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Biomedical subjects

H Brand

Publications and source records attributed to H Brand.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Health targets and health reporting--significance of a basis for health reporting to achieve health targets].

This report demonstrates the benefits for future health policy performance related to a close connection between health monitoring activities and the implementation of health objectives. Health reports are basically useful for setting up and quantifying health targets, for the construction of target-related measures and evaluation procedures. On the other hand health objectives can be regarded as landmarks for the allocation of health monitoring resources. Deriving appropriate results for health policy makers from data collecting activities, health statistics, and related health reports could be more effective if these activities were connected with an elaborate health target programme. An interactive unit or working group of health target workers and health monitoring professionals is to guarantee optimum interaction between future health practice, research and policy.

Benchmarking↗
PubMed1998

[From "reporting" to "surveillance": documentation of abnormalities within the scope of perinatal data collection--a sensitive instrument for monitoring new technologies?].

Analysis of the Hamburg perinatal quality assurance programme shows a dramatic increase in congenital abnormalities of the bones, joints and muscles from 45.29 per 10,000 live births in 1990 to 106.32 in 1994. Comparisons with other perinatal quality assurance programme data reveal almost the same trend. In fact, there is no real increase in these specific congenital abnormalities, but there is an effect, which can be explained by the introduction of ultrasound hip screening in infancy signalling overdiagnostics due to the new technology. This example demonstrates that the perinatal quality assurance programme is a suitable instrument for registering congenital abnormalities and monitoring new technologies and interventions. These results support the proposal by the association of the leading state health officers (AGLMB) to use the already well-established quality assurance programmes which are analysed on state level for a systematic nation-wide documentation and "surveillance" of congenital abnormalities. In addition, it becomes clear that surveillance, understood as a further development of health reporting, offers an opportunity to effect both an assessment and a better orientation in respect of health policies.

Bias↗
PubMed1998

[Social inequalities and health: the role played by local health departments in Germany].

Social inequality in health is one of the most challenging of problems for all Public Health services. Health reports and the development of guidelines in this area are very demanding tasks. Based on the latest academic research on tackling inequalities in health, the article shows how two German cities, Potsdam and Hamburg, started to place inequality in children's health on the public agenda. With reference to research and public health policy in the Netherlands, the authors propose that the German local health departments develop similar methods of intervention in cooperation with all relevant partners in the health and social services.

Community Health Services↗
PubMed1998

[Guidelines and standards for Public Health Service: challenge and orientation for the future?].

Guidelines and standards are not only of increasing importance for clinical medicine, but also for public health services. Their influence is strengthened by a trend from reorientation of public services to well-established modern public service business. Being part of total quality management they particularly challenge organisation development and planning of human resources in the public sector.

Germany↗
PubMed1997

Immune enhancing effects of dehydroepiandrosterone and dehydroepiandrosterone sulphate and the role of steroid sulphatase.

Steroid hormones, such as glucocorticoids (GC), influence immune and inflammatory responses through their suppressive actions. Recent evidence suggests that another steroid hormone, dehydroepiandrosterone (DHEA), provides an immunostimulatory influence opposing the effect of GC. DHEA circulates in its inactive sulphated form, DHEAS, requiring conversion to DHEA by a steroid sulphatase (SS) enzyme for biological activity. Therefore, inhibition of SS activity may affect immune responses, allowing endogenous GC effects to predominate. We have shown that administration of DHEA and DHEAS in contact sensitization (CS) augments ear swelling by 39 and 46% respectively (P < 0.001). DHEAS at doses of 0.5, 5 and 50 mg/kg reverses the inhibitory effect of corticosterone (5 mg/kg) (P < 0.01). In CS, CT2251 (SS inhibitor) at 10 and 0.1 mg/kg inhibited ear swelling by 61 and 38% (P < 0.05) respectively. In addition, it inhibited DHEAS-augmented responses by 49 and 35% respectively (P < 0.05), with no effect on DHEA-augmented responses. DHEAS reversed CT2251 inhibition of the CS response with complete reversal at 50 mg/kg (P < 0.05). DHEAS and CT2251 appear to affect cellular infiltration into the ear, since DHEAS increased the number of lymphocytes by 63.8% and macrophages by 107% (P < 0.001), whereas CT2251 at 0.1 mg/kg decreased the number of lymphocytes by 65% (P < 0.001) and macrophages by 80% (P < 0.001). DHEAS, CT2251 and dexamethasone had no effect on oedema in the ear. From our data we have shown that steroid hormones, such as DHEA, have the potential to act as immunostimulatory factors in vivo. Inhibiting the conversion of DHEAS to DHEA by SS enzyme leads to an anti-inflammatory effect.

