Showing papers in "Gesundheitswesen in 1994"

[Enterobacteria in mineral, spring and table water].

Abstract: Whereas coliform bacteria rank first, non-coliform enterobacteria can be isolated second in frequency from bottled mineral, spring and table waters in South Bavaria. Escherichia coli were found in 8, coliforms in 44 and non-coliform enterobacteria in 41 of 54 manufactories with hygienic problems. 11 different bacterial species were determined from coliforms with Enterobacter cloacae occurring most numerous in 19, Citrobacter freundii in 12 and Enterobacter amnigenus in 7 manufactories. From non-coliform enterobacteria 18 different species could be determined. Again Enterobacter cloacae was found most frequently in 17 manufactories followed by Enterobacter amnigenus in 11 and Serratia liquefaciens in 7 manufactories. The investigation of total Enterobacteriaceae is suggested as a suitable quality criterion for bottled mineral, spring and table waters.

Endemic mercury burden caused by a bleaching ointment in Balken refugees

Abstract: In two camps in Ibbenburen occupied by refugees from Balkan countries we found in 121 inhabitants, among them 56 children, high mercury concentrations in urine and blood. The median of the urinary concentrations was 12 micrograms/l (range: 0.15-770 micrograms/l) or 11.4 micrograms/g creatinin (range: 0.2-446 micrograms/g). 12 adults and 15 children had values above 50 micrograms/l. As source, a mercury-containing bleaching ointment, sold by foreign vendors, was identified. Mercury concentrations in several samples of this ointment ranged from 708 to 17,200 micrograms/g. Similar exposure to mercury may occur elsewhere. Hence, chronic mercury poisoning should by taken into differential diagnostic consideration.

[Comparison of the body burden of the population of Leipzig and Munich with the heavy metals cadmium, lead and mercury--a study of human organ samples].

Abstract: In the former GDR it was almost impossible to perform studies on environmental pollution. Therefore, a short time after the opening of the German interior border the authors started an investigation on the heavy metal burden of humans in the former District of Leipzig (Saxonia). In 1990/91 tissues from 57 deceased were collected from this region. The concentrations of cadmium were determined in specimens from the liver and renal cortex, of mercury in liver, renal cortex and grey matter of the cerebrum and of lead in samples of the pelvic bone and the cortical part of the femur. After sample pretreatment, the heavy metal concentrations were determined by GF-AAS or CV-AAS. The results were compared with studies recently performed by the authors in the region of Munich (southern Bavaria, FRG) and with values from the literature. It was found that the burden with cadmium was similar in both regions, whereas on the average, the bone lead concentrations in Leipzig were 10 times (!) higher than in Munich. Considering dental amalgam as main factor for the burdening with inorganic mercury, the mercury concentrations in the liver and the renal cortex were of the same order of magnitude in both regions. In contrast to this, significantly higher mercury concentrations were found in the brain samples from Leipzig than from Munich. Possible negative health effects of these elevated lead and mercury burden in the Leipzig area are discussed.

Accident in the Hoechst AG company 22 February 1993. 2. Public health evaluation

Abstract: A major chemical accident occurred on 22 February 1993 at plant Griesheim of Hoechst AG Frankfurt/Germany during which approximately 11.8 tons of a chemical mixture containing mostly chlorinated nitroarenes were emitted leading to serious contaminations in Schwanheim/Goldheim, a nearby housing area. Numerous inhabitants of the contaminated area complained of irritation of eyes, skin and mucous membranes, headache and nausea, and 92 persons with moderate symptoms were reported to the National Health Department. Urine samples were collected from the inhabitants of the affected area a few days after the accident and analysed for o-nitrophenol as a representative metabolite to assess the actual uptake of pollutants. O-nitrophenol, however, was also detected in the urine of not knowingly exposed control subjects, an observation not hitherto described in literature. The median levels of o-nitrophenol were three times higher in the exposed population than in the controls. Taking into account the data on pollution measured in the environment, the reported intoxication symptoms, the results of biomonitoring, and the published literature on the components of the mixture, the following conclusions were drawn: (1) The exposure was not high enough to cause severe acute toxic effects. (2) Although the emitted mixture contained carcinogenic components according to animal experiments, the transient exposure to these chemicals does not increase the tumour risk to any measurable extent, i.e. demonstrable by epidemiological methods, especially if weighed against the permanent exposure to "normal" urban pollution.

