Tiefkühlfrüchte als Risikofaktor für Gastroenteritis-Ausbrüche durch Noroviren

An outbreak of acute gastroenteritis occurred in Hamburg among guests of a canteen in August 2005. A total of 241 persons were found ill. In stool samples of 16 of them Norovirus Genogroup I was identified. Neither bacterial nor viral pathogens could be detected in food samples. Among 162 guests enrolled in a cohort study, 69 (42.6 %) met the case definition. A desert dish made from blackberries and yoghurt showed a significant association with the disease (RR 6.9; 95% CI 3.36-14.16). In addition, a protective effect of the decision for the alternative desert dish ice cream was observed (RR 0.9; 95% CI 0.08-0.45). The desert, which was prepared in the canteen kitchen from yoghurt and frozen blackberries, was the most likely source of the outbreak. Frozen berries should be included in the HACCP concepts for canteen kitchens.     

Langzeitüberleben von Frühgeborenen

In view of the increased survival rate of very preterm neonates, several longitudinal studies were done to assess the quality of life of the survivors. They revealed a fairly constant rate of 25-30% of sensorineural and/or motor impairment. Beyond those "major handicaps," further problems may arise in every single period of life, which, albeit less severe, add to the burden of prematurity. These include growth retardation and cognitive delay in the school age, affected psychosocial behavior during adolescence, and the "metabolic syndrome" of formerly malnourished fetuses in adulthood. Thus, the epidemiologic studies not only confirmed the role of regionalization in the quality of perinatology, but also supported a more farsighted approach to the sequelae of prematurity. Like in young adults who grew up with congenital heart defects, also in former preterm neonates, appropriate medical care has to be provided for an increasing number of long-term survivors. Moreover, the life-long effects of metabolic imprinting in growth-retarded fetuses underline the primary-preventive role of perinatal medicine, extending far beyond the "baby" stage of human development.     

Darmkrebsfrüherkennung

Background

Colorectal cancer (CRC) is the second most common cancer among both men and women in Germany. Owing to its relatively slow growth, perspectives for effective early detection are much better than for other forms of cancer.

Aim

To summarize the evidence on effectiveness and cost-effectiveness of CRC screening, and to provide an overview on the current state and perspectives for effective CRC screening.

Materials and methods

Summary and critical review of evidence from randomized trials and observational epidemiological studies.

Results

A reduction in CRC mortality by offering annual fecal occult blood tests or once-only flexible sigmoidoscopy has been demonstrated in randomized trials. Novel fecal immunochemical tests for hemoglobin in stool have been shown to be more sensitive than traditional fecal occult blood tests and could substantially improve noninvasive CRC screening. Epidemiological studies suggest that the majority of CRC cases and deaths could be prevented by colonoscopy and removal of colorectal adenomas. However, adherence to screening offered outside organized screening programs is low. The National Cancer Plan recommends an organized CRC screening program in Germany. The law on the early detection of cancer from April 2013 has paved the way for its implementation.

Discussion

The great potential for CRC prevention by early detection has so far only been realized to a very limited extent in Germany. Introduction of an organized screening program and the offer of enhanced noninvasive screening tests could strongly enhance the utilization and effectiveness of CRC screening in Germany. The political frame has been set, and timely quality-assured implementation is required.     

Die Dimensionen eines gesunden Schulklimas für Schülerinnen und Schüler

Background

The school can be seen as a setting that has an important impact on the health and wellbeing of students. In the context of school health promotion, the school climate could be influenced by the schools, however, it has not been given much attention in German speaking countries.

Objectives

In this article, we investigate which dimensions of the school climate are important for students of different school types in Vienna.

Materials and methods

Six focus groups with students of different age groups from six schools were carried out and analysed thematically.

Results

The four most important dimensions of a healthy school climate for students are: absence of mobbing, interesting lesson designs, good social relationships among the students and with teachers, as well as a clean school building. When asked to prioritise (using prepared cards) more abstractly, the absence of physical violence is also important for the students.

Conclusions

Our results can be well compared with the dimensions from the literature. Some specifics that prevail can probably be ascribed to the Austrian school system.     

Thesen für ein zukünftiges Versorgungskonzept

The current demographic transition is leading to an ever-growing number of individuals needing assistance and physical care. The current health care system is not structured to manage these increasing demands. The elderly, as well as people with dementia or chronic diseases, will account for a large portion of the population. The new visionary system of health care delivery is a composite of local residents and professionals. This system recruits civic involvement within the society from the generation of the so-called third stage of life, thus making professional care affordable. The new system of care is most likely to be realized in regionally defined neighborhood areas, financed though regional budgets and organized by healthcare professionals.     

Wichtige Spurenelemente für die Schilddrüse

Background

Sufficient iodine is required for thyroid hormone synthesis as well as for the prevention of goitre and neoplasia.

Results

New insights also show the importance of iodine for the mammary glands, which both trap iodine and synthesize proliferation inhibiting iodolactones. The thyroid belongs to those organs with the highest selenium content, because selenium dependent enzymes are necessary to reduce the H2O2 generated within the thyroid, and thus to prevent oxidative damage of the thyroid cells. Sufficient selenium supplementation prevents the initiation and progression of an autoimmune thyroiditis and probably also the development of neoplasia. Thyroperoxidase is necessary for the synthesis of thyroid hormones, as this enzyme has a heme group within its active centre and therefore requires iron.

Conclusion

For the prevention of thyroid disease, not only iodine, but also sufficient selenium and iron are necessary.     

