Ageing in rural areas of East and West Germany: increasing similarities and remaining differences

Since unification in 1990, living conditions in Germanys New Länder have slowly converged to the conditions in the Old Länder. One can assume, however, that West–East differences persist more strongly in remote rural areas neglected by economic development. Therefore, this paper aims to investigate and compare the living conditions of older adults in rural areas in East and West Germany with respect to personal and environmental resources which are important preconditions for autonomy and well-being in old age. These conditions were examined in a survey conducted in urban and rural regions of five European countries in 2000. The German rural study was carried out in the districts of Jerichow (Saxony-Anhalt) and Vogelsberg (Hesse), and included 762 men and women aged 55 years or older, randomly chosen in villages of at most 5,000 inhabitants. East–West comparison showed both similarities and differences. Similarities arose in human conditions such as subjective health, parenthood and network variety, and in environmental conditions such as home-ownership, attachment to ones home, length of residence in the same neighbourhood, and satisfaction with mobility options. Differences were found in socio-demographic conditions (e.g. education, income, household composition), basic neighbourhood features, and patterns of social and leisure activities. Regression analysis showed the differing impact of single predictor variables on life satisfaction in the East and West: satisfaction with financial situation and functional health contributes far more to older peoples life satisfaction in the West German rural area, whereas mobility-related aspects affect elders life satisfaction more strongly in the East German countryside. The findings reflect, on the one hand, continuing structural East–West differences and, on the other, diverging socio-cultural habits.     

Intravascular hemolysis associated with porcine mitral valve calcification in children

Intravascular hemolysis was present in 5 of 16 children who underwent porcine valve replacement. Each patient had an abnormal blood smear pattern and reticulocytosis and one or more biochemical changes indicative of hemolysis. In all five patients, the porcine valve was calcified. Cardiac catheterization demonstrated severe mitral stenosis and minimal mitral insufficiency in each of the patients with intravascular hemolysis. The presence of hemolysis is indicative of valve dysfunction.     

Differential modulation of IL-1-induced endothelial adhesion molecules and transendothelial migration of granulocytes by G-CSF

Granulocyte colony stimulating factor (G-CSF) is widely used for mobilization of haemopoietic stem cells into the peripheral blood. However, little is known about the mechanisms involved in mobilization and the immune modulatory effects of this growth factor. In this report we show that G-CSF down-regulated intercellular adhesion molecule 1 (ICAM-1) induced by Interleukin-1 (IL-1) on human endothelial cells. Interestingly, the G-CSF-mediated down-modulation of IL-1-induced ICAM-1 appeared to be biphasic. In pharmacological concentrations (>300 ng/ml), and in dose ranges of plasma G-CSF levels above that of non-febrile healthy individuals (30 pg/ml), a significant decrease in surface ICAM-1 could be observed. This could be explained, at least in part, by an increased autocrine G-CSF production by endothelial cells in response to IL-1 and exogenous G-CSF. In contrast to ICAM-1, IL-1-triggered VCAM-1 expression was superinduced by G-CSF with the optimal concentration of 30 pg/ml. To evaluate the functional significance of these findings, ⁵¹Cr adhesion assays with peripheral blood mononuclear cells (PBMC) or granulocytes known to lack the VCAM-1 counter-receptor very late antigen 4 (VLA-4) and IL-1-stimulated endothelial cells, in the presence or absence of G-CSF, were performed. G-CSF could not inhibit the IL-1-induced adhesion of PBMC to endothelial cells, which may be due to the differential adhesion molecule modulation. In contrast, granulocyte adhesion induced by IL-1 could effectively be blocked by co-incubation with G-CSF. Finally, G-CSF also inhibited transendothelial migration of granulocytes through IL-1-activated endothelial cells in a concentration-dependent manner.     

Social and behavioural science perspectives on out-of-home mobility in later life: findings from the European project MOBILATE

Out-of-home mobility is a crucial prerequisite for autonomy and well-being. The European research project entitled Enhancing Mobility in Later Life: Personal Coping, Environmental Resources, and Technical Support (MOBILATE), funded within the European Commissions Fifth Framework Programme, focused on older adults day-to-day mobility and the complex interplay between their personal resources and resources of their physical and social environments. A survey conducted in 2000 in urban and rural areas of five European countries (Finland, The Netherlands, Germany, Hungary and Italy) with various geographical, structural, and cultural conditions enabled us to compare patterns of older mens and womens actual mobility in different regional settings. The sample included n=3,950 randomly selected persons aged 55 years or older, stratified according to gender and age. Standardised questionnaires and a diary were used to assess the persons socio-structural, health-related, psychological and social resources as well as features of the community that may affect their options of realising outdoor oriented needs. The findings confirm that a persons physical, economic, social and technical resources as well as the structural resources prevailing in the area in which he or she lives in are decisive preconditions of out-of-home mobility. Older persons living singly, women, persons with impaired health and low economic resources, and the rural elderly tend to be particularly at risk of losing their abilities to move about. We conclude that further support and stimulation for enhancing out-of-home mobility in later life must focus as much on transport policy measures as on appropriate social policy measures.     

Risk and speed of transitions to first alcohol dependence symptoms in adolescents: a 10-year longitudinal community study in Germany

Background Although in many western countries alcohol use (AU) and symptoms of alcohol dependence (AD) are frequent in adolescence, temporal patterns and trajectories remain understudied. It is unclear whether early onset of AU is associated with the speed of transition to first AD symptoms and whether specific first AD symptoms and their timing are associated with AD. Aims To examine (i) the incidence patterns of self‐reported first AD symptoms; (ii) whether early AU is associated with the risk and speed of transition to first AD symptoms; and (iii) whether first AD symptoms and their timing are associated with AD. Design A total of 3021 community subjects from Germany aged 14–24 years at baseline followed prospectively over 10 years. AU, AD symptoms and AD were assessed using the Munich–Composite International Diagnostic Interview (DIA‐X/M‐CIDI). Findings Among first AD symptoms, tolerance (13.1%) and much time spent (5.0%) were most prevalent. Five to 30% of all first AD symptoms occurred during the first year after first AU. Early AU was not related to the risk of first AD symptoms. The speed of transition to first AD symptoms was greater among those with AU onset in later adolescence. Tolerance and loss of control were associated with AD development (risk difference 3.9% and 15.4%), as was early onset of tolerance, much time spent and loss of control. Conclusion Early AU and early AD symptoms are frequent among adolescents. Early self‐reported tolerance, much time spent and loss of control are particularly predictive for AD and important targets for early preventive interventions.