{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:15:40Z","timestamp":1790453740410,"version":"4.1.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008678","name":"Universit\u00e4t Leipzig","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008678","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>The aim of this cross-sectional study was to assess oral health-related quality of life (OHRQoL) in patients with rheumatoid arthritis (RA) and its relation to specific RA characteristics.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Material and methods<\/jats:title>\n<jats:p>Within the oral examination, the need for dental (carious teeth showing cavitation) and periodontal treatment (presence of a probing depth \u2265\u20093.5\u00a0mm) and the number of missing teeth (M-T) were recorded. OHRQoL was assessed with the German short version of the Oral Health Impact Profile (OHIP G14). The disease activity score (DAS28-ESR), disease duration, number of swollen\/painful joints and duration of morning stiffness were retrieved from the patient records.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 176 patients with a mean age of 62.5\u2009\u00b1\u200910.2\u00a0years were included. The overall OHIP G14 sum score was 5.4\u2009\u00b1\u20097.1. The M-T showed a significant correlation with the dimensions of oral function (<jats:italic>r<\/jats:italic>\u00a0=\u20090.25, <jats:italic>p<\/jats:italic>\u00a0=\u20090.001) and psychosocial impact (<jats:italic>r<\/jats:italic>\u00a0=\u20090.20, <jats:italic>p<\/jats:italic>\u00a0=\u20090.009) and the sum score (<jats:italic>r<\/jats:italic>\u00a0=\u20090.26, <jats:italic>p<\/jats:italic>\u00a0=\u20090.001). The DAS28-ESR showed a significant correlation with psychosocial impact (<jats:italic>r<\/jats:italic>\u00a0=\u20090.19, <jats:italic>p<\/jats:italic>\u00a0=\u20090.012) and the sum score (<jats:italic>r<\/jats:italic>\u00a0=\u20090.16, <jats:italic>p<\/jats:italic>\u00a0=\u20090.041). The duration of morning stiffness was correlated with oral function (<jats:italic>r<\/jats:italic>\u00a0=\u20090.19, <jats:italic>p<\/jats:italic>\u00a0=\u20090.019), psychosocial impact (<jats:italic>r<\/jats:italic>\u00a0=\u20090.18, <jats:italic>p<\/jats:italic>\u00a0=\u20090.024) and the sum score (<jats:italic>r<\/jats:italic>\u00a0=\u20090.22, <jats:italic>p<\/jats:italic>\u00a0=\u20090.006). The effect size of these correlations was interpreted as small.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Disease activity, morning stiffness and missing teeth are associated to OHRQoL of patients with RA. Accordingly, multidisciplinary dental care appears necessary for these patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Clinical relevance<\/jats:title>\n<jats:p>The prevention of tooth loss as well as the consideration of psychosocial and disease-specific parameters in the multidisciplinary dental care of RA patients is necessary.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00784-020-03226-3","type":"journal-article","created":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T09:03:01Z","timestamp":1580979781000},"page":"3559-3566","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Disease activity, morning stiffness and missing teeth are associated with oral health-related quality of life in individuals with rheumatoid arthritis"],"prefix":"10.1007","volume":"24","author":[{"given":"Gerhard","family":"Schmalz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Noack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susann","family":"Patschan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Patschan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard A.","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annegret","family":"Rupprecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schmickler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Haak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9810-2368","authenticated-orcid":false,"given":"Dirk","family":"Ziebolz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"3226_CR1","first-page":"721","volume":"35","author":"F Ferro","year":"2017","unstructured":"Ferro F, Elefante E, Luciano N, Talarico R, Todoerti M (2017) One year in review 2017: novelties in the treatment of rheumatoid arthritis. Clin Exp Rheumatol 35:721\u2013734","journal-title":"Clin Exp Rheumatol"},{"key":"3226_CR2","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/BOR.0000000000000376","volume":"29","author":"P Katz","year":"2017","unstructured":"Katz P (2017) Causes and consequences of fatigue in rheumatoid arthritis. Curr Opin Rheumatol 29:269\u2013276","journal-title":"Curr Opin Rheumatol"},{"key":"3226_CR3","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s10067-017-3874-4","volume":"37","author":"D