HIV prevalence in blood donors in urban and in rural areas of the Federal Republic of Germany

Summary HIV infection rates in blood donors from the FRG were compared with the prevalence in donors from Berlin to obtain information on the HIV infections in donors of rural versus urban origin. The HIV prevalences decrease similarly in the first years of testing, although on different levels. They are lower in rural areas by a factor of 15 in the first year and of 10 thereafter. The modes of infectivity in both groups are similar although drug abuse seems to be more frequent amongst infected donors of urban areas. Ninety percent or the infected donors are either persons at risk or sexual partners of risk persons. During the observed time period there seems to be a trend from homo-/bisexuality and i.v. drug abuse to heterosexual contacts with persons at risk as the mode of infection. In conjunction with the stabile low and constant rates of infection for the last two years, these data indicate that the risk of HIV infection by blood transfusion is reduced to an acceptable minimum even in urban areas.     

Epidemiology of intrathoracic sarcoidosis in the Federal Republic of Germany

From a total group of 782 cases of intrathoracic sarcoidosis, detected in the German Forces (Deutsche Bundeswehr) from 1965–1969 (incidence 28 per 100,000), the 205 youngest cases of about 20 years of age were compared with 1519 unaffected control soldiers of the same age. The regional distribution did not reveal differences between the North and the South of West Germany. Comparatively low rates of industrialized regions (Nordrhein-Westfalen, Saarland) and big cities (Hamburg, Bremen) can only partly explain the observed regional differences. The highest rate was found for Bayern (49.8 per 100,000), the lowest for Saarland (11.2 per 100,000). Communities of more than 50,000 inhabitants show about half the incidence of small communities, suggesting a rural factor in the etiology. Low rates in communities of less than 500 inhabitants and peak rates in communities of 10,000 – 20,000 inhabitants in the birthplace and life-time residence studies point to a hypothetical urban triggering influence in the development of the disease. Farmers show rates twice as high, and cabinetmakers three times as high as the average rate. Farmers seem to be exposed more to a sarcoidosis agent, whereas in the case of cabinetmakers a facilitating action of wood dust most probably has to be considered. Morbidity rates in the various-sized communities and different professions of another group of patients (92 females and 102 males) of the sanatorium Tönsheide, Schleswig-Holstein, diagnosed from 1955 – 1970, confirmed the results obtained by the Bundeswehr study.     

Low prevalence of hepatitis c virus infection in porphyria cutanea tarda in Germany

Previous studies from Spain, Italy, and France have demonstrated a high prevalence (71% to 91%) of antibodies against hepatitis C virus in patients with porphyria cutanea tarda (PCT). To determine the role of hepatitis C virus (HCV) in PCT in Germany, we have assessed the prevalence of antibodies against HCV and hepatitis B virus (HBV) in 106 patients (mean age, 60 ± 14 years) with the disease. Eight of 106 patients (8%) were positive for HCV antibodies and HCV RNA using second-generation enzyme-linked immunosorbent assay (ELISA), recombinant immunoblot assay, and polymerase chain reaction. Antibodies against HBV core antigen were found in 14 patients (13%). Of the patients with antibodies against HCV alanine transaminase (ALT) (aspartate transaminase [Ast]) levels above normal occurred in 71% (86%). Because elevated ALT (AST) levels were also found in 51% (64%) of 88 patients without markers of HCV or HBV, we suggest that liver damage in PCT may exist in absence of these viruses. This is supported by the finding that in patients without HCV or HBV markers, higher serum ALT and AST activities were found in patients with overt disease or relapse (ALT, 59 ± 44 U/L; AST, 37 ± 21 U/L), whereas patients in remission displayed significantly lower serum enzyme activities (ALT, 16 ± 8 U/L; AST, 16 ± 7 U/L), (P < .001). These results indicate that HCV infection does not play a major role in the pathogenesis of PCT in Germany.     

Drug Addiction in the Federal Republic of Germany: problems and responses

Drug addiction started to become a serious problem in the Federal Republic of Germany (FRG) around 1970. The number of heavy users of illicit drugs, predominantly young people and mainly opiate dependants, increased continually up to the years 1979–80 to an estimated 50,000 people. Since then it has stayed at that plateau. Today there is a strong trend towards polydrug abuse including legal drugs and alcohol. The abuse of cocaine shows an increase, especially among first users of ‘hard’ illicit drugs. At present the most threatening problem is the development of the disease Aids: at least a third of those intravenous drug abusers who underwent the test are HIV positive. The treatment system for drug abusers is predominantly psychosocially orientated and does not include substitute (methadone) programmes. Today there are 580 out-patient and 154 residential drug treatment centres in the FRG. Outcome evaluation studies of the current treatment approach show that about 25 to 35% of the drug addicts are abstaining. The new Narcotics Law of 1982 with its outstanding principle of ‘therapy instead of punishment’ still causes considerable problems in practice. The experience that treatment programmes alone cannot solve the drug problem has led to a large extension of drug abuse prevention during the last years. However, without changes in the organization of research and more participation and research orientation of practitioners we cannot expect marked progress.     

