Gesundheitsziele zur Stärkung der gesundheitlichen Kompetenz von Bürgern und Patienten

Despite the fact that there still exists little experience with health targets at the national level in Germany there is a growing interest in this management tool in health policy. An initiative for developing health targets at the national level was launched by the German government in December 2000 and is being administered by a platform representing a broad range of participants within the german health system (see other articles in this journal).This initiative, called “gesundheitsziele.de”, reflects the growing awareness not only for the approach of setting and implementing health targets, but for fostering patient orientation for overcoming a lack of quality and a lack of patient and public involvement in the german health sector. A special working group within the initiative was set up in January 2002 to develop health targets strengthening the health competencies of citiziens and patients.The following article outlines the range of goals and targets developed until autumn 2002. The four decisive areas for intervention focussed with the strategy are:improving transparency within the health system, strengthening health competencies of patients and increasing patient orientation of institutions in the health sector,developing patients'rights and improving the management of patients'complaints about medical treatment.     

Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation.

The characteristic of malignant pleural mesothelioma is a tumor that grows by plate-like extension over the pleura, and invades adjacent tissues and organs. Radical surgical removal of the tumor is generally not possible, and most treatment regimens involve combined chemotherapy and radiotherapy, as well as debulking surgery. We have prospectively evaluated five locally-aggressive multi-modality treatment programs, using different hemithorax irradiation schedules and chemotherapy regimens. One hundred patients with confirmed malignant pleural mesothelioma entered the study between 1977 and 1989. The treatment programs, which can consecutively, were: I, 20 Gy (10 x 2 Gy) to the hemithorax + CYVADIC (cyclophosphamide 500 mg/m2 d 1, vincristine 1 mg/m2 d 1 and 5, adriamycin 40 mg/m2 d 1 and dacarbazine 200 mg/m2 d 1 and 5, several cycles before and after irradiation); II, 55 Gy (25 x 2.2 Gy) to the hemithorax + 15 Gy (6 x 2.5 Gy) to the tumor + CYVADIC (2 cycles before, 1 cycle during, and 2 cycles after irradiation); III, Mitoxantrone (14 mg/m2 q 28 d, < or = 6 cycles) followed by 70 Gy (56 x 1.25 Gy, twice a day); IV, 4-Epirubicin (110-130 mg/m2 q 28 d, < or = 6 cycles) followed by 35 Gy (28 x 1.25 Gy twice a day) to the hemithorax + 36 Gy (9 x 4 Gy every 2 days) to the tumor; V, Etoposide (150 mg/m2 1, 3, 5 q 28 d) followed by 38.5 Gy (11 x 3.5 Gy) to the hemithorax. A new system for evaluating tumor response in pleural mesothelioma was applied. None of the combined treatment programs prevented local invasive growth or the spread of mesothelioma outside the hemithorax. The median survival time was slightly increased from 8 to 12 months for those patients who completed the protocol treatments, but progressive disease was the invariable outcome. Radiation pneumonitis and fibrosis were severe and compatible with results of total loss of lung function on the irradiated side. We conclude that data relating to therapeutic responses and treatment programs in malignant mesothelioma should be better correlated internationally, if the problems associated with the evaluation of treatment and the management of patients with mesothelioma are to be improved.     

An analytical solution for the SSFP signal in MRI.

Among previous analyses of the steady-state free-precession (SSFP) signal in rapid MRI, one treatment resulted in equations that require the evaluation of infinite binomial series. Here, an analytical solution is derived by a transformation into the power series expansion of the derivative of the inverse sine function, which is essentially a root. The treatment is extended to include higher-order signals. The results demonstrate the identity of the vastly different equations for the SSFP signals reported so far. Applications consist of the derivation of closed expressions for the signal in echo-shifted MRI and a corresponding analysis of TrueFISP sequences.     

Comparison of the effects of DSIP and SP 1-11 on stress-induced chronic sleep disorders in rats

In the present paper the effects of substance P (SP1-11, Arg-Pro-Lys-Pro-Gln-Gln-Phe-Phe-Gly-Leu-MetNH2) and delta sleep inducing peptide (DSIP, Trp-Ala-Gly-Gly-Asp-Ala-Ser-Gly-Glu) to normalize the deprivation of sleep in chronically stressed rats with hyposomnia were investigated. The results indicated that SP1-11 is more potent than DSIP in rats with stress-induced hyposomnia. Different effects were found in the duration of sleep, the percentage of sleep phases compared to wake phases, the rhythm of sleep phases and the time periods of sleep-cycles. Based on the present results both the common and differences in the mode of action were discussed.     

Early stages of the pathogenesis of rat ventral prostate hyperplasia induced by citral

Typical lesions of benign prostatic hyperplasia (BPH) were induced experimentally in the ventral prostate of adolescent (6 week old) male rats by citral, a nonsteroidal compound. Incipient BPH changes were already observed in the acinar glands 10 days after citral administration. A longer period of treatment (1 month) significantly enhanced epithelial hyperplasia, whereas the stromal elements were less reactive. Characteristic BPH lesions involving both prostatic compartments were found after 3 months of treatment. Castration prior to citral administration prevented such BPH changes; however, citral did not prevent the involutive lesions of castration. The mechanism of action of citral is yet unknown, various possibilities concerning the induction of BPH in rats are presented and discussed. The potential advantage of this model, especially as BPH is not necessarily linked to age or exogenous hormones, may offer new alternative pathways for understanding the complexity of BPH pathogenesis in animals and perhaps even in man.     

The effect of season on the circulating concentrations of anterior pituitary, ovarian and adrenal cortex hormones and hormone binding proteins in the subarctic area; evidence of increased activity of the pituitary-ovarian axis in spring

To evaluate the effects of season on the function of the pituitary-ovarian axis and the adrenal cortex in a northern area with great seasonal variation in the length of daylight, 10 healthy women were investigated over 1 menstrual cycle in spring (May-June), autumn (August-September), early winter (November-December) and late winter (February-March). Serum concentrations of LH, FSH, prolactin, estradiol, progesterone, total and free testosterone, cortisol, sex hormone binding globulin (SHBG) and cortisol binding globulin (CBG) were measured, and the indices of free estradiol (FEI), free androgen (FAI) and free cortisol (FCI) were calculated on cycle days 3-4, 6-7, 10-11, on the presumed day of ovulation, and 6-7 and 9-10 days after the presumed ovulation. Spring was the season that most significantly differed from the other seasons. It was characterized by a significantly decreased concentration of SHBG and an increased FAI throughout the whole menstrual cycle, an increased FSH concentration during the follicular phase, significantly increased estradiol concentration and an increased FEI, and significantly decreased concentrations of FSH and LH during the luteal phase of the cycle. The concentration of cortisol and the FCI were significantly increased in the autumn compared with late winter, both seasons having similar day-length. The present data demonstrate that spring, with a long photoperiod, seems to be associated with increased pituitary-ovarian axis activity and androgenic activity, whereas adrenal cortex function did not show any association with day-length.