Pu","year":"2018","unstructured":"Pu D, Luo J, Wang Y, Ju B, Lv X, Fan P, He L (2018) Prevalence of depression and anxiety in rheumatoid arthritis patients and their associations with serum vitamin D level. Clin Rheumatol 37:179\u2013184","journal-title":"Clin Rheumatol"},{"key":"3226_CR4","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.jdent.2013.05.007","volume":"41","author":"DR Reissmann","year":"2013","unstructured":"Reissmann DR, John MT, Schierz O, Kriston L, Hinz A (2013) Association between perceived oral and general health. J Dent 41:581\u2013589","journal-title":"J Dent"},{"key":"3226_CR5","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1111\/joor.12167","volume":"41","author":"CM Visscher","year":"2014","unstructured":"Visscher CM, Lobbezoo F, Schuller AA (2014) Dental status and oral health-related quality of life. A population-based study. J Oral Rehabil 41:416\u2013422","journal-title":"J Oral Rehabil"},{"key":"3226_CR6","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1111\/jcpe.12517","volume":"43","author":"SL Buset","year":"2016","unstructured":"Buset SL, Walter C, Friedmann A, Weiger R, Borgnakke WS, Zitzmann NU (2016) Are periodontal diseases really silent? A systematic review of their effect on quality of life. J Clin Periodontol 43:333\u2013344","journal-title":"J Clin Periodontol"},{"key":"3226_CR7","first-page":"e698","volume":"23","author":"G Schmalz","year":"2018","unstructured":"Schmalz G, Dietl M, Vasko R, M\u00fcller GA, Rothermund L, Keller F et al (2018) Dialysis vintage time has the strongest correlation to psychosocial pattern of oral health-related quality of life - a multicentre cross-sectional study. Med Oral Patol Oral Cir Bucal 23:e698\u2013e706","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"3226_CR8","doi-asserted-by":"publisher","first-page":"2889","DOI":"10.1007\/s00784-018-2375-4","volume":"22","author":"G Schmalz","year":"2018","unstructured":"Schmalz G, Douglas D, Douglas D, Patschan S, Patschan D, M\u00fcller GA, Haak R, Schmickler J, Ziebolz D (2018) Oral health-related quality of life is associated with disease specific parameters in patients with ankylosing spondylitis. Clin Oral Investig 22:2889\u20132896","journal-title":"Clin Oral Investig"},{"key":"3226_CR9","doi-asserted-by":"publisher","first-page":"2661","DOI":"10.1007\/s00784-017-2068-4","volume":"21","author":"S M\u00fchlberg","year":"2017","unstructured":"M\u00fchlberg S, J\u00e4ger J, Krohn-Grimberghe B, Patschan S, Mausberg RF, Schmalz G, Haak R, Ziebolz D (2017) Oral health-related quality of life depending on oral health in patients with rheumatoid arthritis. Clin Oral Investig 21:2661\u20132670","journal-title":"Clin Oral Investig"},{"key":"3226_CR10","first-page":"271","volume":"16","author":"R Tristiu","year":"2018","unstructured":"Tristiu R, Vesa S, Dumitru RB, Arweiler NB, Cosgarea RM, Lascu L, Rednic S, Eick S, Sculean A, Cosgarea R (2018) Association of oral-health related quality of life and general health assessment in patients with rheumatoid arthritis. Oral Health Prev Dent 16:271\u2013280","journal-title":"Oral Health Prev Dent"},{"key":"3226_CR11","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/idj.12023","volume":"63","author":"A Blaizot","year":"2013","unstructured":"Blaizot A, Monsarrat P, Constantin A, Vergnes JN, de Grado GF, Nabet C, Cantagrel A, Sixou M (2013) Oral health-related quality of life among outpatients with rheumatoid arthritis. Int Dent J 63:145\u2013153","journal-title":"Int Dent J"},{"key":"3226_CR12","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/odi.12285","volume":"21","author":"K Ahola","year":"2015","unstructured":"Ahola K, Saarinen A, Kuuliala A, Leirisalo-Repo M, Murtomaa H, Meurman JH (2015) Impact of rheumatic diseases on oral health and quality of life. Oral Dis 21:342\u2013348","journal-title":"Oral Dis"},{"key":"3226_CR13","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1038\/nrrheum.2017.132","volume":"13","author":"J Potempa","year":"2017","unstructured":"Potempa J, Mydel P, Koziel J (2017) The case for periodontitis in the pathogenesis of rheumatoid arthritis. Nat Rev Rheumatol 13:606\u2013620","journal-title":"Nat Rev Rheumatol"},{"key":"3226_CR14","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1177\/0022034513483142","volume":"92","author":"S Kaur","year":"2013","unstructured":"Kaur S, White S, Bartold PM (2013) Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res 92:399\u2013408","journal-title":"J Dent Res"},{"key":"3226_CR15","first-page":"70","volume":"35","author":"P de Pablo","year":"2008","unstructured":"de Pablo P, Dietrich T, McAlindon TE (2008) Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol 35:70\u201376","journal-title":"J