Outbreak of Salmonella paratyphi B infections in connection with consumption of smoked fish

Abstract: In the period from 2-10 August 1991 an outbreak caused by S. paratyphi B occurred in five rural areas of the district of Leipzig. Eleven patients and one excreter were involved, and mild forms of disease were observed in most cases. In three of the patients a mixed infection with S. litchfield was diagnosed. Moreover at the same time 21 cases of enteritis caused by S. litchfield and three excreters associated with this serovar were registered in these five rural areas. Both infections with S. paratyphi B and S. litchfield occurred 1-3 days after consumption of smoked halibut. The fish smoked in a smokehouse in the Grimma rural area was delivered to the shops every day. The inspection of the smokehouse and the dispatch department provided no signs of contaminations. In the smoked fish samples investigated subsequently, Salmonella were no longer detectable. The results of typing confirm the identity of all S. paratyphi B strains isolated. The possibilities of contamination of the smoked halibut are discussed. This study emphasises the possible transmission of salmonella by way of the food fish. On that occasion also a non-frequent serovar such as S. paratyphi B can be isolated and a light course of disease as e.g. febrile gastroenteritis can be observed and may attain epidemiological significance.

Diphtheria immunity in the German population

Abstract: In the years 1991-1993 the diphtheria antitoxin titres of the blood serum of 2404 persons living in germany was determined by means of the ELISA test. Its aim was to to get an idea of the population's protection given by vaccination against diphtheria. It became evident that the average protection given by vaccination against diphtheria was on the decrease as people grew older. Thus only 3.8% of the 2-5-year olds did not have any protection given by vaccination (antitoxin titre 0.1 IU/ml). In the age group of the 51-60-year olds better immunological protection than expected was found, which could be ascribed to the fact that there was a natural immunigation during the last wide-spread diphtheria epidemic in germany in the 'forties. Another aspect of this result could be a better motivation for-diphtheria vaccination in this age group. Furthermore, it was noticed that the average diphtheria antitoxin titres of women in all age groups were below those of men. In view of the great percentage of the adult population which is not sufficiently protected against diphtheria, it appears necessary to provide for more information of this population group to stimulate and motivate them to care for better protection by vaccination.

Chlorophenols in urine as an environmental medicine monitoring parameter

Abstract: Chlorophenols occur ubiquitously in the environment. They are taken up as such in man or are formed in intermediary metabolism e.g. from chlorobenzenes. In particular pentachlorophenol (PCP) is one of those chemical substances used up to the early 70's as a component of wood preservatives also indoors; for many years it has been at the centre of discussion about the environment. Mono, di, tri and tetrachlorophenols as well as pentachlorophenol occur in the urine in the general population often in surprisingly high concentrations. An increased chlorophenol excretion under certain circumstances also indicates an increased dioxin exposure (pre-dioxins). Possible sources of emission and routes of absorption for corresponding organochlorine compounds can be found in industry, agriculture and also private households. Environmental analysis in the air, in earth or dust do not allow any evaluation of health risks. Only biological monitoring with qualitative and quantitative determination of the actual concentration of the substance taken up by the organism allows a reliable estimation of the individual health risk. The background exposure of the general population not occupationally exposed to organochlorine compounds can be used for the determination of so-called norm values. For the determination of the chlorophenol spectrum 50 ml urine are necessary. The following values can be given as reference values for the most important chlorophenols: 4-monochlorophenol: 7.5 micrograms/l, 2.4-dichlorophenol and 2.5-dichlorophenol: 33.6 micrograms/l, 2.4.6-trichlorophenol: 4.7 micrograms/l, 2.4.5-trichlorophenol: 4.5 micrograms/l, 2.3.4.6-tetrachlorophenol and 2.3.5.6-tetrachlorophenol: 22.0 micrograms/l, pentachlorophenol 9.0 micrograms/l urine.