Adjuvants, Immunologic↗
PubMed1997

Effect of pressure ulcers on the survival of long-term care residents.

BACKGROUND: Past studies have emphasized that patients with pressure ulcers are at high risk of dying. However, it remains unclear whether this increased risk is related to the ulcer or to coexisting conditions. In this study we examined the independent effect of pressure ulcers on the survival of long-term care residents. METHODS: We evaluated all 19,981 long-term care residents institutionalized in Department of Veterans Affairs (VA) long-term care facilities as of April 1, 1993. Baseline resident characteristics and survival status were obtained by merging data from five existing VA data bases. Survival experience over a 6-month period was described using a proportional hazards model. RESULTS: Pressure ulcers were present in 1,539 (7.7%) long-term care residents. Residents with pressure ulcers had a relative risk of 2.37 (95% CI = 2.13, 2.64) for dying as compared to those without ulcers. After adjusting for 16 other measures of clinical and functional status, the relative risk associated with pressure ulcers decreased to 1.45 (95% CI = 1.30, 1.65). No increased risk of death was noted for residents with deeper ulcers. CONCLUSIONS: Pressure ulcers are a significant marker for long-term care residents at risk of dying. After adjusting for clinical and functional status, however, the independent risk associated with pressure ulcers declines considerably. The fact that larger ulcers are not associated with greater risk suggests that other unmeasured clinical conditions may also be contributing to the increased mortality associated with pressure ulcers.

Activities of Daily Living↗
PubMed1997

[Periconceptional multivitamin administration result in reduction of congenital abnormalities: adequate evidence for formulating national recommendations for Germany?].

In the discussion about primary prevention of congenital abnormalities, vitamins often have been picked out as a central theme in literature. In randomised controlled trials, a significant reduction of congenital abnormalities up to 17% by the periconceptional use of multivitamins (folic acid, vitamin B12, vitamin B6, vitamin C and zinc) were found. This protective effect can be explained by lower prevalence of neural tube defects, cardiovascular malformations, malformations of the urinary system, limb deficiencies and hypertrophic pyloric stenosis. Multivitamin consumption including 0.8 mg folic acid for at least 28 days before conception and continuing for at least until the second missed menstrual period, have been most effective. These findings in primary prevention of congenital abnormalities raise an import public health issue. Therefore, for women of childbearing age, there are three possibilities of primary prevention of congenital abnormalities: 1. consumption of a vitamin-rich diet, 2. supplementation of vitamins, and 3. food fortification with vitamins. With regard to an appropriate consumption of multivitamins in practice, there are many problems. To ensure that in Germany all women of childbearing age will benefit from the discussions and findings of other countries, food fortification with folic acid and other vitamins should be checked. Furthermore, implementation of a national health policy for Germany should be considered.

Congenital Abnormalities↗
PubMed1997

[Need-based resource allocation--experiences with the RAWP formula in Great Britain].

The RAWP formula used for resource allocation in Great Britain between 1976 and 1991 is a morbidity-oriented instrument of controlling, which has so far received only little attention in Germany. The development of this model was supported by the intention to intervene in the regional pattern of hospital supply by means of resource allocation and to refine it according to the guiding principles of equity and efficiency. The basic elements-regional population, average bed use, ICD chapter-specific SMRs-are discussed and the various modifications outlined. The RAWP formula's potentials of controlling resulted in a progressive reduction of the apparent disparities between regions in hospital supply, and knee was considered to be a "qualified success". The future development in the sense of an internal market addressed.