Rheumatol"},{"key":"3226_CR16","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1902\/jop.2016.160355","volume":"88","author":"J Schmickler","year":"2017","unstructured":"Schmickler J, Rupprecht A, Patschan S, Patschan D, M\u00fcller GA, Haak R, Mausberg RF, Schmalz G, Kottmann T, Ziebolz D (2017) Cross-sectional evaluation of periodontal status and microbiologic and rheumatoid parameters in a large cohort of patients with rheumatoid arthritis. J Periodontol 88:368\u2013379","journal-title":"J Periodontol"},{"key":"3226_CR17","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1111\/odi.12721","volume":"23","author":"G Chamani","year":"2017","unstructured":"Chamani G, Shakibi MR, Zarei MR, Rad M, Pouyafard A, Parhizkar A, Mansoori M (2017) Assessment of relationship between xerostomia and oral health-related quality of life in patients with rheumatoid arthritis. Oral Dis 23:1162\u20131167","journal-title":"Oral Dis"},{"key":"3226_CR18","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1136\/ard.2010.138461","volume":"69","author":"D Aletaha","year":"2010","unstructured":"Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology\/European League against rheumatism collaborative initiative. Ann Rheum Dis 69:1580\u20131588","journal-title":"Ann Rheum Dis"},{"key":"3226_CR19","doi-asserted-by":"publisher","first-page":"213","DOI":"10.5114\/reum.2015.53999","volume":"53","author":"TA Barczy\u0144ska","year":"2015","unstructured":"Barczy\u0144ska TA, Dura M, Blumfield E et al (2015) DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons. Reumatologia 53:213\u2013218","journal-title":"Reumatologia"},{"key":"3226_CR20","first-page":"3","volume":"11","author":"GD Slade","year":"1994","unstructured":"Slade GD, Spencer AJ (1994) Development and evaluation of the oral health impact profile. Community Dent Health 11:3\u201311","journal-title":"Community Dent Health"},{"key":"3226_CR21","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1034\/j.1600-0722.2002.21363.x","volume":"110","author":"MT John","year":"2002","unstructured":"John MT, Patrick DL, Slade GD (2002) The German version of the oral health impact profile - translation and psychometric properties. Eur J Oral Sci 110:425\u2013433","journal-title":"Eur J Oral Sci"},{"key":"3226_CR22","first-page":"668","volume":"63","author":"DR Reissmann","year":"2008","unstructured":"Reissmann DR, Krautz M, Schierz O, John MT, Rudolph M, Szentp\u00e9tery A (2008) Assessment of clinically significant changes in oral health. German Dent J 63:668\u2013680","journal-title":"German Dent J"},{"key":"3226_CR23","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1111\/joor.12396","volume":"43","author":"MT John","year":"2016","unstructured":"John MT, Rener-Sitar K, Baba K, \u010celebi\u0107 A, Larsson P, Szabo G, Norton WE, Reissmann DR (2016) Patterns of impaired oral health-related quality of life dimensions. J Oral Rehabil 43:519\u2013527","journal-title":"J Oral Rehabil"},{"key":"3226_CR24","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/1477-7525-2-35","volume":"2","author":"DS Brennan","year":"2004","unstructured":"Brennan DS, Spencer AJ (2004) Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14. Health Qual Life Outcomes 2:35","journal-title":"Health Qual Life Outcomes"},{"key":"3226_CR25","unstructured":"World Health Organization (WHO) Geneva: Oral Health Surveys 1997; Basic Methods. 4th Edition"},{"key":"3226_CR26","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1111\/j.1600-051X.1993.tb00711.x","volume":"20","author":"A Diamanti-Kipioti","year":"1993","unstructured":"Diamanti-Kipioti A, Papapanou TN, Moraitaki-Zamitsai A, Lindhe J, Mitsis F (1993) Comparative estimation of periodontal conditions by means of different index systems. J Clin Periodontol 20:656","journal-title":"J Clin Periodontol"},{"key":"3226_CR27","volume-title":"Statistical power analysis for the behavioral sciences","author":"J Cohen","year":"1988","unstructured":"Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale","edition":"2"},{"key":"3226_CR28","first-page":"784","volume":"114","author":"MT John","year":"2004","unstructured":"John MT, Micheelis W, Biffar R (2004) Reference values in oral health-related quality of life for the abbreviated version of the oral health impact profile. Swiss Dent J 114:784\u2013791","journal-title":"Swiss Dent J"},{"key":"3226_CR29","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/1477-7525-8-126","volume":"8","author":"AE Gerritsen","year":"2010","unstructured":"Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NHJ (2010) Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes 8:126","journal-title":"Health Qual Life Outcomes"},{"key":"3226_CR30","first-page":"543","volume":"25","author":"M Hultin","year":"2012","unstructured":"Hultin M, Davidson T, Gynther