Health and life style

Abstract: In the theoretically top-heavy, demanding and over-fastidiously artificial and abstract variety of Marxism, some seeds of certain anthropological and biological "constants" of illness and health had been at least sown. This notwithstanding, society as conceived and practised in the former so-called German Democratic Republic was governed by an oversocialised image of Man. The positive core of this tendency to oversocialisation was the axiom that humanising Man coincided with humanising Man's social environment. Negative sequels of such oversocialisation of the human image were, among others, separating Man's anthropological mode of existence from the social context; underestimating the role of borderline situations in human life (as conceived by Jaspers); and massive intrusions by the State into Man's private sphere. Last but by no means least, the vision of the emerging new "rich human being", of a "human being in need of the entirety of human manifestations of life" (Marx) proved to be nothing but a Utopian abstraction. One of the arguments brought forward was that chances to acquire and preserve health are actually options for translating aims of life into reality by means of the possibilities of individual development of one's innate propensities, possibilities offered to Man by and within the framework of social structures. It follows from this manner of reasoning that both the political and the intellectual strata in the German Democratic Republic were convinced that their ideological construction of "congruence" between the interests of society and those of the individual was indeed a reality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Are there predictors for impulsive, homicidal-suicidal acts of violence].

Abstract: Patient's statements or fears that they may "go crazy" and harm themselves or persons around them are rare, but extremely difficult for all participants to deal with. On the basis of the existing, unsatisfactory literature as well as an analysis of 196 incidents of homicidal-suicidal violence designated by German media as "running amok" and fulfilling defined criteria, we examined whether or not there are predictors for the degree of potential danger inherent in such threats. Impulsive, homicidal-suicidal acts of violence among patients with psychiatric disorders often occur in environments characterised by chronic psychosocial estrangement and isolation. Extremely distressing situations may trigger the course of violence, but the actual act is often planned during a seemingly peaceful interval. Personalities with a high affinity to weapons and a tendency toward acting out seem to increase the potential risks. Such events should be treated analogous to suicidal crises, with a strategy that takes the individual disorder into consideration. The parameters investigated in this paper are not sufficient, even in different combinations, to offer a satisfactory explanation or predict the occurrence of this extremely rare behaviour; further research is necessary. Language: de

[Human biomonitoring after a severe chemical accident--results of a study after the Hoechst AG chemical spill 22 February 1993].

Abstract: A major industrial chemical accident occurred on 22 February 1993 at Hoechst AG Frankfurt/Germany. Approximately 11.8 tons of a chemical mixture (mostly chlorinated nitroarenes) were emitted, resulting in heavy contamination of Schwanheim, a nearby housing area. Urine samples were collected from the inhabitants of the affected area a few days after the accident and were analyzed for o-nitrophenol (ONP) as a representative metabolite to assess the actual uptake of the pollutants. As a result, ONP was found in urines of control subjects from elsewhere, an observation hitherto not described in the literature. Mean ONP excretion was about three times higher in the Schwanheim population than in the controls. The results show not only a higher accident-related but also a higher permanent ONP-excretion of the population of Schwanheim, pointing to a permanent environmental pollution in Schwanheim. Both results, the hitherto unknown ONP excretion in controls and regional differences in ONP excretion, require further investigation.

[Prognostic factors in malaria tropica--results of a 1963-1988 evaluation study in Germany].