Survey on the gerontological research in the Federal Republic of Germany (author's transl)]

This survey on the gerontological research shows the topical main accents of work in this field in the Federal Republic of Germany: Social services for aged, old-age-security, social and health situation, and older workers' problems are the most important items of the essay. Empirical examinations are dealt with separately. Moreover, there is a prospect on the different types of projects, research institutions and where they are distributed in the different areas and the different ways of financing this research.     

A Motivational Approach to the Treatment of Alcoholism in the Federal Republic of Germany

A motivational approach to the treatment of alcoholism in the Federal Republic of Germany addresses the breakdown of the alcoholics denial system from the perspective of cognitive dissonance and self-esteem. The counseling strategies involved in this process and guidelines which encourage the alcoholic to be responsible for his treatment and recovery are described.     

High prevalence of hepatitis B and hepatitis C virus infections in Korean patients with hematopoietic malignancies

We performed a large case?Ccontrol study (3,932 cases, 15,562 controls) to investigate the association of hepatitis B virus (HBV) and hepatitis C virus (HCV) with hematopoietic malignancies in Korea, where HBV is endemic. HBV was present in 636 control patients (4.1%), 333 lymphoma patients (12.4%), and 75 leukemia patients (6.0%). HCV infection was present in 173 control patients (1.1%), 76 lymphoma patients (2.8%), and 18 leukemia patients (1.4%). Co-infection of HBV and HCV was present in one (0.007%) control patient, seven lymphoma patients (0.3%), and one leukemia patient (0.08%). HBV infection was associated with increased risks for most subtypes of B and T/NK-cell lymphomas, Hodgkin??s lymphoma, and acute myeloid leukemia. HCV infection was associated with increased risks for diffuse large B cell lymphoma, extranodal marginal zone B cell lymphoma, peripheral T cell lymphoma, and acute lymphoid leukemia B cell early pre-B type. HBV seems to have a more important role than HCV in the pathogenesis of specific hematologic malignancies in Korea.     

Diagnosis and management of hypertension by physicians in the Federal Republic of Germany.

Diagnosis and management of hypertension by physicians in two large cities in the northwest of Germany were studied in 1988. Three hundred and fifteen out-of-hospital physicians (71%) responded to a mailed questionnaire. Sixty-eight per cent reported measuring blood pressure at almost each patient visit and 36% involved allied health professionals in the measurement process. Only 63% used disappearance of sound for the diastolic reading (phase V). A comparison with US data from 1987 showed that German physicians started drug therapy at higher levels of diastolic blood pressure than their American colleagues. Only 43% of the German physicians initiated antihypertensive medication at diastolic blood pressure values below 100 mmHg; this compares with 92% for US physicians. In Germany, beta-blockers were clearly preferred as step-one therapy for young patients, while diuretics were prescribed for the majority of the older patients. Forty per cent reported reducing or stopping antihypertensive medication when the blood pressure was controlled.     

Quality assurance in hospitals following the Health Reform Law of the Federal Republic of Germany

Since January 1, 1989, hospitals licensed in accordance with section 108 of the Social Legal Code, Statute Book V (SGB V) as well as the prevention or rehabilitation facilities under contract in accordance with section 111 SGB V are obliged to participate in quality assurance measures. According to the statement of reasons in the government draft of the Health Reform Law, "quality management in the hospital as well as in the prevention or rehabilitation facilities must ensure high-quality and economic provision of medical services". Quality assurance of medical services in the hospital is intended to disclose professional, structural, and organizational deficits, and thus to create the prerequisites for their elimination. It is not primarily intended to serve as a basis for questions of economy in the hospital. Nonetheless, demands for quality management (above all on the part of the health insurance funds) will also increase continuously for this reason under the pressure of the constantly increasing costs of hospital care. Medical associations and the specialist scientific societies are therefore called on to ensure that not only economic and technical quality are primarily considered, but that the quality of professionally and technically qualified medical action is secured by qualified and convincing contributions to quality assurance.     

Epidemiological features of virus hepatitis in the Russian Army

The last decade of the 20th century was characterized by the improvement of the virus hepatitis (VH) in diagnosis system, on the one hand, and by the change in the VH etiologic structure, on the other hand. This was due to the influence of several processes: the ongoing decrease of hepatitis A (HA) morbidity rate in most regions, the increase of hepatitis B (HB) morbidity, the introduction of methods for hepatitis C (HC) diagnosing and reporting, the emergence and progressive increase of VH number with combined etiology, the improvement of diagnosing and reporting of chronic VH. Analogous processes occurred similarly in the Armed Forces (AF) of Russia. Thus, VH in the army has definite epidemiologic features. It must be taken into account not only by military healthworkers but by civil specialists as well. This can be of critical importance when operating under extreme conditions.