Empfehlungen zu Ernährung und Bewegung von Kleinkindern

Monatsschrift Kinderheilkunde -     

Gesundheitsförderung im Setting Kita

Background

The German law to strengthen health promotion and prevention (Prevention Law, PraevG 2015) along with the Federal Recommendations Framework recognize daycare centers for children as a central setting for health promotion. However, concrete regulations and strategies to support implementation are currently lacking.

Objective

The objective of this article is to discuss how day-care centers for children can be established as a central setting for health promotion in practice.

Methods

The new legal regulations for the setting approach and the agreements with daycare centers of the national prevention conference are presented, the field-specific challenges for health care promotion in daycare enters are compared, the current situation is analyzed, and the needs for action are identified based on the evaluation of the health objective and the federal health report.

Results

The Prevention Law (PraevG 2015) has substantially improved the situation to initiate health promotion activities in daycare centers for children. Educational frameworks offer a number of points for further contact regarding health promotion activities. While a large number of health promotion activities already exist, they mainly tend to be isolated projects offered by various health insurance funds rather than a coordinated approach.

Conclusion

New opportunities should be used to focus on quality development and coordination of the existing programs with due consideration of field-specific requirements. A comprehensive strategy to promote and guide coordinated efforts for activities is needed to replace the current trend of isolated programs.

     

Time factors associated with CT scan usage in trauma patients

Introduction

While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase.

Materials and methods

During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance.

Results

Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9 min. Median start time for the first CT scan was 82 min. The first CT session was completed in a median of 105 min after arrival. Complete radiological workup was finished in 114 min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging.

Conclusion

In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114 min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imaging.     

Intentional non-radical surgery and survival in advanced ovarian cancer: results of a pilot study

Between 1991 and 1993, 31 patients with bulky advanced ovarian carcinoma were entered into a structured protocol where attempts at radical surgery were deemed inappropriate should one or more bowel resections and/or splenectomy be required in order to possibly achieve optimum debulking. Only diagnostic and palliative procedures were undertaken and all patients had> 2 cm residual disease. Adjuvant chemotherapy was administered to 29 patients (25 platinum based). Follow-up of the study group was for a minimum of 24 months and a maximum of 55 months. The overall median survival was 16 months and, for those exposed to platinum agents, 17 months. Complete response to chemotherapy was achieved in 11 (35%) of patients. Median survival in this group was 29 months. Two patients are still alive, 39 and 55 months after primary surgery. This series indicates that avoiding multiorgan resection does not adversely impact on survival, and concerns in proceeding with a prospective randomized trial of primary debulking surgery is advanced ovarian carcinoma are unfounded.     

Infraglenoid tubercle avulsion and greater tuberosity fracture resulting from traumatic glenohumeral anterior dislocation: a case report

Traumatic anterior shoulder dislocation can be associated with anteroinferior glenoid bone loss causing potential recurrent instability. We report on a 62-year-old man with a first-time traumatic anterior dislocation of the right shoulder, resulting in both an infraglenoid tubercle triceps avulsion fracture and a greater tuberosity fracture. After reduction, nonsurgical management was chosen. No inferior-oriented apprehension was noticed during follow-up, which might necessitate surgical treatment of the inferior glenoid rim. At latest follow-up, the patient had recovered his shoulder function. Avulsion fractures of the infraglenoid tubercle are uncommon lesions after an anterior shoulder dislocation and, without signs of instability, can be treated conservatively.     

The prognostic significance of intraperitoneal growth characteristics in epithelial ovarian carcinoma

Maximal cytoreductive surgery in advanced epithelial ovarian carcinoma (EOC) has become commonplace in management despite the inability of prospective trials to demonstrate a convincing improvement in long-term survival. Optimal cytoreduction is only possible in 23–77% of cases, perhaps due to differences in tumor biology. In a retrospective analysis of 219 women, we have investigated one possible variable in tumor biology, namely the pattern of intraperitoneal spread. Median survival in the study group was 15.2 months (CI: 13.2–17.3). One hundred women had predominantly localized bulky spread and 119 had seedling spread to the peritoneum. The number of optimally debulked patients in the two groups was not significantly different ( P = 0.9). Fifteen patients with bulky disease, had complete macroscopic clearance. Residual disease and performance status were highly significant prognostic factors. On univariate analysis, patients with seedling spread had a significantly poorer prognosis. Multivariate analysis showed that if for like cases: stage, residual disease, performance status, age, histology and differentiation were compared, the tumors with bulky spread carried a better prognosis than those with seedling spread. It has been demonstrated in this analysis that the pattern of spread is an independent prognostic factor of clinical significance.     

Familiäre Gesundheitsförderung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Kommunale Gesundheitsförderung, die auf gesundes Aufwachsen ausgerichtet ist, bedarf eines konzeptionellen Rahmens, um...     

Growth promoting properties of cell free malignant ascites and benign peritoneal fluid on epithelial ovarian carcinoma cells in culture

van Geene P, Kehoe S, Luesley D, Ward K. Growth promoting properties of cell free malignant ascites and benign peritoneal fluid on epithelial ovarian carcinoma cells in culture. Int J Gynecol Cancer 1998; 8 : 197–202.
The growth of epithelial ovarian carcinoma is regulated by a number of cytokines, some of which are stimulatory and some inhibitory. The cells of origin of these cytokines are known in only a few cases but include tumor cells, lymphocytes, macrophages, other components of the immune system, and mesothelial cells. Malignant ascites and non-malignant peritoneal fluid contain varying quantities of cytokines dependent on the cell populations present and therefore the relative importance of any individual cytokine in the stimulation of tumor cells may vary between patients. Because of the potential for cytokines to act in synergy or in short paracrine loops it is proposed that the overall growth regulating effect of ascites is of clinical importance to the patient with ovarian carcinoma. We have measured the overall stimulatory effect of 38 malignant and 26 benign, cell free, peritoneal fluids on the growth of epithelial ovarian carcinoma cells cultured in vitro . In all cases, peritoneal fluid increased the growth of ovarian carcinoma cells in vitro when compared to standard growth media. There was no significant difference in stimulation between peritoneal fluid obtained from benign ovarian tumors and other benign gynecologic conditions, but fluid obtained from patients with ovarian carcinoma had a significantly greater growth stimulatory effect ( P = 0.0132).