Abstract: A retrospective study was performed on all cases of malaria recorded in the Federal Republic of Germany between 1963 and 1988. The questionnaires evaluated by the Federal Bureau of Public Health showed a total of 8049 cases, of which 3991 concerned malaria tropica, and 173 deaths. During this 26-year period, 90% of the patients suffering from malaria tropica had contracted the disease in Africa. Deaths from malaria had shown a constant figure of almost 10% between 1963 and 1978, but after that there was a distinct drop. Differentiated analysis revealed that between 1979 and 1988 the death rate for malaria tropica acquired in Africa had been 3.3%. This was clearly dependent on chemoprophylaxis behaviour, on the time of initiation of treatment and on the age of the patients; if tablets were taken regularly, the death rate was 2.3%, rising to 3.1% on irregular intake and to 5.4% without chemoprophylaxis. If therapeutic measures were initiated on the 1st to 5th day of onset, the death rate was 0.6%, on the 6th to 10th day 2.4%, on the 11th to 15th day 2.5% and on the 16th to 20th day 16.7%. In the age group between 60 and over 60 years the lethality was 15.9%. In the course of this study the authors worked out a new malaria questionnaire for the Federal Bureau of Public Health.

[Digoxin content in blood lipids of children, athletes, sports ground attendants and residents after content with dioxin-containing surface slag (Kieselrot)].

Abstract: In 1991 it was discovered, that a large number of sporting grounds and playgrounds in Germany were covered with a waste slag material from a former copper smelter located at Marsberg, Germany. This material was found to contain high levels of PCDD/F ranging up to 100,000 TE/kg. The objective of the present study was to assess whether subjects sporting on such grounds had elevated levels of PCDD/F in blood. PCDD/F in blood fat was used as an indicator of the PCDD/F body burden. Additionally, six children and seven residents of a contaminated sporting and playground were examined. Generally, the levels of PCDD/F in blood fat were in the range of background levels in all subjects. Taking into account the effect of age, slightly elevated blood levels of PCDD/F were detected in children. The results show that the bioavailability of PCDD/F in the slag material is very low. However, from the preventive point of view children who might ingest slag material by hand-to-mouth-activities, should not play on such contaminated playgrounds.

[Work capacity--a central category of practical social medicine].

Abstract: Gainful employment-related performance capacity is a central but rarely considered category of practical social medicine. Its evaluation belongs to the workday routine of social physicians. Special difficulties arise if chronic pain disorders are to be evaluated, especially in chronic "nonspecific" cases, i.e. in the absence of biomedically relevant signs. Employment-related performance is conceptualised as a multidimensional construct with several latent variables. It integrates and extends the domains of "impairments" and "disabilities" of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) of WHO. Three basic dimensions are distinguished: one comprising biomedical, the other psychological, the third function-related variables. They are specified within a multidimensional model of employment-related performance. This includes different components of the perception and appraisal of pain, concomitant bodily complaints (e.g. vital exhaustion), psychological impairments as helplessness or anxiety, special facets of the pain behaviour, and functional limitations and allows an estimate of the chronification and prognosis of the pain problem. Some diagnostic measures are still inadequate in respect of established clinimetric standards. In particular, assessment of functional limitations requires further development and research.

Prevalence of hepatitis A virus antibodies in hospital personnel

Abstract: We screened 351 employees of a county hospital for the presence of antibodies against hepatitis A virus (anti-HAV). Hospital staff tested was from the department of paediatrics, infectious diseases unit, institute of microbiology, hospital kitchen, and the day-care centre. 292 donors from the hospital blood bank served as a control group. The prevalence of anti-HAV in indigenous hospital staff less than 30 years of age was extremely low, but showed an age-dependent increase to 69 per cent in personnel more than 50 years of age. The anti-HAV prevalence rate of indigenous health-care workers did not show significant differences from that of volunteer blood donors. The high prevalence of anti-HAV in non-indigenous employees with almost total exposure in persons more than 40 years of age most probably reflects the high risk of childhood infection in endemic regions. We conclude that the risk of occupational exposure to HAV in the hospital setting appears to be small. Active immune prophylaxis with hepatitis A vaccine should be restricted to employees with frequent contact with HAV-contaminated faeces. Pre-vaccination screening for anti-HAV is cost effective in indigenous hospital staff more than 30 years of age and in all non-indigenous employees.