Evidenzbasierte Medizin für den Bürger

Zusammenfassung Die Methode der evidenzbasierten Medizin beinhaltet die Forderung nach einer hohen Aktualität und Qualität medizinischer Informationen. Im Idealfall basiert diese auf Daten aus randomisierten klinischen Studien. Diese „beste verfügbare externe Evidenz“ ist die Grundlage für ein effektives Arzt-Patienten-Gespräch so wie für laiengerechte Angebote von Gesundheitsinformationen. Der Artikel beschreibt die internationalen und deutschsprachigen Bemühungen zur Bereitstellung von evidenz-basierten Patienteninformationen und die Einflüsse, die diese Bemühungen auf die Modelle der Arzt-Patienten-Kommunikation haben.     

Pflegebedürftigkeit

In Germany, more than 2 million people are currently in need of care, and another 3 million need help below the threshold that entitles them to benefits by social legislation. Thus, the need of care, in contrast to the need of help, is a general risk recognised by legislation. Accordingly, the German long-term care insurance was introduced in 1994, where entitlement to benefits depends on the ability to perform activities of daily living; it neglects the requirements of care arising from gerontopsychiatric impairments. In this article, the concept of "need of care" will be critically discussed and the influence of demographic changes on the state of needing care will be explored. Against this background, future challenges of caregiving will be analysed. This analysis leads to a call for "mixed care arrangements", where family care can only be maintained by relying on professional relief and support of voluntary helpers, and where care institutions would have to define themselves as partners of families. This demand will have to be reflected in changed training concepts. Structurally, it is necessary to develop arrangements, which promote self-determined individual solutions, e.g. by implementing (personal) care budgets. Moreover, target group-orientated counselling offers and network structures will have to be established; in this respect, co-operative efforts between professional case management and voluntary work are exemplary approaches.     

Rechtfertigung und Begründung für die Fortsetzung des Archivs für Gewerbepathologie

Ohne ZusammenfassungProf. Dr. med., Dr. med. h. c., Dr. phil. h. c., Dr. jur. h. c., Dr. sc. tech. h. c.     

Soziale Determinanten des täglichen Frühstücksverzehrs bei Schülern in Deutschland

Background

A balanced breakfast is an important element of a healthy diet and in childhood and adolescence it is associated with better health status and improved school performance. This analysis examined potential differences in breakfast behavior among primary and secondary school pupils in Germany according to age, sex, family form, socioeconomic status (SES) and migration background.

Methods

The analysis was based on data from the first follow-up of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009–2012). The proportion of pupils aged 6–17 years (n = 7547) who reported having breakfast at home every weekday was analyzed. Family form distinguished between nuclear, single-parent and step-families. The SES was based on data on parental education, occupation and income. Migration background refers to country of birth and nationality of both parents and child.

Results

Approximately two thirds of the girls (65.7%) and boys (70.3%) have breakfast at home every weekday. With increasing age the respective proportions gradually decrease. Children in nuclear families have daily breakfast at home more often than children in step-families and single-parent families. A higher SES corresponds to a higher percentage of children having breakfast at home every weekday. Children with a two-sided migration background have breakfast every weekday at home less often than children without a migration background.

Conclusion

The results may help to conceptualize activities that promote healthy nutrition in families and schools. When interpreting the presented results it has to be taken into account that out-of-home breakfast was not assessed and the data do not allow conclusions about the nutritional quality of the breakfast.

     

Klinische Prüfung

Ohne Zusammenfassung     

Klinische Prüfungen

Zusammenfassung An die Stelle der Therapiebewertung auf der Basis tradierten Erfahrungswissens, subjektiven Eindrucks und persönlichen Heilungserlebens tritt seit Mitte der 50er-Jahre die Therapiebewertung auf der Basis Klinischer Prüfungen, zunächst—in Reaktion auf Arzneimitteltragödien—bei der Medikamentenzulassung, dann zunehmend auch in anderen Bereichen der Medizin, wie z. B. bei der Beurteilung von Medizinprodukten oder operativen Techniken. Klinische Prüfungen sind prospektive Studien, in denen Therapien zu Studienzwecken wiederholt angewendet und in Bezug auf Wirksamkeit und Sicherheit untersucht werden. In der Regel werden die Therapien dabei mit Kontrollen auf statistischer Basis verglichen. Die initiale Vergleichbarkeit der Studiengruppen (Strukturgleichheit) wird im Idealfall durch Randomisation sichergestellt, Behandlungs- und Beobachtungsgleichheit durch Verblindung erreicht. Klinische Prüfungen führen nicht zu eindeutigen Ja-/Nein-Aussagen, schränken aber das Spektrum möglicher Interpretationen zur Wirksamkeit und Sicherheit von Therapien stark ein und stellen damit eine brauchbare objektive Grundlage zur Entscheidungsfindung dar. Klinische Prüfungen haben damit einen zentralen Beitrag zu den medizinischen Fortschritten der letzten 50 Jahre geleistet und sind für die heutige medizinische Forschung unverzichtbar. Versuchs doch mit deinen Knechten zehn Tage und lass uns Gemüse zu essen und Wasser zu trinken geben. Und dann lass dir unser Aussehen und das der jungen Leute, die von des Königs Speise essen, zeigen; und danach magst du mit deinen Knechten tun nach dem, was du sehen wirst. Und er hörte auf sie und versuchte es mit ihnen zehn Tage. Und nach den zehn Tagen sahen sie schöner und kräftiger aus als alle jungen Leute, die von des Königs Speise aßen. Da tat der Aufseher die Speise und den Trank, die für sie bestimmt waren, weg und gab ihnen Gemüse. Daniel, Kap. 1, Vers 12–16     

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