Budgets↗
PubMed1996

Tumor necrosis factor receptor-associated factor (TRAF)-1, TRAF-2, and TRAF-3 interact in vivo with the CD30 cytoplasmic domain; TRAF-2 mediates CD30-induced nuclear factor kappa B activation.

CD30 is a member of the tumor necrosis factor receptor superfamily, which can transduce signals for proliferation, death, or nuclear factor kappa B (NF-kappa B) activation. Investigation of CD30 signaling pathways using a yeast two-hybrid interaction system trapped a cDNA encoding the tumor necrosis factor receptor-associated factor (TRAF)-2 TRAF homology domain. TRAF-1 and TRAF-3 also interacted with CD30, and > 90% of in vitro-translated TRAF-1 or -2, or 50% of TRAF-3, bound to the CD30 cytoplasmic domain. TRAF-1, -2, and -3 bound mostly, but not exclusively, to the carboxyl-terminal 36 residues of CD30. The binding was strongly inhibited by a CD30 oligopeptide centered around a PXQXT (where X is any amino acid) motif shared with CD40 and the Epstein-Barr virus transforming protein LMP1, indicating that this motif in CD30 is an important determinant of TRAF-1, -2 or -3 interaction. At least 15% of TRAF-1, -2, or -3 associated with CD30 when coexpressed in 293 cells. The association was not affected by CD30 cross-linking. However, cross-linking of CD30 activated NF-kappa B. NF-kappa B activation was dependent on the carboxyl-terminal 36 amino acids of CD30 that mediate TRAF association. TRAF-2 has been previously shown to have a unique role in TRAF-mediated NF-kappa B activation, and NF-kappa B activation following CD30 cross-linking was blocked by a dominant negative TRAF-2 mutant. These data indicate that CD30 cross-linking-induced NF-kappa B activation is predominantly TRAF-2-mediated.

Amino Acid Sequence↗
PubMed1996

Preventing sudden infant deaths--the slow diffusion of an idea.

The sudden infant death syndrome (SIDS) is among the leading causes of post-neonatal mortality in industrialised countries. Research has highlighted that many of these deaths are avoidable by adopting a few simple precautions. These include sleeping in the supine position, avoiding exposure to tobacco smoke, breast feeding where possible, and avoiding over heating. The paper traces the development of understanding of the role of sleeping position in the aetiology of SIDS and the diffusion of this knowledge among and within industrialised countries. In retrospect, evidence began to become available in the early 1980s but it was several years before it was acted upon, initially in The Netherlands and subsequently in New Zealand, the United Kingdom and Scandinavia. Several countries have mounted major national preventive campaigns, of various kinds, each of which has been associated with a reduction in deaths from SIDS, but others have not. The reasons for these differences are explored. The evidence for a causal link between sleeping position and SIDS is now very strong and the costs of implementing a policy to change behaviour is small, compared with other health care interventions. This information is now widely available in the international literature. The example of SIDS provides information on the barriers to adoption of knowledge as well as the factors that promote it.

Developed Countries↗
PubMed1996

Changing life expectancy in central Europe: is there a single reason?

BACKGROUND: During the 1980s, at a time that life expectancy at birth in western Europe has increased by 2.5 years, it has stagnated or, for some groups, declined in the former socialist countries of central and eastern Europe. METHODS: A study was carried out to ascertain the contribution of deaths at different age groups and from different causes to changes in life expectancy at birth in Czechoslovakia, Hungary and Poland between 1979 and 1990. RESULTS: Improvements in infant mortality have been counteracted by deteriorating death rates among young and middle-aged people, with the deterioration commencing as young as late childhood in Hungary but in the thirties or forties in Czechoslovakia and Poland. The leading contributors to this deterioration are cancer and circulatory disease but, in Hungary, cirrhosis and accidents have also been of great importance. CONCLUSIONS: The patterns observed in each country differ in the age groups affected and the causes of death. Further work is required to explain these differences.

Adolescent↗
PubMed1995

Denominator estimation: approaches in the Hamburg paediatric sentinel network.

