Geschlechts-Krankheiten Allgemeiner Teil

Ohne Zusammenfassung     

Postnatal depression and reproductive success in modern,low-fertility contexts

Background and objectives: Postnatal depression (PND) presents a puzzling phenomenon to evolutionary anthropologists as it is highly prevalent and yet detrimental to child development and maternal health. Adaptive explanations have been proposed, but have not been tested with data that directly link PND to female fertility. Methodology: A survey was designed to gather complete reproductive histories and retrospective measures of PND to measure the effects of PND on fitness. Respondents were born between 1930 and 1967, with the majority based in the UK during their childrearing years. The hypothesis that PND is detrimental to fitness is assessed using Mann–Whitney U tests on completed fertility. Binary logistic regression modelling is used to test the hypothesis that PND reduces the likelihood of parity progression. Results: Women experiencing PND at their first or second birth have lower completed fertility, with PND at the first birth leading to lowered fertility. Logistic regression analyses show that this is the result of reductions in the likelihood of parity progression to a third birth when PND is experienced at the first birth or when repeat bouts occur. Conclusions and implications: Our results call into question adaptationist arguments, contribute to the growing understanding of the importance of emotional wellbeing to fertility decision making, and given the economic consequences of markedly below replacement fertility, highlight a potential new source of financial incentive to invest in screening and preventative measures to ensure good maternal mental health.     

Public entrance accessibility: Psychometric approach to the development of a new assessment instrument

BackgroundThe accessibility of public facilities for all is an issue increasingly gaining focus in policy debates, especially regarding the ageing population.ObjectiveThis paper describes a psychometric approach to the development of a new instrument for assessing the accessibility of public entrances.MethodsItems to include were selected by means of literature review and classified according to a typology of person-environment fit that uses the International Classification of Functioning, Disability and Health (ICF) as theoretical framework. Content validity was assessed by a scientific panel approach and construct validity by using simulation techniques and correlation analysis with a related construct. Reliability was evaluated by inter-rater agreement analysis, where 15 strategically selected public entrances were assessed by five rater pairs.ResultsContent validity was assessed as high (3.6 on a scale from 1 to 4) and correlation indicating convergent validity between instrument scores and a related construct was moderate (r_s = 0.60, p < 0.001). Inter-rater reliability was acceptable to good (kappa 0.42, overall agreement 81%). After an iterative process including review of validity and reliability results, the resulting assessment instrument consisted of 56 items in 7 sections.ConclusionsThis study demonstrated good content validity and acceptable to good inter-rater reliability. Though initial results were promising, user involvement and further testing of construct validity is needed. The goal of the new instrument is a feasible tool for planning, evaluation and accomplishment of policies intended to make public entrances accessible for all. The extent to which the instrument succeeds remains to be tested by practical use.     

Mathematical Modelling of Glucose‐Dependent Insulinotropic Polypeptide and Glucagon‐like Peptide‐1 following Ingestion of Glucose

The incretin hormones, glucose‐dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP‐1), play an important role in glucose homeostasis by potentiating glucose‐induced insulin secretion. Furthermore, GLP‐1 has been reported to play a role in glucose homeostasis by inhibiting glucagon secretion and delaying gastric emptying. As the insulinotropic effect of GLP‐1 is preserved in patients with type 2 diabetes (T2D), therapies based on GLP‐1 have been developed in recent years, and these have proven to be efficient in the treatment of T2D. The endogenous secretion of both GIP and GLP‐1 is stimulated by glucose in the small intestine, and the release is dependent on the amount. In this work, we developed a semimechanistic model describing the release of GIP and GLP‐1 after ingestion of various glucose doses in healthy volunteers and patients with T2D. In the model, the release of both hormones is stimulated by glucose in the proximal small intestine, and no differences in the secretion dynamics between healthy individuals and patients with T2D were identified after taking differences in glucose profiles into account.     

Questions about questions: cognitive survey of questionnaire development

OBJECTIVES: Traditional pretests are used in the development of survey items to identify technical and comprehension problems. Cognitive processes involved in answering survey questions are not the object of this kind of test. METHODS: Cognitive survey methods were used here to test a questionnaire screening for rehabilitation needs in people suffering from back pain. Essential techniques of cognitive testing (think-aloud, probing, confidence ratings) are outlined. We applied these techniques to 20 patients suffering from either acute or chronic back pain in order to test the survey. RESULTS: The main goal, i.e., identifying problems in item formulation by means of cognitive testing, was achieved. Almost one third of the survey questions were rephrased according to the results of the study. Some of the improvements of the questionnaire are illustrated. CONCLUSIONS: The increased effort required to perform cognitive testing as compared to traditional pretesting pays off. The two methods have specific pros and cons and cannot replace one another.     