[After-care of patients with diabetic foot by general practitioners or special ambulatory care--effects on rate of amputation]

Abstract: The impact of a diabetic foot clinic on amputations rates was assessed in 55 diabetic patients with foot lesions, consecutively treated in hospital at the medical department of the university of Dusseldorf. After discharge from the hospital, wound care was continued at home by a mobile nursing team, in conjunction with an outpatient diabetic foot clinic, until complete healing of the lesions after 86-91 days on average. About 18-30 months later, the patients were re-assessed: 39 of them had kept in touch with the foot clinic (0.83 visits per month), and 16 had not (0.09 visits of the foot clinic per month) and were cared for by their general practitioners. Both groups did not differ with regard to age, sex, duration of diabetes, prevalence of peripheral ischaemic vessels disease, mortality, and other items. The prevalence of patients with relapsing foot lesions was also similar in both groups. However, there was a significant difference in amputation rates, in that the patients under care of the foot clinical had only 21% amputations per relapsing patient as compared to 68% amputations in relapsing patients under care of general practitioners (p < 0.05). It is concluded that patients with relapsing diabetic foot lesions are less frequently amputated when cared for by a specialised diabetic outpatient footclinic, as compared to the care provided by general practitioners.

Guidelines for social medicine assessment and evaluation of primary fibromyalgia

Abstract: Primary fibromyalgia belongs to the spectrum of rheumatic soft tissue disorders. It is characterized by wide-spread chronic pain and a low pain threshold. The etiology of the disorders is still unknown. Clinical diagnosis requires examination by a rheumatologically trained physician pathognomonic findings are largely lacking. Classification criteria have been published by Wolfe et al. on behalf of the American College of Rheumatology (ACR). The prognosis of FMA is unfavourable and does hardly, respond to therapy. FMA patients' work capacity cannot be established by mere diagnosis; individual impairments have to be taken into account: Clinical, psychosocial and behavioural dimensions have to be considered. Neither inpatient rehabilitation nor early retirement seem to significantly influence the course of FMA. The patient can usually work fulltime in jobs requiring light activities.

Management of indoor air pollution by polychlorinated biphenyl compounds exemplified by two Hagen schools

Abstract: An indoor pollution of polychlorinated biphenyls (PCB) of about 4000 ng/m3 could be reduced by an average amount of 68% by temporary sealing of the primary source in combination with intensive cleaning. The costs were around DM 100,000.- for the school building containing 12 classrooms. Due to this procedure a continued usage of the building is possible until a concept of decontamination is available. In another building the PCB indoor pollution was reduced by 73% in a representative trial restoration, whereas the stripping of the paint with a chemical caustic substance induced a significant reduction of the PCB concentration. The usage of special air conditioners--called "Luftwascher"--in the classrooms did not reduce the PCB concentration. The realisation of disturbing factors such as the fluctuation of the temperature is of great importance for judging the efficiency of decontamination procedures. The possible misinterpretation regarding the results and the data of decontamination procedures can be excluded by parallel measurements in control rooms. Costs induced by these additional analyses will be reduced by the early realization of ineffective steps.

[Environmental medicine ambulatory and counseling centers in Germany--conceptional approaches, organizational structures, facility design and responsibilities].

