Selbstständigkeit, bewusst angenommene Abhängigkeit, Selbstverantwortung und Mitverantwortung als zentrale Kategorien einer ethischen Betrachtung des Alters

Zusammenfassung In einem ersten Schritt wird eine kurze Einführung in grundlegende Fragestellungen der Ethik gegeben. Die Suche nach dem Selbstsein der Dinge, die Haltung des Wertsichtigen im Kontext der ethischen Analyse, das methodische Vorgehen bei der Reflexion der persönlichen Leitbilder eines „guten Lebens“ und der Entscheidungen wie auch der Handlungen in sittlich bedeutsamen Situationen sowie die Veranschaulichung der einführenden Aussagen zur Ethik am Beispiel der Stoa bilden Gegenstand dieses Kapitels. In einem zweiten Schritt wird aufgezeigt, dass Selbstständigkeit, bewusst angenommene Abhängigkeit, Selbstverantwortung und Mitverantwortung Kategorien darstellen, die für die ethische Analyse aller Lebensalter relevant sind, dass diese allerdings einer lebensaltersspezifischen Präzisierung bedürfen. Diese Präzisierung wird im nachfolgenden Beitrag speziell für das Alter vorgenommen; es wird ausführlich begründet, inwiefern die vier Kategorien im Alter besondere Aktualität auch für eine ethische Analyse gewinnen. In einem dritten Schritt wird jede dieser vier Kategorien ausführlich im Kontext ethischer Positionen diskutiert. Dabei erfolgt die ethische Analyse jeweils aus der Perspektive der Person, ihrer Umwelt und der Gesellschaft. Bei der Darstellung der gesellschaftlichen Perspektive wird besonderes Gewicht auf die gesellschaftlichen Leitbilder eines gelungenen Lebens im Alter gelegt, die Einfluss darauf ausüben, inwieweit sich eine altersfreundliche Kultur entwickeln kann, die alte Menschen zur Übernahme von Mitverantwortung motiviert. Sie entscheiden zudem mit darüber, inwieweit es alten Menschen gelingt, im Falle bestehender Abhängigkeit die notwendigen Hilfen zu nutzen und diese wie auch die Abhängigkeit bewusst anzunehmen.Herrn Prof. Dr. Dr. h. c. mult. Hans Thomae (1915–2001), der am 31. Juli 2005 90 Jahre alt geworden wäre, gewidmet.     

History of Medical Mycology in the former German Democratic Republic

After the Second World War the development of medical mycology in Germany had taken a very different course in the east and west parts depending on the political division. In this respect our contribution deals with the situation in the former German Democratic Republic. Efficient mycological centres were founded step by step almost in all medical universities on the basis of the mycological laboratories in dermatological hospitals competent for diagnostic work, but also for teaching and scientific research. In this context biologists were the main stay of mycology, they finally were integrated to the same degree in the universities like physicians. The effectiveness of the Gesellschaft für Medizinische Mykologie der DDR (GMM), its board of directors and its working groups as well as the topics of human and animal mycology during this period are described. Especially the merger of the GMM with the Deutschsprachige Mykologische Gesellschaft after the reunification of Germany without problems and the kind co-operation of Prof. Dr. Johannes Müller during this procedure are emphasized.     

Wer macht Public Health in Deutschland?

Due to the rapid and dynamic development in the field there is no simple and straightforward answer to the question asked in the title. However, the present article will try to give a brief summary of the state of the art in Germany.     

Outcome and risk factors in children after traumatic cardiac arrest and successful resuscitation

