Übergewicht und Adipositas im Kindes- und Jugendalter

The prevalence of overweight and obesity in children and adolescents is increasing. In Germany, 10-20% of children and youth are overweight and obese. Childhood obesity is associated with cardiovascular and other comorbidities. 25% suffer from arterial hypertension and/or hypercholesterolemia, 1% from diabetes mellitus type 2. In addition, one third suffer from orthopedic and psychosocial disorders.Therefore, countermeasures are necessary. Kindergarten or school settings offer a possibility for preventive measures. Results, however, are inconsistent and depend on several factors such as socioeconomic status, parental integration, etc.To counteract the epidemic of obesity, national and international data should be collected, results and recommendations adapted to individual necessities of different settings. The implementation of such strategies is only possible with a combined and qualified procedure by a concerted and qualified action of all health care employees based on adequate political structures.     

Eosinophile Granulomatose und Polyangiitis – Diagnostik und Therapie

Eosinophilic granulomatosis with polyangiitis (EGPA, Churg–Strauss Syndrome) is an allergic necrotizing granulomatous angiitis of the small vessels associated with eosinophilia. EGPA initially presents with upper airway tract and lung involvement, which often progresses over many years and eventually requires systemic glucocorticoid treatment. In addition to the respiratory tract, any organ system can be affected, leading to vasculitic skin lesions, peripheral neuropathy (mononeuritis multiplex), eosinophilic myocarditis, and glomerulonephritis. Progressive blood and tissue eosinophilia is found in almost all cases, while perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) may be present in 30–40% of the patients. The diagnosis is based on the criteria proposed by the American College of Rheumatology (ACR). In addition, application of these criteria requires the histological evidence of vasculitis or surrogate features of vasculitis. Long-term treatment is based either on immunosuppressive standard therapy (glucocorticoids/immunosuppressants) or immunomodulation using biologicals.     

Diabetes mellitus und Herzinsuffizienz – Inzidenz und chirurgische Therapieoptionen

The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4-6% in control populations. Epidemiologic studies have demonstrated an increased risk of heart failure in diabetics. Experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis.The knowledge of the diabetes status may help to define the optimal therapeutic strategy for heart failure patients. In ischemic cardiomyopathy the choice of the surgical treatment may differ according to diabetes status, coronary atherosclerosis and left ventricular function.At present, surgical revascularization techniques seem to be superior to interventional revascularization procedures.In the last decade a growing part of diabetics presenting severe heart failure underwent heart transplantation. Thereby, it was found that the survival rates of patients with uncomplicated diabetes mellitus and of nondiabetics did not differ. The survival rates in patients with severe and progressive form of diabetes mellitus are discussed controversially in the literature. Because of donor organ shortage each diabetic patient presenting severe heart failure should be evaluated to find the best therapy including permanent mechanical circulatory support ("destination therapy").     

Neoadjuvante und adjuvante Therapie des Magen- und ?sophaguskarzinoms

The prognosis of locally advanced gastric and oesophageal cancers is poor, but it has been shown that multimodal treatment can lead to better outcomes than surgery alone. Two randomised studies conducted in Europe have shown that perioperative chemotherapy does significantly improve the survival of patients with adenocarcinoma of the stomach and oesophagogastric junction. These results have had a profound effect on the treatment of patients presenting with stage II or stage III disease. Because of the results of recent meta-analyses, patients with locally advanced adenocarcinomas of the oesophagus receive neoadjuvant chemotherapy or chemoradiation therapy. Squamous cell cancer of the oesophagus is treated with chemoradiation. Secondary resection is optional. Patients with locally advanced gastric and oesophageal cancer should always be referred to an experienced high-volume centre where findings are discussed by a multidisciplinary tumour board. It has been demonstrated that outcomes are better when such patients are treated in designated centres.     

