Pharmakoökonomie und Public Health

The main purpose of Public health is improvement of the health state of the population. Thereby necessary coasts have to be considered. Public Health research is directly practice-related because of the development and implementation of health policy strategies. Important aims of the public health research are the realization of interventions in practice and their reevaluation. Health economy is an essential point of Public health. The public health research aims at analyzing the medical care and control systems. Further aims of the health economy are the individual processes of decisions of participating persons (e.g. physicians, patients)are object of research. Pharmacoeconomic aspects belong to an optimal therapy, that means the quality assurance and improvement with regard to circumstances. Quality assurance is not possible without the consideration of the state of knowledge. Only on the basis of actual data from the medical care system specific interventions on the political and individual level may be established. Subsequently these programs can be evaluated according to quality and cost outcomes. Drug information services and pharmacotherapy circles (Peer review groups)can contribute to an optimization in medical treatment. As a result these interventions are of consequence for health economy and medical care.     

Sleep in Adolescents with Primary Major Depression and Schizophrenia: A Pilot Study

Abstract— The present study aimed at investigating the question whether abnormalities of sleep, especially disinhibition of rapid eye movement (REM) sleep, are already present in adolescents with primary major depressive disorder (MDD). Ten healthy controls assessed at home, 10 inpatients with MDD and 10 inpatients with schizophrenia (age range: 13–19 years) were investigated polysomnographically. REM latency was significantly shortened in MDD compared with the two other groups. Adolescents with MDD did not display disturbances of sleep continuity as typically observed in adults with major depression. The most pronounced impairment of sleep continuity was noted in schizophrenic patients. The results stress that shortened REM latency may already occur in adolescent depression.     

Mutant androgen receptors in prostatic tumors distinguish between amino-acid-sequence requirements for transactivation and ligand binding

Mutant androgen receptors are thought to contribute to hormone resistance in prostate carcinoma. The part they play in this process, however, is ill-defined. Here we report on transactivation by 2 mutant androgen receptors from prostatic tumors with single amino-acid exchanges in their hormone-binding domains. These exchanges enhance the transactivation property of the receptors, particularly to androsterone and androstanediol, 2 metabolized derivatives of testosterone present in the prostate. Additionally, they enhance the transactivation potential of the mutant receptors to hydroxyflutamide, an anti-androgen frequently used in hormone ablation therapy. The increased transactivation by the mutant receptors did not result from altered affinity of the receptors to the inducing ligands nor from measurable changes in conformation of the liganded receptors. Thus the single amino-acid exchanges identify differences in amino-acid-sequence requirements for transactivation and ligand binding in the hormone-binding domain of the androgen receptor. These results provide new insights into ligand-dependent transactivation, and form a framework for the search for effective antagonists to be used in prostate-cancer therapy.     

Effects of antihistamines on leukotriene and cytokine release from dispersed nasal polyp cells

In this study the effects of antihistamines on the release of eicosanoids and the pro-inflammatory cytokine tumor necrosis factor alpha (TNF alpha) were compared. Enzymatically dispersed cells from human nasal polyps served as an in vitro model of chronic respiratory mucosal inflammation. Nasal polyp cells (2 x 10(5)/ml) were sensitized with human IgE pre-incubated azelastine (CAS 58581-89-8), terfenadine (CAS 50679-08-8), levocabastine (CAS 79516-68-0) or cetirizine (CAS 83881-51-0), and stimulated with anti-human immunoglobulin E (IgE). Thromboxane B2 (TBX2) and leukotriene C4 (LTC4) were measured by radioimmunoassay (RIA), TNF alpha by enzyme-linked immunosorbent assay (ELISA). Data represent mean values of % inhibition estimated from the untreated positive control or mean IC50 (n = 5). Azelastine and terfenadine inhibited TNF alpha release with IC50 values of 6.2 mumol/l and 4.3 mumol/l, respectively. Terfenadine reduced TXB2 release by 37 +/- 15%, and LTC4 release was decreased by azelastine and terfenadine very potently by 86% and 100%, respectively. Azelastine shows anti-inflammatory properties in therapeutically relevant concentrations as assessed by its ability to reduce TNF alpha release as well as its ability to inhibit LTC4 production in allergically stimulated human nasal polyp cells.     

Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review

Background  

To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).     

An international review of projects on hospital performance assessment

BACKGROUND: Assessing the quality of health care has become increasingly important in health care in response to growing demands from purchasers, providers, clinicians and the public. Given the increase in projects and programs to assess performance in health care in the last 15 years, the purpose of this paper is to review current indicator projects for hospital performance assessment and compare them to the Performance Assessment Tool for Quality Improvement in Hospitals (PATH), an initiative by the WHO Regional Office for Europe. METHODOLOGY: We identified current indicator projects through a systematic literature search and through contact with experts. Using an inductive approach based on a review of the literature, we identified 10 criteria for the comparison of indicator projects. We extracted data and contacted the coordinators of each indicator project to validate this information. In addition, we carried out interviews with coordinators to gather additional information on the evaluation of the respective projects. RESULTS: We included 11 projects that appear to have adopted a common methodology for the design and selection of indicators; however, major differences exist with regard to the philosophy, scope and coverage of the projects. This relates in particular to criteria such as participation, disclosure of results and dimensions of hospital performance assessed. CONCLUSION: Hospital performance assessment projects have become common worldwide, and initiatives such as the WHO PATH project need to be well coordinated with existing projects. Our review raised questions regarding the impact of hospital performance assessment that should be pursued in further research.     

Localized detection of glioma glycolysis using edited 1H MRS

In vivo ¹H MRS can be used to detect and quantify the lactate resonance at 1.3 ppm provided that overlapping lipid resonances are eliminated. A homonuclear spectral editing method was developed to acquire uncontaminated ¹H spectra of lactate with adiabatic pulses. An advantage of the adiabatic pulse sequence is the ability to induce uniform flip angles and to maximize sensitivity in applications employing surface coil transmitters which produce highly inhomogeneous B₁. Glycolytic activity in an intracerebral C6 glioma in rats was monitored by using adiabatic editing sequences to observe [3-¹³C]lactate produced from infused [1-¹³C]glucose. Acute hyperglycemia (serum glucose >22 mM, n = 10) had no significant effect (P = 0.08) on the total ([¹²C]+ [¹³C]) tumor lactate signal intensity.     

Gallium-67 scans in renal tumors

The role of gallium-67 is limited in the genitourinary tract [1]. The rare occurrence of increased⁶⁷Ga uptake in renal carcinoma and other tumors is notable because of a lack of documentation in the literature [2]. This report is of such cases found in the last year. Gallium-67 scanning has been performed at our institution since 1972 with an average of 200 cases per year.