Abstract: This paper presents the different concepts of realisation of the currently existing counselling institutions in Germany and ambulances for environmental medicine. It is based on the specific conceptual papers, reports of the ambulances and an inquiry with 20 counselling institutions and ambulances conducted especially for this purpose. From the noted special characteristics a typology of the "ambulance approach" is derived especially with regard to its place in larger institutions, theoretical concepts, specific contents, way of working, diagnostic as well as counselling requests, and usage frequencies. Basic differences exist between research and service projects and between the more general environmental medical services, the special wards in the framework of larger clinical departments (e.g. in dermatology, gynaecology and neurology) and the resources of the departments of occupational medicine. In addition, definite differences exist concerning the number of personnel and equipment, analytical and diagnostical possibilities, data assessment, data documentation, data processing and reporting. Current efforts of standardisation of documentation are presented as well as concepts for a better connection of environmental medical ambulances with physicians' private offices, hospitals, public administrations and laboratories.

[Hepatitis B in persons at high risk for sexually transmitted diseases. Screening and vaccination campaign--acceptance and results].

Abstract: The prevalence of HBV-markers in our patients in STD high-risk groups was markedly higher than the average in Vienna. 19% of the registered prostitutes, 44% of the illegal prostitutes, 29% of the bar hostesses and 39% of the STD patients were found to be positive in at least one HBV marker. I.v. drug abuse. African origin and irregular condom use were the most important risk factors in our patients. The hepatitis B vaccination campaign was successful to a high degree. 69% of the registered prostitutes and 85% of the regularly examined bar hostesses accepted the vaccination. Promotion programmes should focus on institutions caring for STD risk persons rather than on the persons themselves.

Acceptance of preventive vaccinations by physicians and the general population

Abstract: The acceptance of vaccinations depends on the quality of information on effects and side effects. This publication deals with the results of three questionnaire studies: Questionnaire 1 was directed to the general population and contained questions on vaccination history and acceptance of vaccinations, questionnaire two and three were addressed to practitioners (general medicine/paediatrics/internal medicine) with additional questions on the number of vaccinations performed per year. An average of 50% of the persons taking part in the questionnaire study had been vaccinated within the last 10 years against diphtheria, tetanus, polio and/or influenza. The acceptance of these vaccinations was quite satisfactory whereas opinions on mumps and measles vaccinations were quite negative. In the course of the questionnaire study with practitioners it could be demonstrated that vaccinations against diphtheria, tetanus, polio and influenza were regarded as useful while immunisation against mumps, measles, tuberculosis, pertussis and chicken-pox were not regarded as useful. Information programes on vaccinations and the need for further investigations are discussed as well as the problem of mandatory vaccinations.

[Basic medical care of drug dependent patients and young homeless persons--a report from general practice].

Abstract: During the last few years there has been an increasing number of reports from the staff in low level acceptance institutions as well as from streetworkers, about poor physical condition among drug addicts and young drifters. In May 1993 this caused the Public Health department of Cologne to set up a mobile medical service. This service offers consultation hours in so called "contact cafes" as well as in an out-of-service ambulance for drug addicts of the open drug scene and young drifters around the central station. Past experience has shown that the affections are by no means trivial ones. Phlegmoneous inflammations, abscesses, parasitosis and pyodermias of any kind as well as lesions of peripheral nerves and different kinds of acute or chronic virus infections are among the diseases. Without medical treatment there will be grave consequences. Difficulties in the treatment of drug addicts and other marginal social groups formed the term of the patient "who resists any medical treatment". As a result of bad experiences with existing medical institutions drug addicts consult the doctor either too late or they break off the treatment too early. In the treatment of drug addicts and young homeless it is absolutely necessary to face them without any prejudice and to create an atmosphere of confidence in order to guarantee an efficient medical care. There traditional medical services are not able to provide medical aid, the public health department is obliged to establish possibilities of complementary treatment. Drug addiction and homelessness cannot mean exclusion from medical care. That would also mean that the health insurances should participate in the costs.

[The chemical accident of the Hoechst AG facility 22 February 1993--1. Extent of environmental pollution and clean-up].

