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A Zink

Publications and source records attributed to A Zink.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Help status and help prospects of severely handicapped patients with rheumatoid arthritis].

UNLABELLED: Although increased efforts have been made, rheumatoid arthritis still leads to severe disability and dependence on external help in about one-third of the patients. Relatively little is known on how help-dependent RA patients manage everyday life, to what extent they need help, by whom the help is given, what the patients' future help perspectives are and what kind of patient- and resource-related characteristics are associated with unmet need. METHODS: By means of standardized interviews a representative sample of severly disabled RA patients was investigated with respect to present life situation, functional capacity, amount of help needed, relationship of caregiver and patient, health status of caregiver, stability of the help situation, housing preferences and help-seeking behaviour. The patients were classified as being either in definite need of help or independent of external help. RESULTS: Patients with comparable disabilities living on their own had only one-third of the help of those living together with others. They received help slightly more often from non-family caregivers, such as visiting nurses or privately paid household help, than from family members. Although many patients had rather uncertain perspectives for the future, the majority vehemently rejected living in a retirement home or in a home for the disabled. This refusal to live in an institution was independent of functional capacity, adequacy of the present help situation and the financial situation. Unmet need was highly associated with the age and health status of the caregiver as well as the help-seeking behaviour of the dependent person, but not with functional status or available resources. CONCLUSION: Given an appropriate home, the majority of conditions for a self-determined life for help-dependent RA patients are satisfied by the present outpatient help and care systems in Germany, but patients and their care givers need to be encouraged to take advantage of the available help and care facilities.

Activities of Daily Living↗
PubMed2001

The national database of the German Collaborative Arthritis Centres: I. Structure, aims, and patients.

OBJECTIVE: To describe the aims, principles, and content of the German rheumatological database and to present data on patient mix and healthcare provision for the year 1998. METHODS: The German rheumatological database contains clinical and patient derived data of the outpatients with inflammatory rheumatic diseases seen at one of the 24 collaborative arthritis centres. The case mix, institutional context, and demographic features of 25 653 patients from the year 1998 were analysed. RESULTS: 51% of the patients had rheumatoid arthritis, 23% seronegative spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, and 19% had vasculitis, including SLE (5%). The distribution of the age at onset of patients with RA with < or = 2 years' disease duration was comparable with recent incidence data from population studies. The case mix differed between university departments and rheumatology hospitals as well as individual practices. 65% of the male and 46% of the female patients at ages 18-60 were still in gainful employment, the rates of employment were 14% below the population rates for women, and 11% below those for men. 62% of all patients had seen a rheumatologist within the first year of disease, 73% within the first two years. Ankylosing spondylitis was seen in rheumatological care much later than all other diseases (only 39% within the first year). The mean number of contacts with a rheumatologist was five a year; rheumatologists in individual practices saw their patients seven times a year on the average. Together with visits to the non-specialist doctor mainly treating the patient, the mean number of visits to the doctor for a rheumatic condition was 20 a year. CONCLUSION: Large databases like this one give information about the patient case mix in different healthcare settings, about treatment practice, and about the consequences of disease. Patients treated in specialised rheumatology units in Germany are referred earlier than in the past, which probably reflects better regional cooperation due to the implementation of arthritis centres. University departments and outpatient clinics of rheumatology hospitals contribute considerably to the specialised care of patients with arthritis and connective tissue diseases.

Adolescent↗
PubMed2001

The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis.

OBJECTIVE: To describe current treatment of patients with rheumatoid arthritis (RA) in German rheumatology. METHODS: Data from the German rheumatological database of 1998, comprising clinical and patient questionnaire data of 12 992 outpatients with RA seen at 24 collaborative arthritis centres in Germany, were analysed. RESULTS: At the time of documentation, 88% of the patients with RA were undergoing disease modifying antirheumatic drug (DMARD) treatment. Methotrexate (MTX) was prescribed to 56% of the patients (61% with seropositive and 45% with seronegative RA). Combination treatment was used in 15%. MTX was the drug of first choice even in patients with up to one year's disease duration (49%), followed by antimalarial drugs (21%). Patients treated by non-rheumatologists within the previous year had received DMARD treatment in only 33% of the cases. In steroid treatment, low doses (< or = 7.5 mg/day) were used by rheumatologists much more often (44%) than higher doses (12%). 16% of the patients had been inpatients during the previous year, with a median length of stay accumulated over the year of 21 days. Together with stays in inpatient rehabilitation, 22% of all patients had had some form of inpatient treatment. Comprehensive measures such as occupational therapy and patient education were prescribed to fewer than 12% of the patients, mostly during their hospital stay. CONCLUSION: German rheumatologists do follow recent recommendations about early and effective treatment. However, there are still deficits in outpatient care with non-medicinal measures like occupational therapy and patient education, which may partly explain the high hospital admission rates.