Style of management and the relevance for workplace health promotion in small and medium sized enterprises

In a small company, the whole company culture, including the management style, is dominated by the owner. The management culture in small companies and above all the management style of the owner determine the chances of successfully introducing workplace health promotion (WHP). For this reason a typology was developed that describes the management personalities who affect the company culture in small enterprises. This provides a guide to the possible success of WHP in connection with the management style. Although a summary of the management and corporate culture of small companies in a few categories cannot show the variety of social reality, it can provide orientation. The typical categories of company social order (a mixture of ownership and leadership) in small and medium-sized enterprises are given below. Furthermore, there is an assessment of what the chances of realising workplace health promotion are in each type of company. Small and medium-sized companies (SME) have a number of organisational characteristics which are just ideal for the introduction and implementation of workplace health promotion. The work of the employer and employees is often the same. Information in the company is generally comprehensive and easily available. The lack of information which employees often complain about in large companies is not a problem. There is a good flow of communication. Small companies have a flat hierarchy that enables participation, the essential requirement for WHP. There is a close social relationship between the company head and the workforce, although it must be said that this closeness can be dangerous, particularly if it is misused as complete social control. The readiness to implement Workplace Health Promotion (WHP) in SME and the degree of success depends largely on the personality of the company manager and the style of leadership. Considering the importance of a manager’s personality for WHP in SME, modules and instruments to assist company owners and managers in SME are to be developed. On behalf of and in co-operation with the Austrian Network for Workplace Health Promotion several modules have been introduced to assist owners and managers of SMEs.     

Reproductive factors in hereditary breast cancer

Background: An early age at menarche, a short menstrual cycle length, and a high age at first full term pregnancy or nulliparity are known risk factors for breast cancer. These risk factors have previously been reported to differ between breast cancer patients with and without a family history of breast cancer and also between breast cancer patients and controls. Methods: Self-administered questionnaires were filled out by 95 women belonging to 24 families with known BRCA1 mutations, 16 women belonging to nine families with known BRCA2 mutations, and 95 women belonging to 65 families with hereditary breast cancer where no BRCA1 or BRCA2 mutations could be detected. Thirty-nine women were BRCA1 mutation carriers and 56 women were BRCA1 negative, 11 women were BRCA2 carriers and five BRCA2 negative. All women were born between 1905 and 1979. Results: Age at menarche, physiological menstrual cycle length at age 30 or at current age in younger women (when not using oral contraceptives), age at first full term pregnancy, and nulliparity did not significantly differ between BRCA1 mutation carriers and BRCA1 negative women. Too few women were BRCA2 negative to serve as a control group. BRCA2 mutation carriers were therefore compared with BRCA1 negative and BRCA2 negative women. None of the above reproductive factors did significantly differ between BRCA2 mutation carriers and from BRCA1 and BRCA2 families. Women from non-BRCA1/BRCA2 hereditary breast cancer families had a higher age at menarche, but this was no longer significant after adjustment for other factors in a multivariate model. Conclusion: Our results suggest that reproductive risk factors of breast cancer are not related to BRCA1 or BRCA2 carrier status. There was also no indication that these factors differ in carriers of unknown susceptibility genes compared with non-carriers from BRCA1 and BRCA2 families.     

Drehtrauma des Kniegelenks

Torsion fractures of the knee are frequently followed by injuries of the internal structures of the knee joint. The attendant physician is required to follow a course of investigation that combines a secure diagnosis with what is economically viable. The most important elements of this are the case history and the clinical examination, which, together with plain radiographs (knee a-p and lateral views, patella tangential view), often allows a clear clinical diagnosis and planning of further therapy. If the clinical diagnosis is not clear, in MRI investigation we now have a method available that allows highly accurate recognition of menisceal ruptures and lesions of the cruciate ligament lesions and of cartilage. It can make a decisive contribution to reducing the number of purely diagnostic arthroscopies performed and thus to cost reduction. The procedure followed for spiral injury to the knee joint is a classic illustration of how diagnostic algorithms can make a contribution to the quality of treatment outcome while economic aspects are taken account of at the same time.