Abstract: A major industrial chemical accident occurred on 22 February 1993 at Hoechst AG Frankfurt/Germany Due to a series of errors in operational procedures approximately 118 tons of a chemical mixture were emitted, partly resulting in heavy contamination of a nearby housing area The chemical mixture consisted of about 26% anorganic and 74% organic substances, mostly chlorinated nitroarenes, the most important organic contaminant being o-nitroanisol (about 27% of the total amount) Maximum earth contamination in allotment gardens was up to 8 g o-nitroanisol/m2, in the housing area 547 mg/m2 Maximum air contamination was up to 18 micrograms o-nitroanisol/m3, declining quickly during redevelopment and staying constantly below 2 micrograms/m3 from 2 March 1993 onwards In 96% of more than 300 indoor air measurements no o-nitroanisol could be detected Redevelopment measurements were started and completed very quickly: Removal of contaminated earth, recultivation of the gardens, cutting bushes and cutting down coniferous trees, cutting off and renewing street-surfaces, cleaning up footpaths and roofs of the houses Four weeks after the accident, redevelopment measurements were completed, as confirmed by numerous analyses

Nosocomial infection as the cause of death

Abstract: Hospital-acquired infections are a worldwide problem especially in hospitals for the treatment of acute cases. These infections are among the leading causes of death. Certificates of death of 4656 patients who died in hospitals were analysed. Of these, 564 deaths were caused by nosocomial infections (12.1%). It was estimated that annually around 40,000 deaths in the Federal Republic of Germany are attributable to infections acquired in the hospital.

[Health screening at school entry--foreign models and prospective considerations]

Abstract: In Germany, all pupils are subjected to medical examination at school entry. This is in fact one of the primary tasks of the School Health Services in respect of importance and the amount of work involved. Nevertheless, neither are these results properly evaluated, nor has their epidemiological relevance been explored. The examination criteria are not uniform, and results are therefore greatly at variance. This has given rise to much criticism when comparing the german approach to that in other countries. With particular reference to experiences in Great Britain, Australia and the Netherlands, we should discourage a general medical examination at school entry that focuses on the status of each individual from a medical point of view, as has been the practice in Germany to date. Instead, selective examinations should be performed with greater emphasis on expert pedagogic knowledge with the aim of assessing whether a child is mentally and sociologically sufficiently mature to attend school (the German term for this concept is "Schulreife", a non-translatable word somewhat equivalent to "school age maturity").

Criteria for chronification of diseases of the musculoskeletal system

Abstract: Musculoskeletal disorders, especially low back pain, are responsible for most of the days of work absenteeism in western industrial countries. Part of these disorders will get chronic in course of time. The question is, which criteria could be used to identify persons with chronic complaints. In the present study were selected persons with degenerative disorders and persons with idiopathic low back pain. As criterion for chronic complaints we used accumulated days of work absenteeism in two different ways. The first method identified persons with chronic complaints by percentiles of days of work absenteeism in 1990 leading to four groups (Q1-4). The second method used as the relevant criteria the number of years with days of work absenteeism for rheumatic complaints identifying three groups (Q1-3). Both suggested methods were compared for plausibility and validity with relevant parameters (progress of days of work absenteeism, sociodemographic variables, health status). Any method could identify persons with chronic disorders, so we propose to integrate subjective data to get a more valid index.

The epidemiologic significance of varicella

Abstract: A total of 552 persons working in the university hospital of Freiburg, Germany (nurses, pediatric nurses, administration--and technical personnel) was screened for antibodies to varicella zoster virus. Prevalence of antibodies to VZV among men was higher than among women. While the degree of immunity of nurses and administration/technical personnel was comparable, pediatric nurses had a significantly higher seroprevalence ( 30 years 98.6%). Therefore, pediatric nurses should be screened and susceptible persons should be vaccinated.

