Ergebnisse von CO-Messungen im Wetterstrom,in Schlechten von Kohlenflözen und in der Luft von Kohlenstaubhaufen

Ohne ZusammenfassungBergwerksdirektor der Zeche Hannover und Hannibal: Bergassessor Fritz Lange.     

Ursachen von Übergewicht

Background

Obesity is an increasing problem in Germany. This underlines the importance of preventive activities as part of primary health care. In this study we analysed patients’ beliefs about the causes of obesity, which were identified in behaviour-change counselling interviews with general practitioners.

Methods

Twelve physicians audiotaped check-up dialogues with 52 overweight patients (BMI≥25 kg/m^²). After the interviews were transcribed, a content analysis was performed using the method of Mayring.

Results

Patients attributed their overweight to both behavioural and non-behaviour-related causes during counselling interviews with physicians. Among the behavioural causes, we found different statements of self-responsibility. Patients identified metabolic factors or other predispositions as non-behaviour-related causes.

Conclusions

Patients have complex concepts about their beliefs about overweight; these offer physicians valuable access to patients’ perspectives. In terms of counselling about overweight, physicians should use this knowledge to strengthen their prevention activities.     

Sicherheit von Nahrungsergänzungsmitteln

Food supplements are foodstuffs. Food which is not safe shall not be placed on the market. Adherence to the laws which aim for the safety of food ensures that food supplements are safe. Unfortunately, there are still gaps in the legislation for food supplements. However, even intrinsically safe foods can bear a risk for the consumer if not used appropriately, for example if food supplements are consumed instead of healthy diets or if food supplements are used as substitutes for indicated drugs.     

Die Bedeutung von Sentinels für die Implementierung und Evaluation von Impfstrategien

In sentinel surveillance a prearranged sample of reporting sources-often healthcare providers-agrees to report all cases of defined conditions. The German "Protection Against Infection Act" (IfSG) provides a mandate to the Robert Koch-Institute (RKI) to establish sentinel surveillance of not notifiable diseases relevant to public health. Sentinel systems with RKI involvement include two networks of private practitioners reporting cases of influenza and measles (within the Working Groups on Influenza and Measles, respectively). In addition a laboratory-based sentinel system reports cases of certain bacterial infections in children. Results from these systems serve as a basis for framing vaccination recommendations and goals as well as for the evaluation, adjustment and promotion of vaccination strategies. The data indicate time trends (e. g. number of cases by season, age and region) and supply specific information (e. g. for determination of risk factors, distribution of pathogens). Methodological problems of sentinel surveys (e. g. selection of appropriate samples, population-based estimates) can be accounted for with appropriate methods of analysis. More effective implementation of sentinel surveillance in Germany could be achieved through better coordination of existing structures. This would make more effective use of limited resources and better enable timely and flexible investigation of conceptual and organisational questions.     

Rechtliche Regelungen zum Schutz von Beschäftigten vor den Wirkungen von Gefahrstoffen

This article describes the central legal rules regarding the protection of the health and safety of workers against hazardous substances. As placing of chemicals on the market is covered by the European Regulation REACH and the upcoming GHS which are directly effective in Germany, the European directives according to occupational safety and health, chemical agents as well as carcinogens and mutagens at the workplace have to be implemented into national laws. In Germany these are the Labour Protection Law and the Hazardous Substances Ordinance. They define the duties of employers handling hazardous substances. Because these duties are described at an abstract level, there are more precise guidelines in a body of regulations below the laws. As not each occupational action can be included in those regulations, it is the central obligation of the employer to conduct an assessment of the special working conditions and to establish adequate risk mitigation measures. Comprehensive data sheets which must be provided by the producer, manufacturer or importer of the substance support the employer. The workers have extensive rights when handling hazardous substances especially to receive necessary information.     

von Hippel-Lindau病一例

患者男,22岁,学生.因头痛、头晕不适1个月余,伴恶心呕吐10余天于2010年2月入院.MRI示左侧小脑大囊小结节样占位病变.见图1.诊断为小脑血管母细胞瘤(Lindau病),行小脑血管母细胞瘤切除术.术后患者自述左眼视物不清半年,因双眼近视,自以为近视加重,未就诊.查体:右眼裸眼视力为0.1,矫正视力为1.0,左眼裸眼视力为HM/眼前,矫正视力不提高,左眼前节正常,散瞳后见视乳头颞上发出一支粗大滋养动脉及其伴随的粗大迂曲静脉,颞上网膜中周部见瘤体,局部视网膜脱离.见图2.FFA示左眼网膜颞上粗大动脉充盈早于视盘充盈,较其他动脉充盈早1～2s.颓侧网膜大量荧光渗漏.遗问家族史,得知患者伯父、堂哥3年前均确诊为小脑血管母细胞瘤.本例患者诊断:von Hippel-Lindau(VHL)病,左眼继发性视网膜脱离.     

