Prävention und Rehabilitation von arteriellen peripheren Durchblutungsstörungen im Alter

Zum Thema Im Alter wird Pr?vention und Rehabilitation durch differente Ergebnisse einer vorausgehenden kurativen Medizin bestimmt und ist somit abh?ngig einerseits vom Krankheits- und Behinderungsgrad und andererseits von den sozialen und individuellen Beeintr?chtigungen. Entsprechend stellt es im Alter nicht die Regel dar, die ursprüngliche Funktionalit?t von funktionellen Auswirkungen (Krankheitsfolgen) peripherer Verschlüsse der arteriellen Strombahn wieder herzustellen. Eine unumg?ngliche Amputation als schlimmste Folge l?sst immer nur eine begrenzte Reversibilit?t von Funktionsdefiziten mittels Hilfsmitteln zu. Pr?vention und Rehabilitation der peripheren arteriellen Verschlusskrankheit orientieren sich nicht nur an Klassifikationssystemen, sondern werden durch dieselben ebenfalls reglementiert. So basiert jegliche Rehabilitationsmedizin auf der ICIDH nach WHO, nach welcher Behinderung vom Standpunkt der Lebensumst?nde einer Person klassifiziert wird. Den klinischen Bedürfnissen der Patienten entsprechend erfolgt eine Stadieneinteilung nach Fontaine, geeignete Tests dienen der Beurteilung von Funktionsdefiziten.     

Pr?vention des Schlaganfalls

On the background of aging population an increase of patients suffering from stroke has to be expected during the next years and decades. Strokes are the 3rd leading cause of death and reason for disability in Germany and many other countries. An effective treatment of the modifiable risk factors hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, smoking, alcohol consumption, and adipositas is of enormous impact. Due to the linear relationship between blood pressure and risk of stroke, the treatment of hypertension is the most important and effective one in primary as well as in secondary prevention. Treatment with platelet inhibitors plays an additional important role in secondary prevention. Patients with atrial fibrillation should receive an effective oral anticoagulatory therapy when there are certain risk factors.     

Kardiovaskuläre Prävention und Rehabilitation

The distinction between primary and secondary prevention has been abandoned in favor of cardiovascular prevention, mandating individual risk assessment. First, the individual cardiovascular risk of a person is determined by index diseases like myocardial infarction, peripheral arterial disease or other, or, if absent, by a score consisting of a number of conventional risk factors. According to current guidelines, cardiovascular prevention is indicated, as soon as the risk for fatal cardiovascular disease is > or = 5 %, equivalent to a risk for a major cardiovascular event of > or = 20 %. Non-pharmaceutical approaches are: refraining from smoking, mediterranean diet with fatty fish, physical activity and normal body weight. Blood pressure and diabetes mellitus are optimized. In addition, the following agents are used: platelet inhibitors, beta-blockers, ACE-inhibitors, statins and omega-3 fatty acids. A number of structural problems add to individual factors impeding optimal implementation of cardiovascular prevention in Germany.     

Prävention im Alter: Stellungnahme zur Pneumokokkenimpfung

Infections due to pneumococci especially in the elderly are vastly underestimated, e.g., because non-invasive infections such as pneumonia may appear with only few symptoms. Sequential vaccination with the pneumococcal conjugate vaccine PCV13, followed by the 23-valent polysaccharide vaccine, is considered as the best preventive measure for individual protection, even though clinical study data demonstrating the efficacy of this sequence are not yet available. Increase of “awareness” by use of computer-based reminder functions may result in a significant improvement of vaccination compliance.     

Prähospitalversorgung und Akuttherapie des ischämischen Schlaganfalls

An acute ischemic stroke (AIS) is always a life threatening medical emergency. The possibility and success of applying an effective acute therapy depends mainly on a fast decision-making process within the pre-clinical phase of patient care. Systemic thrombolysis using recombinant tissue plasminogen activator (rtPA) is an effective treatment for AIS, but is restricted to the first 3 h after symptom onset and is most effective the earlier the treatment is applied. Thus, avoiding delays until treatment is the main challenge in the acute care of stroke patients. Time to treatment consists of two distinct segments, each having its own special problems and challenges: the pre-hospital phase and the early in-hospital treatment. However, for optimized stroke care, both parts need to be closely coordinated. In this article, specifics and problems of pre- and in-hospital care of acute stroke patients are discussed.     