G, Helgesson G, Jemt T, Lekholm U, Nilner K, Nordenram G, Norlund A, Rohlin M, Sunnegardh-Gronberg K, Tranaeus S (2012) Oral rehabilitation of tooth loss: a systematic review of quantitative studies of OHRQoL. Int J Prosthodont 25:543\u2013552","journal-title":"Int J Prosthodont"},{"key":"3226_CR31","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jdent.2014.09.006","volume":"43","author":"G Aarabi","year":"2015","unstructured":"Aarabi G, John MT, Schierz O, Heydecke G, Reissmann DR (2015) The course of prosthodontic patients\u2019 oral health-related quality of life over a period of 2 years. J Dent 43:261\u2013268","journal-title":"J Dent"},{"key":"3226_CR32","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/RHU.0000000000000463","volume":"22","author":"LM Gonz\u00e1lez-Gamboa","year":"2016","unstructured":"Gonz\u00e1lez-Gamboa LM, Barocio-Ram\u00edrez AK, Rocha-Mu\u00f1oz AD, de Santos-\u00c1vila F, Meda-Lara RM, Gonz\u00e1lez-L\u00f3pez L, G\u00e1mez-Nava JI, G\u00f3mez-Ba\u00f1uelos E, Chavarria-Avila E, Dur\u00e1n-Barrag\u00e1n S, Navarro-Hern\u00e1ndez RE, Pizano-Mart\u00ednez OE, Nu\u00f1ez-Atahualpa L, V\u00e1zquez-del Mercado M (2016) Disease activity score on 28 joints and polypharmacy are independent predictors for health-related quality of life evaluated by INCAVISA in patients with rheumatoid arthritis. J Clin Rheumatol 22:399\u2013404","journal-title":"J Clin Rheumatol"},{"key":"3226_CR33","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.3111\/13696998.2012.712927","volume":"15","author":"I Iqbal","year":"2012","unstructured":"Iqbal I, Dasgupta B, Taylor P, Heron L, Pilling C (2012) Elicitation of health state utilities associated with differing durations of morning stiffness in rheumatoid arthritis. J Med Econ 15:1192\u20132000","journal-title":"J Med Econ"},{"key":"3226_CR34","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3109\/03009742.2011.566434","volume":"125","author":"JA da Silva","year":"2011","unstructured":"da Silva JA, Phillips S, Buttgereit F (2011) Impact of impaired morning function on the lives and well-being of patients with rheumatoid arthritis. Scand J Rheumatol Suppl 125:6\u201311","journal-title":"Scand J Rheumatol Suppl"},{"key":"3226_CR35","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s41927-019-0080-9","volume":"3","author":"W Katchamart","year":"2019","unstructured":"Katchamart W, Narongroeknawin P, Chanapai W, Thaweeratthakul P (2019) Health-related quality of life in patients with rheumatoid arthritis. BMC Rheumatol 3:34","journal-title":"BMC Rheumatol"},{"key":"3226_CR36","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/17423953060020020601","volume":"2","author":"H Lempp","year":"2006","unstructured":"Lempp H, Scott D, Kingsley G (2006) The personal impact of rheumatoid arthritis on patients' identity: a qualitative study. Chronic Illn 2:109\u2013120","journal-title":"Chronic Illn"},{"key":"3226_CR37","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1016\/S0140-6736(10)60826-4","volume":"376","author":"DL Scott","year":"2010","unstructured":"Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094\u20131108","journal-title":"Lancet"}],"container-title":["Clinical Oral Investigations"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-020-03226-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00784-020-03226-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-020-03226-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T02:13:08Z","timestamp":1612491188000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00784-020-03226-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,6]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["3226"],"URL":"https:\/\/doi.org\/10.1007\/s00784-020-03226-3","relation":{},"ISSN":["1432-6981","1436-3771"],"issn-type":[{"value":"1432-6981","type":"print"},{"value":"1436-3771","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,6]]},"assertion":[{"value":"4 November 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Gerhard Schmalz declares that he has no conflict of interest. Stefan Noack declares that he has no conflict of interest. Susann Patschan declares that she has no conflict of interest. Daniel Patschan declares that he has no conflict of interest. Gerhard A. M\u00fcller declares that he has no conflict of interest. Annegret Rupprecht declares that she has no conflict of interest. Jan Schmickler declares that he has no conflict of interest. Rainer Haak declares that he has no conflict of interest. Dirk Ziebolz declares that he has no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in the current study were in accordance with the ethical standards of the institutional ethics committee (application No. 14\/2\/13) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}