Incidence of lichens in the area of the Hamburg airport

Abstract: It was examined whether the co-additional effect of kerosene and benzine influences the air quality and the population of lichens. These plants were chosen since lichens serve as important indicators of air pollution. It was found that exhaust gases from a much frequented highway influence the number and the variation of species of lichens, whereas near the runway some less common species were found. These results show that air traffic exercises less influence on the lichen population than the road traffic emissions.

Adaptation of medical care to the changing disease spectrum of adolescents

Abstract: The spectrum of diseases affecting today's children and adolescents has changed. Today's urgent health problems are no longer acute and infectious disorders but much rather psychosomatic and chronic disorders. However, the present health delivery system has not adapted its structure to this changed spectrum of disease. This paper reports on a study carried out by the project "Health Risks and Structures of Medical and Mental Health Care." The project belongs to the North Rhine-Westphalian Consortium for Public Health, and the study was carried out in cooperation with the Special Research Unit 227: "Prevention and Intervention in Childhood and Adolescence." Results show that a small proportion of adolescents actually consult general practitioners. Inadequate cooperation between medical and mental health care services as well as insufficient links between these services and the life world of adolescents have led to a situation in which the use of professional assistance meets with barriers. As a result, adolescents continue to avoid visiting a physician even when they have already become ill. For this reason, there is an increasingly strong need to consider how to change the structures of medical and mental health care. Proposals are developed that meet the needs of adolescents and are oriented toward the requirements arising from the changing spectrum of disease.

The impact of reproductive loss for human fertility. Results of the German part of a European study of the epidemiology of infertility and subfertility

Abstract: Within the German part of an European Community study of the epidemiology of infertility and subfecundity we analysed the fetal loss (i.e. spontaneous abortions, artificial abortions, ectopic pregnancies, stillbirth, early neonatal death and all babies who died after the 7th day within the first year of life). For this investigation women from 5 urban and rural regions in Germany in the age group 25-45 years were selected in five districts from random samples of the local registers. 1531 interviews were conducted in 1992 by trained female interviewers in the same way as in the other participating European countries. 1248 of the women had a positive reproductive anamnesis with 3018 pregnancies. 565 (= 45.3% of women who were pregnant at any time) had fetal loss. In East Germany as well as in West Germany we found a positive age and pregnancy association. The main loss we observed in the age group under 20 and over 35 years. In all groups artificial abortion was the most important part of fetal loss (rural region of East Germany: 15.5% and West Germany: 13.1% of all registered pregnancies). The time to pregnancy (TTP) was prolonged in women over 30 years of age. Here we also found an increasing rate of spontaneous abortions. Smokers are more prevalent in women with ectopic pregnancies, spontaneous abortions and live born babies who died within the first 7 days after delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Dioxin level of small volume gardeners in Duisburg

Abstract: The PCDD/F levels were determined in the venous blood of 21 allotment gardeners in Duisburg (Germany). Soil analyses had shown elevated levels of PCDD/F in garden soil (range 16.4-77.6 ng I-TE/kg). Vegetable plants also had elevated levels of PCDD/F, mainly due to airborne contamination. The highest levels were found in kale (2.6-65.6 ng I-TE/kg d.w.) and endive (1.7-28.5 ng I-TE/kg d. w.). The study population consisted of 5 females and 16 males (mean age 57 years; range 43-67 years), who had been cultivating their allotment gardens for an average of 20 years (range 7-36 years). About 50% of their total vegetable consumption and 30% of their fruit consumption were from their own gardens. The mean 2.3.7.8-TCDD toxicity equivalents (TE) of PCDD/F in blood fat were 44.3 pg I-TE/g fat (range 29.2-81.1 pg I-TE/g fat). Compared to reference data these values are within the range of background PCDD/F-levels in the German population. The concentrations in individual gardeners as well as the congener pattern were not different from those of normal subjects. The present study shows that increased levels of PCDD/F in garden soil and garden products do not have a significant effect on the PCDD/F burden in gardeners, even if they consume homegrown vegetables and fruits from their own allotment gardens for many years in succession.