The research situation in abdominal sonography in the gastroenterology departments of university hospitals in the Federal Republic of Germany

Objective of the present study is to provide a current overview of the present state of research in abdominal ultrasound in the gastroenterological departments of university hospitals in Germany. We conducted a survey assessing the number of research projects in progress, sources of financial support, sponsorship by the private sector and publications generated. Reports from 28 of 35 gastroenterological departments responding to the survey indicated that a total of 124 research projects were in progress during the survey period, for an average of 3.5 projects per department. Clinical issues were addressed in 78 studies, technical questions in 33 studies and other questions in 13 studies. Of the 117 publications generated, 50 appeared in German-language journals and 67 in English-language journals. At present, neither the German Research Association (DFG) or the European Union (EU) is financially underwriting an ultrasound research project in the gastroenterological department of any German university hospital. Ultrasound remains the most frequently applied diagnostic imaging technique in gastroenterology. In order to convert the enormous technological progress into improved diagnostic capabilities, there must be a significant expansion in research support for gastrointestinal ultrasound.     

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.     

Quality assurance in United States hospitals

The internal quality assessment and assurance activities in U.S. hospitals can be described in terms of four specific programs: quality assurance, utilization review, risk management, and patient/guest relations. Quality assurance also depends on a strict control of licensing for the health professions, with state and federal involvement, and on a robust malpractice complaint system.     

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.     

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.     

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.     

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.     

Intestinal helminths of domestic dogs in the Hessian Neckar Valley, Federal Republic of Germany

In a small town and its adjacent villages of the Hessian Neckar Valley, Federal Republic of Germany, 155 of the officially registered domestic dogs were examined for intestinal helminths. Twenty percent of the animals proved to be infected. The highest prevalence of 5.8% could be attributed to infections with Toxocara canis. These values are well below the average rates for dogs in the larger German cities.     

HIV prevention among IVDUs in the Federal Republic of Germany: stability and change.

These comments on German drug and AIDS policy are based on the author's two decades of experience in the field of drug user treatment, on recent studies about the epidemiology and etiology of HIV among IVDUs, and on evaluative studies on demonstration projects. German drug use/user policy did not change much in the face of AIDS: no large maintenance or needle-exchange programs were initiated. This is because a well-prepared system of low-threshold methods targeted at IVDUs not ready to undergo treatment was in place before the epidemic. This system has been modified to integrate the aims of HIV prevention among IVDUs and is free of charge and available throughout the country.