Adolescent↗
PubMed2001

Practice variation in the treatment of rheumatoid arthritis among German rheumatologists.

OBJECTIVE: To describe practice variation in the treatment of rheumatoid arthritis (RA) among German rheumatologists with regard to drug and non-drug therapy. METHODS: We used data of 7,326 patients with RA registered in a national German rheumatological database in 1998. In the database, every patient with an inflammatory rheumatic disease seen at one of the German Collaborative Arthritis Centres is registered once a year with a standard clinical data form and a patient questionnaire. We compared health care provided by 29 rheumatological outpatient units. For drug and non-drug treatment unit prescription rates, ranges and outliers were calculated. Logistic regression analysis was used for case mix adjustment and for the identification of practice patterns. RESULTS: We observed variation concerning the frequency of use of single disease modifying antirheumatic drugs (DMARD). The median of the prescription rates in the 29 units for methotrexate (MTX) was 55% in 1998 (1st quartile: 51%, 3rd quartile: 63%); sulfasalazine had a median of 15% (quartiles: 10%/19%), antimalarials a median of 8% (quartiles: 5%/21%). Combination DMARD therapy was used in 11% (quartiles: 6%/18%). Prescriptions of low dose steroids (< or = 7.5 mg) had a median of 45% (quartiles: 35%/55%), and nonsteroidal antiinflammatory drugs (NSAID) had a median prescription rate of 58% (quartiles: 50%/70%). High variation was also found concerning active physiotherapy (median: 41%; quartiles 34%/55%) and passive physical measures (median 14%, quartiles 9%/37%). Differences in case mix (age, sex, rheumatoid factor, disease duration, severity, disability) only explained a small proportion of the total variation. When the units were grouped according to the frequency of prescription of DMARD combination therapy, treatment patterns could be identified. Units with higher rates of DMARD combination therapy used more drugs for the prevention and treatment of osteoporosis, more active physiotherapy but fewer NSAID and fewer passive physical therapies. CONCLUSION: Variation in drug and non-drug treatment indicates significant differences in health care provision. Trends in the drug management of RA are adopted differentially by the members of the rheumatology community. The large variability in non-drug therapies may, apart from differences in availability, suggest a lack of agreement on therapeutic effectiveness.

Adrenal Cortex Hormones↗
PubMed2000

Molecular evidence for different stages of tuberculosis in ancient bone samples from Hungary.

This paleomicrobiologic study was conducted on osseous tissue specimens from ancient Hungarian skeletal samples from the 7-8th and the 17th centuries AD with typical macromorphologic evidence of osseous tuberculosis (n = 3), morphologic alterations probably due to tuberculosis (n = 6), or with nontypical osseous changes of vertebral bodies suggestive of inflammatory reaction (n = 5). From these bone samples, DNA was extracted and amplified by polymerase chain reaction (PCR) by using various primer pairs recognizing DNA segments of different mycobacterial species. To confirm specificity of the analysis, the amplification products of several samples were subjected to restriction enzyme digestion and/or direct sequencing. Of the analyzed 14 cases, 8 were unambiguously positive for mycobacterial DNA of the Mycobacterium tuberculosis complex, as shown by the amplification of the IS6110 sequence. In 13 cases we found a PCR product with primers specific for the 65-kDa antigen gene, including 2 cases without genomic DNA. We conclude that the application of other mycobacterial DNA primers may reveal contamination of bones with atypical saprophytic mycobacteria. A positive result for typical mycobacteria was seen in 2 of 3 cases with typical morphologic signs of tuberculosis and amplifiable DNA, in 3 of 6 probable cases, but also in 3 of 6 cases with nontypical bone changes. This indicates that minor osseous reactions of the surface of vertebral bodies may be due-at least in several cases-to infections with bacteria of the M. tuberculosis complex. In these cases the disease may have proceeded rapidly, and the morphologic osseous changes may represent "early" stages of tuberculous infection of the vertebrae.

Adult↗
PubMed2000

[Goals and methods of clinical studies].

The validity of clinical patient-oriented research is always threatened by the influence of bias, confounding factors or random effects that might distort the results. However, the susceptibility to distortion varies between different study designs. The best protection against spurious relationships or distorted results are specific focused research questions and rigorous integration of sound study methodology during the design and performance phase.