STUDY OBJECTIVE: The aims were to develop an estimator for the size of paediatric practices to be used as a denominator for purposes of comparison; to analyse the age structure of the patients attending paediatric practices and to check the necessity for an age specific denominator; and to validate the denominator information by other available data. DESIGN: This was an observational study. SETTING/PARTICIPANTS: A sentinel network was set up comprising 26 self selected paediatric practices. Weekly patient contacts in relation to age and sex were counted three times during the study period of two years. In addition, accounting data, including the total number of children treated in a given three month period (quarter), were available. MAIN RESULTS: Weekly patient contact counts were stable over time, not in terms of the absolute number of contacts but in the rank positions of the practices (rs = 0.86) and in their age structure. The age distribution of weekly patient contacts differed significantly between the practices. Cross validation of the weekly contact count by means of the quarterly accounting data resulted in a rank correlation of rs = 0.90. CONCLUSIONS: Sentinel networks with paediatric practices should use age specific denominator information. Weekly contact group, estimated by counts in a sample of weeks, is a stable and easily available denominator for sentinel practices in the context of the German health care system.

Age Distribution↗
PubMed1995

[Health policy goals in child and adolescent health reporting--evaluation with reference to an intermediate-term evaluation].

As a result of the first report on the health of children in Hamburg (1990) 14 primary health policy objectives were identified and related to specific intervention fields. The health information system group at Hamburg has prepared an interim evaluative statement for 1994 on whether and how far each objective has been achieved compared to the targets formulated for the years 1995 and 2000 respectively. 8 out of 14 objectives are considered remaining unchanged as before (i.e. unintentional conception), either proceeding towards the target (i.e. low birth weight, dental health) or having reached the target for 1995 (i.e. infant mortality, age-appropriate vaccination). With 4 objectives the trend deteriorated (i.e. body weight of teenagers, accidents). One objective was monitored on the basis of a new data source (violence against children) and for one objective information could not be proved or updated (breast feeding). In traditional areas of local health policy (i.e. dental health, infant mortality) the health information system and the health targets may be sufficient to help improve the health of the city. In non-lobbied fields (i.e. breast feeding) or those without a consensus on responsibilities (i.e. violence, health and social discrimination) health reports on their own do not invoke achievements, but need to be supported by additional measures.

Adolescent↗
PubMed1994

The World Bank, the Monetary Fund, and poverty.

The debt crisis into which heavy borrowing, steeply rising interest rates, and a worldwide recession had plunged a number of developing countries in the late 1970s and 1980s was alleviated largely by policies and conditionalities imposed by the International Monetary Fund and the World Bank. These policies and conditions were meant to strengthen the export and financial markets of those countries, stabilize their currencies, and reduce the reach of their governments in their economies. However, they contributed to deepening poverty and structural crises, as the reports and data published by the international financial institutions themselves attest.

Developing Countries↗
PubMed1993

[The knee arthrometer KT-1000: value of instrumental measurement in diagnosis of complex anterior knee instability].

Clinical examination is the most accurate means of determining cruciate ligament integrity in the initial evaluation. In the case of a rupture of the anterior cruciate ligament the Lachman test has a high diagnostic accuracy, especially if the end point is absent. The Knee Arthrometer KT-1000 is a useful tool, as it is easy and fast to handle by an experienced examiner. Supplementary to noninvasive diagnostical methods it improves the confidence in clinical diagnosis. However, the importance of instrumental measurement should not be overrated even though reproducible results can be obtained. To compare the results of different studies the design has to be very similar. Although the examination conditions in this study were very homogeneous, a systematic mistake was produced. The average value of tibial displacement was significantly higher for the left knee. Data, obtained retrospectively in clinical practice, should not be used to scientifically document the results of therapeutic procedures.

Adult↗
PubMed1993

[International solutions for promoting social medicine competence in training courses--the London School of Hygiene and Tropical Medicine].

The London School of Hygiene & Tropical Medicine is an important institution for postgraduate teaching and research in public health and tropical medicine. Advanced training is provided in a wide range of disciplines leading to different qualifications. As an example the Master of Science course in Public Health Medicine is used: Training is provided by a one-year course divided in three terms. The first term starts with an orientation period and shared-core components. In the second term teaching is largely based on study units. Term three is mainly project work. A training course for membership examination of the Faculty of Public Health Medicine is also offered.

Cross-Cultural Comparison↗