Primär- und Sekundärprävention des Schlaganfalls bei Diabetes

Stroke is one of the most important causes of permanent disability and death in adults worldwide. In addition to hypertension, smoking, lack of physical activity and cardiac diseases, diabetes mellitus is an independent and modifiable risk factor for ischemic stroke. To date no unambiguous evidence exists for a reduction of the incidence of stroke by normalizing and lowering of long-term glucose levels with or without drugs. Nevertheless, normalization of blood glucose is an important goal in daily clinical practice. This also applies to the acute phase after stroke. Excessive lowering of short-term and long-term glucose levels is not recommended due to the increased risk of adverse events (hypoglycemia) which outweighs possible benefits. The focus in the prevention of stroke in patients with diabetes consists of guideline-conform treatment of modifiable vascular risk factors, such as hypertension, hyperlipoproteinemia, obesity and smoking.     

Prävention des Diabetes

The aims of diabetes prevention are reduction of visceral obesity at the physiological level, the implementation of prevention managers at the structural level and realization of measures for primary prevention of diabetes in the daily routine at the conceptual level. The IMAGE toolkit for diabetes prevention is one of the products of a European study group of the IMAGE project. It is based on IMAGE evidence-based guidelines and the IMAGE training curriculum for prevention managers. It includes practical examples and worksheets which substantially facilitate the implementation of a prevention program and can be directly transferred from the toolkit. After a European curriculum for prevention managers was developed within the framework of the IMAGE project, it could be implemented in Germany over the previous 2 years and intensively evaluated. Since the beginning of 2013 a German curriculum for the further training to prevention manager is available and can currently be appreciated in Dresden. Various healthcare insurances rely on this model and intend to increase the use of preventive measures by the linking of prevention and healthcare treatment. The check-up 35+ can be such a measure. This article reports on these and other elements of prevention.     

Pathophysiologie und Prävention des Typ-2-Diabetes

Die Diabetologie - In den letzten beiden Jahren wurden neue Erkenntnisse zur Pathophysiologie und Prävention des Typ-2-Diabetes im Rahmen des Diabetes Updates präsentiert, die in...     

Diagnostik und Training von Kraft und Gleichgewicht zur Sturzprävention im Alter

The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.     

Möglichkeiten von Krankheitsprävention im Alter

Ohne Zusammenfassung Eingegangen: 1. Dezember 2000 Akzeptiert: 15. Dezember 2000     

Prävention von Malignomen des Verdauungstrakts

Malignancies of the gastrointestinal tract are the most common causes of cancer-related deaths in Germany. They also induce significant morbidity. Despite both surgical and medical therapeutic improvements, advanced stages of these cancers can rarely be cured. Preventive and screening measures are suitable to decrease gastrointestinal cancer-related mortality. Weight reduction and cessation of smoking are effective in preventing esophageal, pancreatic and colorectal cancer. Treatment of infections like chronic viral hepatitis and helicobacter pylori gastritis is able to protect from hepatocellular and gastric cancer, respectively. Colonoscopy is one of the best established screening methods. It allows early detection of colorectal neoplasia. Preneoplastic adenomas can be endoscopically removed during the same session. We here review simple prevention strategies and effective screening methods in gastrointestinal cancers of relevance in daily practice.     

Prävention von Erkrankungen des Respirationstrakts

There are multiple possibilities for pulmonary or bronchial damage and their number exceeds that for the other organ systems dealt with in this issue. This multiplicity of diseases which are at least in part attributable to exogenous damage gives rise to manifold approaches to prevention. This overview does not claim to be complete. It is however intended to clarify the possibilities that exist for the prevention of pulmonary diseases. In addition, it intends to show that effective primary and occasionally secondary and tertiary prevention is inadequately utilized in pulmonology or not even used at all. Against the background that individual preventive measures in pulmonology are considerably more successful than curative measures, also from a health economics point of view, various options for successful prevention are described. The great need for studies on the effectiveness of preventive strategies is also addressed.     