Alcohol Drinking↗
PubMed2000

Detection of leprosy in ancient human skeletal remains by molecular identification of Mycobacterium leprae.

We isolated ancient DNA from skeletal remains obtained from a South German ossuary (approximately 1400-1800 AD) and from a 10th century Hungarian cemetery partially indicating macromorphologic evidence of leprosy. In samples taken of 2 skulls from Germany and of 1 hard palate from Hungary, Mycobacterium leprae-specific fragments of RLEP1 and RLEP3 were amplified using polymerase chain reaction (PCR), thereby confirming their specificity by sequencing. In another case, PCR with primers targeting IS6110 of Mycobacterium tuberculosis gave positive results only for a mandibular specimen. No signal for any mycobacterial DNA was observed in samples from 2 Hungarian foot bones. In ancient material, osseous involvement of M leprae may be detected and distinguished from other mycobacterial infections by specific PCR. In the small bones of leprous hands and feet, not enough M leprae DNA seems to be present for detection. This supports the view that rhinomaxillary leprous alterations result from direct bacterial involvement, while osseous mutilations of hands and feet result from a nervous involvement and/or secondary infections due to small lacerations of the overlying soft tissues.

Base Sequence↗
PubMed2000

Molecular evidence of bacteremia by gastrointestinal pathogenic bacteria in an infant mummy from ancient Egypt.

In this study, we describe an infant mummy from ancient Egypt that showed macromorphologic signs of chronic anemia and vitamin C deficiency. From this infant, we have obtained a sterile sample from a metatarsal bone to extract ancient bacterial DNA. Following polymerase chain reaction amplification and subcloning of the amplicons, the sequence of the 16S ribosomal DNA was determined in several resulting clones. The presence of pathogenic and apathogenic bacteria, such as Escherichia coli, are indicated by our result, providing evidence of bacteremia, which probably contributed to death due to septicemia. These findings suggest that the infant, who already had chronic anemia and vitamin C deficiency, acquired a gastrointestinal infection, which finally led to a systemic spread. To our knowledge, this is the first case identifying potentially septicemic bacterial dissemination in an ancient Egyptian mummy. Using our approach, we hope to investigate distinct paleomicrobiological aspects of ancient populations, which will potentially enlighten our understanding of the development and evolution of pathogenic bacteria.

Bacteremia↗
PubMed2000

Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers.

OBJECTIVE: To describe indicators of disability and handicap in the 2 major inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to estimate the burden of illness in terms of functional status, pain, and global well being, as well as with regard to unemployment and early retirement. METHODS: Data from the German rheumatological database on 52,444 patients with RA and 8,776 patients with AS seen at 21 collaborative arthritis centers in Germany between 1993 and 1997 were analyzed. To estimate the burden of the 2 diseases at different biographical phases, age and sex matched groups of patients were compared for functional disability, pain, global assessment of health status, education level, and employment status. RESULTS: For comparable ages, disability in female patients with AS or RA was rated similarly by the physicians (e.g., 61-70 years: 42% severe disability in RA and 44% in AS), whereas men with AS were rated more disabled than men with RA (61-70 years: 35% in RA and 48% in AS). Patients' self-ratings of disability were generally worse for women than for men (age 61-70: women 37% severe disability in RA and 35% in AS, men: 24% in RA and 19% in AS). Pain intensity was rated similarly by women and men with RA and AS at ages < 51 years (33% severe pain at ages 41-50 in men and 34% in women in both diseases). It increased with age in women (> 70 years: 41% severe pain in RA and 44% in AS) and remained stable in men (27% RA and 29% AS > 70 years). At 71.3% the employment rate in AS was clearly higher than in RA (49.5%). There was significant influence of the education level (men 51-60 years with AS: low education 56% employment rate, high education 79%) and the labor market (men 51-55 years with AS: 80% employment rate under good, 59% under bad overall labor market conditions). CONCLUSION: Age and sex matched groups of patients with RA and AS in tertiary rheumatological care show similar amounts of disability, pain, and reduction in well being. Therefore, the offer of comprehensive care and pain management to both groups should be comparable.

Activities of Daily Living↗
PubMed2000

HLA-DRB1 genes, rheumatoid factor, and elevated C-reactive protein: independent risk factors of radiographic progression in early rheumatoid arthritis. Berlin Collaborating Rheumatological Study Group.