Lebensqualität und psychosoziale Anpassung bei Kindern und Jugendlichen mit juveniler idiopathischer Arthritis und reaktiven Arthritiden

Zusammenfassung Ziel der Studie war die Erfassung der gesundheitsbezogenen Lebensqualität (health-related quality of life, HRQOL) und der psychosozialen Anpassung von Kindern und Jugendlichen mit juveniler idiopathischer Arthritis (JIA) und reaktiven Arthritiden. Wir suchten, Faktoren zu identifizieren, die mit eingeschränkter Lebensqualität und psychosozialer Anpassung assoziiert sind. Methoden 72 Kinder und Jugendliche wurden mit dem Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen (KINDL-R) zu ihrer HRQOL befragt. Beeinträchtigungen in der Teilnahme an Aktivitäten des täglichen Lebens wurden mit der deutschen Version des Childhood Health Assessment Questionnaire (CHAQ) erhoben, Aspekte der psychosozialen Adaptation der Kinder und Jugendlichen als proxy-Einschätzung (Mütter) mit der deutschen Child Behavior Checklist (CBCL). Ergebnisse Kinder und Jugendliche mit juveniler idiopathischer Arthritis und reaktiven Arthritiden berichteten im KINDL-R im Vergleich zu gesunden Kindern über Einschränkungen der Lebensqualität in verschiedenen Lebensbereichen. Kinder litten besonders unter Beeinträchtigungen des Selbstwertes, Jugendliche waren in mehreren Bereichen betroffen. Fast 20% des Studienkollektivs zeigte Verhaltensauffälligkeiten, insbesondere soziale Rückzugstendenzen und ängstlich- depressive Verstimmungen. Kinder und Jugendliche in ambulanter Behandlung und mit längerer Erkrankungsdauer berichteten über bessere Lebensqualität als Kinder und Jugendliche in stationärer Behandlung und mit kürzerer Erkrankungsdauer. Die funktionale Kapazität des Kindes zeigte Zusammenhänge mit der Lebensqualität und Verhaltensauffälligkeiten. Soziale Isolation und ängstlich-depressive Verstimmungen erwiesen sich außerdem als gute Prädiktoren der Lebensqualität. Schlussfolgerungen Selbstberichtete Lebensqualität und Verhaltensauffälligkeiten erwiesen sich als bedeutsame Outcome-Parameter, die im Rahmen einer psychosozialen Betreuung von Kindern und Jugendlichen mit chronischer Arthritis regelmäßig erhoben werden sollten.Wir danken dem Verein zur Förderung der Rehabilitationsforschung in Schleswig-Holstein e. V. (vffr) für die Finanzierung der Studie.     

Substanzmissbrauch im mittleren und höheren Erwachsenenalter—Alltagsdrogen Alkohol und Nikotin: Gebrauch und Missbrauch

Alcohol as a semi-luxury item is socially accepted in our society and its usage constitutes a normative behaviour. The transition from consumption to abuse is often rapid. Results supply evidence for widely spread alcohol addictions in Germany. The following paper examines the consumption and the abuse of alcohol using the data from the Interdisciplinary Longitudinal Study of Adulthood (ILSE). The findings of a questionnaire investigating diet and medical examination data [interview data referring to alcohol consumption and laboratory findings concerning Gamma-Glutamyl-Transferase levels (Gamma-GT-levels)] based on two cohorts (years of birth 1930-1932 and 1950-1952) from centres of investigation in Heidelberg and Leipzig are adopted in this study. The centre comparison indicates higher alcohol consumption in the Leipziger study participants. The findings register less alcohol usage at the second measurement point, where as the Gamma-GT-levels rise and a greater endangering of health can, therefore, be noted. Besides alcohol, cigarettes are a widely accepted everyday drug in Germany. The health risks are enormous (e. g. high blood pressure, bronchitis and lung cancer). The smoking habits of the two cohorts will be described at two measurement points concerning participants from Heidelberg and Leipzig. The cohort comparison demonstrates a significant disadvantage of the younger women, although, as for as, the men are concerned no clear difference can be found.     

Soziale Integration und Lebenszufriedenheit kinderloser Frauen und M?nner im mittleren und h?heren Erwachsenenalter

Objectives

Adult children are important members of the social network of older persons. Children are particularly important in facilitating the social integration of the aged. Against this backdrop, this paper explores possible effects of childlessness on the social integration and life satisfaction of middle and older aged women and men.

Materials and methods

The data used in this study are drawn from the German Socio-Economic Panel (GSOEP), an annual survey of private households in Germany. The analysis is restricted to respondents aged between 45 and 84 who live in a marital or nonmarital partnership. Multivariate models are used to examine the effect of childlessness on contacts with relatives and friends, civic, political, and religious participation, as well as life and family satisfaction.

Results

Cohabiting childless women and men in mid- and late life are only slightly less socially integrated than parents living in a partnership. Compared to parents, childless elders have fewer social contacts. However, childless men and women do not differ from empty nest parents in their civic, political and religious participation. Moreover, childless elders do not have a lower level of life satisfaction than mothers and fathers. Quite the contrary, childless men und women are happier than parents who coreside with their adult children.