ICD-Infektionen: Prävention und Therapie

Infections of implantable cardioverter defibrillators (ICD) are severe, potentially life-threatening complications of ICD therapy. In the majority these infections are nosocomial by staphylococci, which become apparent within 0.5 years after implantation. Prophylaxis requires a strictly sterile environment during implantation and perioperative antibiotics. While infection of the ICD pocket is diagnosed clinically, infection of the electrodes must be proven by transesophageal echocardiography and positive blood cultures. Therapeutically, the complete ICD system has to be removed to avoid relapses of infection. Beyond 6 months after implantation, lead extraction might become technically demanding and should be done with a standby of cardiac surgery. Antibiotic treatment has to be started before removal of the system, continued for at least 2 weeks before reimplantation and for another 10 days thereafter. Reimplantation should be done outside the originally infected area.     

Prävention und Nachsorge der Sepsis

The 1st revision of the S2k guideline on the prevention and follow-up care of sepsis, provided by the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information on the effective and appropriate medical care of critically ill patients with severe sepsis or septic shock. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.     

Therapie und Prävention der Hyperthyreose

A decreased serum TSH level can be observed in more than 10% of the German population. Although treatment is not mandatory in each of these cases patients with an unrecognized autonomous thyroid dysfunction have a substantial risk of developing thyrotoxicosis when exposed to large amounts of iodine. Thionamid drugs in combination with potassium perchlorate are given for preventive and therapeutic reasons until definitive thyroidectomy or radioiodine therapy is performed. In younger patients Graves' disease is the main cause of hyperthyroidism. Medical treatment with antithyroid drugs is established to render patients euthyroid. Having decreased the dose as far as possible, drug therapy is continued for 12-18 months to achieve a maximum rate of permanent remission. Ongoing clinical research aims to characterize clinical or laboratory predictors associated with a high risk of relapse after medication is stopped. Selenium supplementation is proposed to be a new therapeutic approach for autoimmune thyroid disease. It is already used quite liberally although data of powerful randomized trials are not available.     

Diagnostik und Prävention kardiovaskulärer Erkrankungen

Ohne Zusammenfassung     

Acetylsalicylsäure und Prävention kolorektaler Karzinome

Observational and some randomized clinical trials suggest that aspirin protects from occurrence and progression of colorectal neoplasias (adenomas, carcinomas). However, there are still open questions, regarding the benefit/risk ratio (bleedings) as well as dosage and duration of treatment during the probably long-term medication, before stringent recommendations regarding clinical use of aspirin can be made. Specifically, there is currently no generally accepted mode of action or molecular target of aspirin, though a relationship to tumor-associated enhanced PGE₂ levels in the affected mucosa is likely. Regular daily intake of aspirin in antiplatelet doses of 100 mg appears to be sufficient in responding persons. If this is confirmed in prospective randomized trials that are currently underway, this might add to the prophylactic use of aspirin and would suggest a pharmacological relationship to inhibition of COX-1 mediated prostaglandin/thromboxane biosynthesis as a common primary target for both cardiocoronary and antineoplastic prophylaxis. Prophylactic aspirin use might then add to an undoubtedly important healthy lifestyle including appropriate diet.     

Potenziale und Ansätze der Prävention

Zusammenfassung Prävention und Gesundheitsförderung sind lohnenswerte Investitionen in die Zukunftssicherung der sozialen Sicherungssysteme und bieten einen nachhaltigen gesamtgesellschaftlichen und individuellen Nutzen. Die Bundesregierung hat die Stärkung von Prävention und Gesundheitsförderung in ihrer Koalitionsvereinbarung ausdrücklich zur gemeinsamen Strategie ihrer Politik erklärt und will diese Bereiche in Deutschland aufwerten und ausbauen. Das Bundesministerium für Gesundheit und Soziale Sicherung trägt durch verschiedene Maßnahmen und Strategien zur Verbesserung der Rahmenbedingungen für eine nachhaltige Stärkung von Prävention und Gesundheitsförderung bei, u. a. durch die Arbeiten an einem Präventionsgesetz sowie durch die Gründung des Deutschen Forums Prävention und Gesundheitsförderung.