Ärztemangel in der hausärztlichen Versorgung auf dem Lande und im Öffentlichen Gesundheitsdienst

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der Mangel an Ärztinnen und Ärzten in der hausärztlichen Versorgung (speziell in ländlichen Regionen) und im...     

Die Epidemiologie von chronischen Krankheiten und Pflegebedürftigkeit

Background

It is generally assumed that chronic diseases and multimorbidity increase the risk of long-term care. Nevertheless, a systematic study on the nature and the prevalence of those diseases associated with long-term care has not been yet undertaken in Germany.

Materials and methods

The study was perfomed using claims data of one nationwide operating statutory health insurance company in 2006. Inclusion criteria were age ≥?65 years, minimum of 1 out of 46 diagnoses in a minimum of three quarters of the year (n?=?8,678). A comparison group was formed with n?=?114,962. We calculated prevalences and relative risks —using nominal regression— to determine influential factors on long-term care.

Results

A small number of diseases (e.g. dementia, urinary incontinence, chronic stroke and cardiac insufficiency) show high prevalences (>?20?%) among long-term care users and at the same time great prevalence differences between users and non-users

Conclusion

These data are important for improving medical and nursing care of long-term care users. Further research is needed with regard to the question by which mechanisms those diseases produce disability and frailty, thus leading to long-term care requirements.     

Conservative Treatment of a Cervical Thoracic Duct Cyst: a Case Report

Cysts of the thoracic duct are uncommon entities that can occur in the abdominal segment, the cisterna chyli, the thoracic segment and the cervical segment of the thoracic duct. The rarest presentation is in the cervical segment, with only seventeen cases reported in English literature.

The diagnosis can be made by puncture and with the use of computed tomography or ultrasonography. The cystic fluid always contains an excess of T-lymphocytes and triglycerides. Except for two cases, all reported cervical thoracic duct cysts were surgically treated by excision and ligation of the lymphatics connected to the cyst.

We present a case of a successful non-operative treatment of a cervical thoracic duct cyst that was resolved by repeated aspiration and dietary changes only.     

Occupational Therapy: Still at Work

Many occupational therapists are moving into the field of occupational health and safety. This move is a reflection of the political and economic climate of Australia as well as the changing legislation related to occupational health. Only New South Wales legislation will, however, be examined in this instance. Occupational therapy's move from a medical model to a holistic conceptual basis has also resulted in an increased awareness of primary prevention strategies and health promotion. The workplace-based strategies which occupational therapists can offer the corporate sector are many and varied and reflect the unique contribution to be made by the profession to occupational health and safety.     

Endocrine Profile of 45 Patients with Sertoli Cell Only Syndrome

Endokrines Profil bei 45 Männern mit Sertoli-Zell-Syndrom
Bei 45 Männern mit Sertoli-Zell-Syndrom wurden die Hormonbasiswerte für FSH, LH, Prolaktin und Testosteron mit denen von Klinefelter-Paitenten, Männern mit Oligozoospermie und gesunden, fertilen Männern verglichen. Dabei ergab sich, daß die FSH- und LH-Werte bei Sertoli-Zell-Syndrom signifikant höher lagen als bei Gesunden. Die Erhöhung der Gonadotropine bei Patienten mit Sertoli-Zell-Syndrom was allerdings nicht so hoch und Testosteron nicht so herabgesetzt wie man es bei Klinefelter-Paitenten gefunden hatte. Aus dem Resultat, daß die LH-Werte erhöhte waren, während Testosteron sich im normalen Rahmen bewegte wird die Schlußfolgerung gezogen, daß hier eine kompensierte Dysfunktion der Leydigzellen bei den Patienten mit Sertoli-Zell-Syndrom vorliegt. Für Oligozoo-spermie-Patienten ließ sich keine Differenz der Hormonwerte gegenüber Gesunden feststellen.