Einfluß von ammoniumchlorid und natriumbicarbonat auf die ausscheidung von schwefelkohlenstoff durch den harn

Zusammenfassung Es wurde die Schwefelkohlenstoffausscheidung durch Harn bei den Inhalationsexposition von 12 Kaninchen verfolgt (Exposition fünfmal wöchentlich 6 Std, insgesamt 30 Wochen) bei einer Konzentration von 1000, später 1500 µg CS₂/Liter, and es werden Veranderungen festgestellt, welche bei der alkalischen und sauren Diät entstehen (perorale Verabreichung von 1 g NH₄Cl und NaHC0₃).Es wurde ein statistisch bedeutender Unterschied in der Ausscheidung des gebundenen CS₂ bei Kaninchen mit NH₄Cl-Diät gegenüber der Gruppe, der NaHCO₃ verabreicht wurde, and gegenüber der Gruppe mit normaler Nahrung festgestellt. Die saure Diät verursachte eine beträchtlich niedrigere Ausscheidung des gebundenen CS₂ und eine geringe Erhöhung des freien CS₂. In den Versuchsbedingungen war der gesamt ausgeschiedene CS₂ (freier + gebundener) etwa 2,5mal niedriger bei Kaninchen mit NH₄Cl-Diät als bei Kaninchen mit normaler Nahrung oder mit NaHCO₃-Diät.Auf Grund dieser Ergebnisse muß die Bestimmung des CS₂ im Harn; die als Expositionstest in Schwefelkohlenstoffbetrieben durchgeführt wind, mit dean Vorbehalt beurteilt werden, daß ihre Ergebnisse durch die verabreichte Nahrung beeinflußt sein könnten.Es werden der Verlauf eines langfristigen Versuches mit Kaninchen und die Vegiftungssymptome beschrieben. Durch elektrophysiologische Analyse des neuromuskulären Systems werden objektiv Veränderungen der funktionellen motorischen Fasern nachgewiesen.Es wurde festgestellt, daß die Intoxikationssymptome bei den Tieren mit saurer Diät einige Monate früher als bei den Tieren mit normaler oder alkalischen Diät entstanden.In dem kurzfristigen Versuch mit Mausen (90 exponierte Tiere in der Konzentration 36–39 mg CS₂/Liter während 60–80 min) wurde eindeutig nachgewiesen, daß die CS₂-Toxicität bei Verabreichung saurer Diät auch bei den Mäusen auffallend anwächst.Es werden die Möglichkeiten den Beeinflussung des CS₂-Stoffwechsels durch Verabreichung saurer and alkalischen Diät diskutiert.Hygienisches Institut der medizinischen Fakultät der Universität in Osaka (Japan).     

Gesundheitsökonomische Bewertung von Disease-Management-Programmen

Disease management has become an important element in the improvement of care for people with chronic illnesses and has become embedded in the discussion on health policy in recent years. The approach has been introduced very differently to the health systems worldwide. Since 1 January 2003 accredited disease management programs (DMPs) have been a part of the risk structure compensation scheme of the German statutory health insurance. This is seen as the first step to a morbidity orientation of the risk structure compensation. DMPs have to be evaluated according the German Social Law, especially whether the objectives of the programs and the criteria for inclusion of the patients have been met and the quality of care for the patients is insured. The criteria for evaluation are threefold: medical issues, economic issues and subjective quality of life of the patients. Due to the immense amounts of data which can be expected the evaluation of the German DMPs is a huge logistical challenge. Until now not very much is known about the data quality. The evaluation is focused on the perspective of the sickness funds as e.g. information about indirect cost is not collected. In the article the methods for evaluation are described and critically discussed.     