IntroductionProspective collected data of the TraumaRegister DGU^® were analyzed to derive survival rates and predictors for non-survival in the children who had suffered traumatic cardiorespiratory arrest. Different time points of resuscitation efforts (only preclinical, in the emergency room (ER) or preclinical + ER) were analyzed in terms of mortality and neurological outcome.MethodsThe database of the TraumaRegister DGU^® comprising 122,742 patients from 1993 to 2013 was analyzed. The main focus of this survey was on the paediatric group defined by an age ≤14 years who could be compared to adults. Different statistical analysis (univariate and multivariate analysis, logistic regression) were performed with mortality as the target variable. Differences between the paedatric group and adults were analysed by Fisher's exact test.ResultsData after preclinical and/or ER resuscitation from 152 children and 1690 adults were analyzed. A good or moderate outcome (GOS 5 + 4) was found in 19.4% of the children's group compared to 12.4% of the adults (p = 0.02).Analysis of the GOS 5 + 4 subgroups after preclinical resuscitation only revealed that these outcomes were achieved by 19.4% of the paediatric group and 13.2% of the adults (p = 0.24), after ER-only resuscitation by 37.0% of the children and 19.6% of the adults (p = 0.046), and after preclinical and ER resuscitation by only 10.9% of the children compared to 2.5% of the adults (p = 0.006). Taking only survivors into account, 84.8% of the children and 62% of the adults had a GOS 4 + 5.The highest risk for mortality in the logistic regression model was associated with preclinical intubation, followed by GCS 3, blood transfusion and severe head injury with AIS ≥3 and ISS.ConclusionsCPR in children after severe trauma seems to yield a better outcome than in adults, and appears to be more justified than the current guidelines would imply. Resuscitation in the ER is associated with better neurological outcomes compared with resuscitation in a preclinical context or in both the preclinical phase and the ER. Our children's outcomes seem to be better than those in most of the earlier studies, and the data presented might support algorithms in the future especially for paediatric resuscitation.     

Induction of DNA repair synthesis in isolated rat hepatocytes by 5-diazouracil and other DNA damaging compounds

5-Diazouracil, which has been recommended in cancer chemotherapy, induced DNA repair synthesis in isolated rat hepatocytes. Repair synthesis was determined by means of the bromodeoxyuridine (BrdUrd)-CsCl-gradient centrifugation method. The validity of this technique was demonstrated using various DNA damaging compounds.     

EEG patterns and their correlations with short- and long-term mortality in patients with hypoxic encephalopathy

ObjectiveTo analyze the association between electroencephalographic (EEG) patterns and overall, short- and long-term mortality in patients with hypoxic encephalopathy (HE).MethodsRetrospective, mono-center analysis of 199 patients using univariate log-rank tests (LR) and multivariate cox regression (MCR).ResultsShort-term mortality, defined as death within 30-days post-discharge was 54.8%. Long-term mortality rates were 69.8%, 71.9%, and 72.9%, at 12-, 24-, and 36-months post-HE, respectively. LR revealed a significant association between EEG suppression (SUP) and short-term mortality, and identified low voltage EEG (LV), burst suppression (BSP), periodic discharges (PD) and post-hypoxic status epilepticus (PSE) as well as missing (aBA) or non-reactive background activity (nrBA) as predictors for overall, short- and long-term mortality. MCR indicated SUP, LV, BSP, PD, aBA and nrBA as significantly associated with overall and short-term mortality to varying extents. LV and BSP were significant predictors for long-term mortality in short-term survivors. Rhythmic delta activity, stimulus induced rhythmic, periodic or ictal discharges and sharp waves were not significantly associated with a higher mortality.ConclusionThe presence of several specific EEG patterns can help to predict overall, short- and long-term mortality in HE patients.SignificanceThe present findings may help to improve the challenging prognosis estimation in HE patients.     

Bericht vom VII. Kongress der Westafrikanischen Ophthalmologischen Gesellschaft (SOAO)

Zusammenfassung  Im November 2007 fand in Ouagadougou, der Hauptstadt Burkina Fasos der 7. Kongress der Westafrikanischen Ophthalmologischen Gesellschaft SOAO (Société Ouest Africaine d'Ophtalmologie) statt. Ein Tag des Kongress war dem Glaukom gewidmet, wobei sich etwa 40 Beitr?ge – Grundlagen- und state-of-the-art-Vortr?ge ebenso wie freie Vortr?ge – auch mit der Diskrepanz zwischen westafrikanischer Realit?t und den Grundlagen modernen Glaukommanagements besch?ftigten. Der Kongress wurde von der SOAO zum Anlass genommen, in einer Fernsehsendung über das Problem Glaukom – h?ufigste Ursache nicht heilbarer Erblindung in Westafrika mit hoher Pr?valenz auch bei jungen PatientInnen – zu sprechen.