Conclusions

The results presented here revise the common assumption that childlessness negatively affects the social integration and life satisfaction of middle- and older-aged persons.     

Ätiologie und Pathogenese

Ohne Zusammenfassung     

Ätiologie und Pathogenese

Ohne Zusammenfassung     

Ätiologie und Pathogenese

Ohne Zusammenfassung     

KISS und SARI: Benchmarking und Referenzdaten für Krankenhausinfektionen, Antibiotika-Verbrauch und Resistenz auf deutschen Intensivstationen

Zusammenfassung Zur Lieferung von Orientierungsdaten zu Intensivstations-assoziierten nosokomialen Infektionen für das interne Qualitätsmanagement wurde seit 1997 ein Surveillance- System für nosokomiale Infektionen aufgebaut. Es heißt KISS (=Krankenhaus-Infektions-Surveillance-System). Zusätzlich wurde als Ergänzungsprojekt seit 2002 ein weiteres Projekt eingerichtet, SARI (= Surveillance der Antibiotika-Anwendung und der bakteriellen Resistenzen auf Intensivstationen). Die Methoden beider Systeme basieren auf Surveillance- Komponenten der amerikanischen Centers for Disease Control and Prevention (CDC): Das National Nosocomial Infections Surveillance (NNIS) System and das Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Project.Inzwischen wurden 274 Intensivstationen in KISS eingeschlossen und 35 Intensivstationen nehmen an SARI teil. Wir erfassen kontinuierlich Daten aus diesen Intensivstationen und berechnen sogenannte device assoziierte Infektionsraten für Pneumonie, Sepsis und Harnweginfektionen. Zusätzlich werden Daten zur Verteilung der Antibiotika-Anwendung (standardisiert nach definierten täglichen Anwendungsdosen) und zum Anteil der Resistenz bei 13 ausgewählten Erregerarten geliefert. Insgesamt haben wir inzwischen einen Überblick über mehr als 2,1 Mio. Patiententage in KISS und mehr als 300 000 Patiententage in SARI. Zur besseren Berücksichtigung der unterschiedlichen Risikofaktoren der Patienten in verschiedenen Intensivstationen werden die Daten nach der Art der Intensivstation stratifiziert. Dieser Artikel konzentriert sich auf die Daten für internistischen Intensivstationen. Das Projekt hat insgesamt ein breites Interesse erzeugt, und viele Intensivstationen wenden dieselben Methoden an, um sich an den KISS und SARI-Daten orientieren zu können.     

Sklerodermie und Paul Klee: Metamorphose von Leben und Kunst?

Paul Klee was born in 1879 in Münchenbuchsee, not far from Bern, and died at the age of 60 in Switzerland due to severe scleroderma, which was diagnosed in 1936. From this time on, this connective tissue disease had followed him continuously and had strongly influenced his enjoyment of life, personal development and creative power in art work, before finally causing his death in 1940. Based on diaries, letters, personal remarks and notes, his case history was reconstructed from the first symptoms to the date of diagnosis up until his death and an analysis was made of the influence his illness had on his art work in aura, color, figure and productivity.     

Techniken und Komplikationen im postinterventionellen und Langzeitintervall der Sondenernährung

Enteral nutrition in patients is a well established procedure. Percutaneous endoscopic gastrostomy has been widely used to maintain long-term enteral nutrition and has become the method of choice. Under careful observation of indication, contraindication and technique the risk of complication of PEG is reduced drastically. The enteral nutrition via PEG is a step of the multimodal treatment in critically ill patients.     

Rehabilitationsverlauf und Nachhaltigkeit—

A rehabilitation care management oriented towards the severity of the disease, the individual competence and the patient's needs essentially improves the effectivity and the sustainability of inpatient rehabilitation. The Institute of Gerontology of the University of Heidelberg is developing an assessment for elderly stroke patients to optimize placement decision by an early rehabilitation prognosis. Data concerning functional, cognitive and psychological status were collected in 267 patients participating in a postacute rehabilitation program on admission, after two weeks and on discharge and six weeks later. In this article are presented the study design and patients' characteristics during the rehabilitation process. The first assessment at admission gives important information about the sustainability of the ADL-competence after discharge. Severe stroke, premorbid ADL-competence, cognitive impairment, communication problems, depression and higher age were found to be predictors for the outcome of the rehabilitation process.