OBJECTIVE: To evaluate the prognostic value of HLA-DRB1 antigens, rheumatoid factor (RF), and C-reactive protein (CRP) with the radiographic outcome of rheumatoid arthritis (RA). METHODS: In total, 139 patients with early RA (< 2 years) were followed up. At the end of 3 year treatment with disease modifying antirheumatic drugs (DMARD) HLA genotyping and external radiographic scoring were performed. The time up to the first development of erosive disease [Ratingen radiographic score (RS) > 0, > 5, > 10] was compared by methods of survival analysis. RESULTS: At 4 years' disease duration, DRB1*04 or DRB1*01 positive patients had RS > 0 or > 10 (73% and 27%, respectively) significantly more frequently than DRB1*04 or DRB1*01 negative patients (37% and 7%, respectively). Nearly independently of the genetic predisposition, RF and elevated CRP at the start of DMARD treatment were predictive for erosive RA at 4 years. Elevated CRP (> or = 15 mg/l) increased the probability of erosive RA in DRB1*04 or DRB1*01 positive patients from 64.0% (in patients with CRP < 15 mg/l) to 83.9%, and in DRB1*04 and DRB1*01 negative patients from 18.8% to 70.1%. The corresponding figures for RF+ and RF- patients were 58.2% and 82.5% in HLA predisposed patients and 23.5% and 60.2% in those who were negative for DRB1*04 and DRB1*01. The probability of a RS > 10 was 40.9% for HLA predisposed patients with elevated CRP. In contrast, no case with RS > 10 was found in 43 patients who had neither of these 2 risk factors. CONCLUSION: Our findings support that HLA predisposition plays an important role with regard to radiographic progression. However, this effect is modified by RF serum concentration and disease activity.

Arthritis, Rheumatoid↗
PubMed2000

Prognosis of patients with juvenile chronic arthritis and juvenile spondyloarthropathy.

OBJECTIVE: Evaluation of the course and the prognosis of juvenile chronic arthritis (JCA) and juvenile spondyloarthropathy (JSpA). METHODS: The entire medical histories of 171 patients with JCA or JSpA were reviewed. The study cohort comprised 102 patients with oligoarticular, 17 with systemic, and 24 with polyarticular onset of JCA; 28 patients had a SpA; 91 patients with JCA from a population based cohort were included in that study cohort. The mean period of followup was 7.4 years. The probability of remission was estimated by survival analysis methods (Kaplan-Meier method). RESULTS: After a disease duration of 10 years the highest probability of complete remission was estimated for patients with oligoarticular or systemic onset of JCA (54% and 38%, respectively). In the oligoarthritis group with late onset of JCA, a lower probability of remission was found for the HLA-B27+ patients compared with HLA-B27- patients. Patients with polyarticular onset of JCA had the poorest prognosis, with a significantly lower probability of complete remission (15%) within 10 years, more secondary injuries, and a lower functional capacity at followup. Patients with JSpA showed a 17% probability of remission after a disease duration of 5 years and ranged between the remission rates for oligoarticular and polyarticular JCA. The estimated remission rates for the patients with JCA in the population based cohort and in the whole cohort were quite similar. CONCLUSION: Our data suggest a favorable prognosis for JCA and JSpA in general, but with differences among the subtypes. It seems that more than 50% of the patients with JCA and JSpA reach adulthood with active arthritis and need further rheumatological care.

Adolescent↗
PubMed2000

Loss of physical independence in rheumatoid arthritis: interview data from a representative sample of patients in rheumatologic care.

OBJECTIVE: The goal of the study was to obtain an estimate of the proportion of patients with rheumatoid arthritis (RA) in rheumatologic care who are unable to live independently. It investigates the association of age, disease duration, disease activity, joint involvement, and comorbidity with dependence on help and care. In addition, we attempt to derive an estimate of the level of physical disability at which dependence on external help is to be expected in more than 50% of the cases. METHODS: A sample of 273 patients with RA and considerable physical disabilities (less than 67% of full functional capacity) was drawn from the Berlin rheumatologic database. Standardized questionnaires and interview data were used to ascertain dependence on help and care. Patients were classified as in need of help when they depended on external help to manage household chores and as in need of care if beyond this they depended on assistance to manage personal hygiene and nutrition. RESULTS: More than 50% of the patients who had less than 58% of full functional capacity (Health Assessment Questionnaire [HAQ] > 1.54) required help, and for patients with less than 30% (HAQ > 2.3) the need for help was almost certain (more than 95%). Generalizing these results to all RA patients treated by rheumatologists in Berlin, 33% were expected to be dependent on external help and 7% to be dependent on care. Even in patients with disease duration < or = 5 years, a rather high expected proportion of help-dependence was found (26%). When single joints were compared, the highest amount of disability resulted from impaired wrists. Our data suggest that the contribution of comorbidity to functional impairment was low, especially in patients in need of help, while patients independent of help reported more frequently that their comorbid condition had an impact on their physical function. CONCLUSION: The results support the importance of identifying high-risk patients and of the employment of a strategy of early therapeutic intervention, since a high degree of dependence on help was observed in patients with short disease duration. As help-dependence is highly influenced by the condition of the wrists, more attention should be paid to the treatment and stabilization of these joints.

