für die ätiologische Zuordnung und Prognosebestimmung entscheidend ist. Die Rolle einer genetischen Testung wird hervorgehoben, nicht nur zur Bestätigung der Diagnose, sondern auch zum effektiven Familienmanagement. Therapeutische Empfehlungen umfassen die Integration neuartiger Behandlungen, wie Mavacamten für die hypertrophe obstruktive Kardiomyopathie (HOCM). Darüber hinaus definiert die Leitlinie als eigenständige Kardiomyopathieform die nichtdilatative linksventrikuläre Kardiomyopathie (NDLVC) und unterstreicht die Bedeutung einer integrierten, multidisziplinären Betreuung.