Bevölkerungsmedizinische Relevanz von Kopfschmerzen

Headaches are an enormous burden both for the individual sufferer and for society. The WHO lists migraine among the 10 diseases with the highest impact on the quality of life and functionality of the sufferers. The treatment of headache patients in Germany is relatively poor compared to other European countries. Only a minority of patients receives a treatment according to published guidelines, although sufficient care can be provided on all levels of the health care system. The total costs caused by headaches in Germany are approximately 27 bio € per year with 17 bio € caused by migraine. With respect to the individual annual costs of a headache, the highest costs are caused by medication overuse headache with 3600 € followed by migraine with 1200 €.     

Prävalenz von Hysterektomien bei Frauen im Alter von 18 bis 79 Jahren

In many countries, hysterectomy is one of the most frequently performed surgical procedures in gynaecology. The aim of this study is to analyse the prevalence of hysterectomy in Germany by socio-demographic factors and factors of (reproductive) health. Analyses are based on data from the “German Health Interview and Examination Survey for Adults (DEGS1)”, which is part of the health monitoring of the Robert Koch Institute (RKI). The prevalence of hysterectomy among participating women (18–79 years old) was 17.5% (n?=?689). Most women (49.1%) were 40–49 years old when surgery was performed. 6.1% of hysterectomised women had cancer of the uterus or ovaries, and 19.7% underwent a simultaneous oophorectomy. There were significant differences in the prevalence of hysterectomy regarding social status, place of residence in 1988, number of live births, and body weight. DEGS1 is the first study showing the prevalence of hysterectomy in a representative sample of the German population. More detailed analyses of the DEGS data, among other data sources, are needed to evaluate the importance of the described associations and to assess trends. An English full-text version of this article is available at SpringerLink as supplemental.     

Klinische Prüfung von Arzneimitteln

With the 12th Amendment of the German Drug Law, in addition to other changes, transformation requirements resulting from the Directive 2001/20/EU of the European Parliament and the Council on clinical trials for medicinal products for humans have been fulfilled. Resulting changes in this context for competent federal authorities and other institutions involved are briefly presented and their relevance discussed. These new legal regulations provide a number of opportunities to plan clinical trials more effectively and to perform them in a more structured and better harmonized way, thus leading to increased safety for patients and more reliable results.     

Evaluation von Gesundheitsf?rdernden Schulen

Background

Regarding the evaluation of health promotion interventions specific characteristics of the particular setting have to be considered. Based on the concept of the health promoting school this article focuses on the explanation of general terms, characteristics and different approaches and objectives of evaluations in school settings.

Methods

On the basis of a literature survey different evaluation approaches are discussed. In conclusion, challenges and findings regarding evaluation processes and methods considering the principles of health promotion are brought into focus.

Results

The evaluation of health promoting schools proved to be a rather complex endeavour as several factors have to be taken into account: Both the particular context and the principles of health promotion have to be considered. Besides, evaluators have to meet high requirements which can be associated with the growing demand for process and outcome evaluations and the combination of quantitative and qualitative methods.     

GCP-Inspektionen von klinischen Prüfungen

The new regulations on clinical trials with medicinal products for human use include rules for Good Clinical Practice (GCP) inspections. These rules pertain to such inspections as part of the surveillance program of the relevant state authorities, in preparation for a decision on the authorization of clinical trials by the federal authorities, and pre and post approval GCP-inspections as one tool of Good Regulatory Practice (GRP). The overall aim of such inspections is to verify compliance with the provisions on GCP and, thus, to ensure the protection of trial subjects, the credibility and reliability of clinical trial results, and the pro-active protection of patients. Since inspection results have to be acknowledged by other member states, there is an increasing importance for quality assurance and harmonization of inspection procedures. As in most cases a considerable number of sites are involved in the conduct of clinical trials in different member states, there is a need for coordination of GCP inspections between these states.     

Verwertungsdefizite von Patientenbefragungen — Eine Ursachenanalyse

A lack of utilization is one of the main problems of patient sur eys in hospitals. The article tries to demonstrate, that this shortcoming is caused by the absence of a patient centered organizational culture and an institutionalized quality management according to the approach of Total Quality Management. For this purpose main principles of Total Quality Management and obstacles in realization with respect to hospitals are compared. Total Quality Management is described by costumer focus, continous impro ement, cross-functional process orientation and an institutionalized quality management. Compared with this the hospital organization is characterized by expert focus, a static definition of quality, a highly functional organizational culture and a lack of infrastructure for impro ements. It is shown in detail how these obstacles impede the utilization of patient sur eys. In order to be successfull patient sur eys should therefore become integrated into a patient centered organizational culture according to the Total Quality Management approach.