Activities of Daily Living↗
PubMed2000

Anthropological and palaeopathological analysis of the human remains from three "Tombs of the Nobles" of the necropolis of Thebes-west, upper Egypt.

During several recent excavation campaigns at the necropolis of Sheikh-Abd-el-Gurna, Thebes-West, Upper Egypt, we investigated the human remains of three "Tombs of the Nobles" totalling at least 273 individuals. The investigation covered the human material (skeletons and mummy residues) from the tombs TT-84, TT-85 and TT-95. These tombs had been built in the New Kingdom (approx. 1500-1000 B.C.) and used until the Late period (up to 330 BC). All samples were analyzed macroscopically, isolated findings were further investigated by endoscopic and radiological techniques. The at least 273 individuals covered an age range from newborns to senile individuals with a main age of death between 20 and 40 years of age. The rate of infants and subadults was at 20.2% of all individuals and there was a slight male predominance comprising 54.5% of the adults. In this population a fairly high rate of pathological lesions was seen. Thus, dental conditions generally were poor with a high degree of dental abrasion, an also high rate of carious dental lesions (affecting between 13.8% and 27.7% of the yaws) and consequently a significant number of dental abscesses (mean 15.9%). Residues of trauma were observed in a considerable number of individuals ranging between 12.3% and 22.6% depending on the burial place (mean 15.8%). Inflammatory bone reactions (except the dental abscesses) were present to variable extent, in some locations ranging up to 6.8% of the cases (mean 5.1%). In addition, we noted several cases showing cribra orbitalia (mean 29.2%) and porotic hyperostosis (15.4% of cases), mild to severe osteopenia (7.5%) and in several cases subperiosteal new bone formation suggestive of chronic vitamin D-deficiency ("scurvy") (9.5%). The data support the notion of a significant impairment of living conditions in a high number of individuals. The rates of osteoarthrotic joint alterations were considerably variable depending on the burial places (between 1.9% and 18.5%) providing insight into the physical activities of subpopulations in different locations of the burial places. Similarly, the rate of spondylosis showed also variable extent ranging between 12% and 66.1% of vertebral bodies. In general, our analysis provides evidences that the living conditions in the ancient Egyptian population of one of the main necropoles of Thebes analyzed in this study were quite poor. This is somewhat in contrast to the usually assumed high standard of living of the socially higher population of the capital of ancient Egypt.

Adolescent↗
PubMed1998

[Contribution of databases to regional and supra-regional quality improvement in rheumatologic treatment and patient management. Professional Society of Regional Cooperative Rheumatic Disease Centers].

The uniform database of the German Collaborative Arthritis Centers is an important instrument for health services research, the observation of outcomes of daily rheumatological care, and for quality assessment in rheumatology. Deficits concerning modern medical and comprehensive therapy in non-specialized outpatient care were shown. The data give evidence of the benefits of the initiation of rheumatological care. Data of practice variation in rheumatology are used for internal quality assessment.

Arthritis, Rheumatoid↗
PubMed1998

Incidence and prevalence of juvenile chronic arthritis in East Berlin 1980-88.

OBJECTIVE: To estimate the incidence and prevalence rates of juvenile chronic arthritis (JCA). METHODS: The study population was children under 16 years of age living in the East Berlin area (part of the former German Democratic Republic). By admission order that was effective up to 1990, all children with symptoms of a rheumatic disease living in the East Berlin area had to be referred to the 2nd Children's Hospital at Berlin-Buch. This specific condition allowed us to ascertain cases from the clinical records and to calculate population rates. Based upon this data, the results of surveys with different methods of case ascertainment are compared. RESULTS: An incidence rate of 3.5 per 100,000 and a prevalence rate of 2.0 per 10,000 children were calculated. The frequency of JCA is higher for girls, with an incidence of 4.3 per 100,000 and a prevalence of 2.3 per 10,000. The figures for boys are 2.7 per 100,000 and 1.7 per 10,000, respectively. CONCLUSION: Because of the specific prerequisites, the population rates of prevalence and incidence that were based on clinical records can be regarded as valid in this study. Deviant results of other surveys can be explained by differences in the study design or in the diagnostic procedures used.

Adolescent↗