Sozialmedizinische Maßnahmen

During the seventies and eighties of the 20th century, France reported a considerable decline in the overall rate of preterm deliveries. The figure for all births before 37 weeks gestation dropped from 8.2% in 1972 to 4.9% in 1988, and births before 34 weeks accounted for 2.4% of all births in 1972 and 0.9% in 1988. This development was paralleled by the creation of a national program for the active support of women, children and families. This program was aimed at improving medical care, together with financial and social support, in particular for education and improved working conditions for mothers inside as well as outside of the home. Surprisingly, in the nineties a rise in the rate of preterm deliveries was noticed and in a national survey in France the number for all deliveries before 37 weeks was 6.8% in 1998 and 2.0% for the early preterm deliveries. A similar development was also seen in other countries. This could not be explained by changes in socio-medical support programs. Instead, it was related to a rise in the mean age of pregnant women as well as to the development of assisted reproduction. The example of France demonstrates that a political initiative for the support of women, children and families is not only effective in reducing the number of preterm deliveries but also has a positive effect on the national fertility rate. In Europe, France together with Ireland, with 1.89 children per women, rank at the top of the list of national fertility rates. The mean for Europe is 1.41 and countries like Spain and Italy, with fertility rates of 1.22 and 1.25, are at the end of the list.     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Osteoporose: eine Volkskrankheit?

Zusammenfassung Im folgenden Beitrag werden die Ursachen der Osteoporose und ihre Behandlungsmöglichkeiten dargestellt. Diskutiert werden verschiedene Strategien zur Prävention anhand beeinflussbarer und nicht beeinflussbarer Risikofaktoren sowie die Möglichkeiten, das Frakturrisiko zu reduzieren. Von besonderem Interesse sind Therapien mit und ohne Östrogenzusatz, wie z. B. die Calciumsubstitution, die Vitamin-D₃-Substitution, die singuläre Östrogentherapie sowie die Therapie mit Bisphosphonaten und selektiven Östrogenrezeptormodulatoren. Die Östrogentherapie ist die Therapie der Wahl bei Osteporose. Abstract The following article presents the causes of osteoporosis and possible treatment modalities. Various strategies for prevention are discussed based on modifiable and nonmodifiable risk factors as well as measures to reduce fracture risk. Of particular interest are therapy regimens with and without estrogen supplements, e.g., calcium substitution, vitamin D₃ substitution, single estrogen therapy, and treatment with bisphosphonates and selective estrogen receptor modulators. Estrogen therapy is the treatment of choice for osteoporosis.     

Motor assessment of cocaine/polydrug exposed infants at age 4 months.

Fifty nondrug-exposed infants and 74 cocaine/polydrug-exposed infants were evaluated on the Movement Assessment of Infants (MAI). The test provides an assessment of risk for motor dysfunction at age 4 months. There was a significant difference in total risk scores between the two groups of infants with cocaine-exposed infants having higher total risk scores (p less than .0001). Categorical risk scores revealed significant differences between the infants in muscle tone, primitive reflexes, and volitional movement with cocaine-exposed infants scoring more poorly in each category (p less than .0001). The groups scored differently on 11 of the 49 MAI items in those categories. Placement of infants within previously established ranges of risk scores (0-7 = no risk; 8-13 questionable risk; greater than 13 = high risk) revealed a significant difference in distribution between the two groups (p less than .0001). Earlier studies of the effects of intrauterine drug exposure have not revealed significant differences in motor development. The MAI demonstrated differential assessments of risk for motor dysfunction between cocaine-exposed and nondrug-exposed infants.     

Should balloon angioplasty and stents have any role in operative intervention for lower extremity ischemia?

p < 0.01). Cumulative combined primary patency at 1 year by life-table methods was 82 ± 10% in the staged group and 83 ± 9% in the simultaneous group (p= 0.79). Mean follow-up was 13 ± 6 months. There is a role for balloon angioplasty and stent placement in operative revascularization of ischemic limbs in selected patients: patency was similar to that produced with the staged approach while the length of stay was shorter. Intraoperative balloon angioplasty is safe and effective and stents permit a measure of control in assuring an optimal intraoperative postangioplasty result.