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Biomedical subjects

M Klett

Publications and source records attributed to M Klett.

At least 19 recordsLinked to original sources
PubMed2006

[Independent dental patient consultation service--experiences of the information center for the Rhine-Neckar district].

Patients should be the focus of health care - or so resounds the frequently heard cry of politicians, consumer protection groups and patient representatives. It cannot be denied that the increased co-determination of the insured and of patients in the health service is a sign of the times. Demanding ever increasing health insurance premiums and exacting higher additional contributions from patients on the one hand without increasing their say and their rights on the other hand meets with little sympathy. Spouting like a mantra about "personal responsibility", the "voice of the patient" or the "sovereignty of the consumer" in talk-shows or studio debates is not sufficient. Words must be followed up by actions in order to give patients the necessary skills to enable them to make autonomous decisions. One step in this direction is the model of an independent dental consumer and patient advisory service in the Rhine-Neckar district health authority presented here and sponsored by the central associations of the health insurance companies in the scope of the funding provided under section sign 65 b SGB V [Social Security Code]. Since 2001 over 4000 people seeking advice have received information about dental treatment, planned therapies or legal issues. More than half of those seeking advice are between 40 and 70 years old and the number of women outweighs the number of men. The majority of patients want an independent second opinion, demonstrating the limits of call centres or Internet advice services. The anonymity of the consultation is an important factor for those seeking advice. The successful integration of the advisory service is evident, not only from the high number of consultations, but also from the fact that the majority of those seeking advice have been referred to the service by their respective health insurance company. For various reasons it can be assumed that there will be an increasing demand for qualified dental advice. It is therefore incumbent on health policy to create a regulatory framework and to ensure the funding on a broader base. Wherever possible the public health service can take control, ensuring the independence of the advisory service and guaranteeing that group interests remain outside.

Adolescent↗
PubMed1999

Effect of iodine supply on neonatal thyroid volume and TSH.

A cross-sectional study was performed to prove the correlation between iodine intake and neonatal thyroid volume in a randomized group of 100 mother/newborn pairs. Thyroid volume and iodine excretion were measured by ultrasound and urinary iodine excretion, respectively. Iodine intake and, nutritional and smoking habits were estimated by questionnaire. In 89 mother/child-pairs the data were complete for all parameters and have been analyzed: 32 mothers substituted with iodine tablets, average dose 175 microg K-Iodide/day. Iodine excretion of prenatally iodine-substituted newborns increased by 62% whereas neonatal thyroid volume was reduced by 18% compared with the non-iodine-supplemented group. Smoker's newborns (n = 8) had a thyroid volume 20% larger than that of newborns of non-smokers. Neonatal TSH-screening values remained within normal limits.

Cross-Sectional Studies↗
PubMed1999

[Quality management of health examinations of schoolchildren--factors influencing the quality of documentation of preliminary examinations before school admittance].

Quality management for screening programmes of preschool children is a valuable tool to manage the process of investigation, data computing and evaluation of data and its systemic biases. As an example the quality of structure and processing of the system was evaluated for selected criteria in order to prove plausibility. Results identify computing process as a main criterion for quality management since it includes individuality of the investigator as well as the several factors due to the setting of investigation process (time, premises, computing, plausibility and individual factors). As a main influencing factor could be identified the time-span for investigation and commitment of the investigator. Selected training facilities for the investigators could improve quality and commitment and are qualified as an instrument for quality protection.

Child, Preschool↗
PubMed1998

Childhood tuberculosis: an index measuring the ability to detect cases early.

SETTING: Tuberculosis control programmes are conventionally monitored using data from sputum smear positive adult patients. Good overall results may mask significant and avoidable shortcomings with tuberculosis control in children. OBJECTIVE: To develop a specific surveillance tool for child patients, using the ability to detect cases early as a parameter for the impact of control measures. DESIGN: A simple index of early detection was compiled with values ranging from 0 to 100. Three groups of tuberculous children diagnosed in Germany between 1985 and 1994 (n = 303), and five other groups from the literature, were used to make a preliminary assessment of the validity of the index. RESULTS: The index values of 10, 13 and 24 for the German groups correlate well with other analysed patient data and the different functions of the institutions where the patients were diagnosed. Comparable characteristics could be found when applying the index to published data of other cases, with values of between 12 and 74. CONCLUSION: The proposed index seems suitable for monitoring early detection of child cases. Unexpected trends can be disclosed or effects of changed programme activities assessed. Routine use of the index would help the health services focus their attention on problem areas and specific patient groups with extremely low or falling index values. Conclusions can be drawn regarding the overall impact of the control programme.

Adolescent↗
PubMed1998

Childhood tuberculosis in Germany between 1985 and 1994: comparison of three selected patient groups.

SETTING: Clinical and epidemiologic features of childhood tuberculosis in Germany are unknown for recent years. The characteristics of patient groups may show typical differences, depending on the source of data. OBJECTIVE: To identify typical features of childhood tuberculosis in Germany, and to relate the characteristics of patient groups to the purpose of the reporting centres. DESIGN: Comparative, retrospective, descriptive analysis of clinical and notification records by standardized data sheet. Evaluation of cases of active tuberculosis in children recorded between 1985 and 1994 at three study centres. RESULTS: One clinical study centre was a referral centre for sick children with an unclear diagnosis, the second specialized in tuberculosis, and the third was a public health office. Almost two thirds (64%) of the 285 evaluated patients were four years of age and under. Between 73% and 96% of children suffered from pulmonary disease and 17% to 58% were culture positive (range between study centres). Source cases had been found for 23% to 52% of children, and the primary reason for clinical evaluation was a positive tuberculin test for between 12% and 57%. Foreign-born children showed characteristic differences. CONCLUSION: The characteristics of reported childhood tuberculosis differ depending on the reporting centre. A significant number of notified cases were probably wrongly diagnosed.

Adolescent↗
PubMed1997

Epidemiology of congenital hypothyroidism.

According to world-wide data obtained from neonatal thyroid screening programs congenital hypothyroidism (CH) occurs with an incidence of 1:3000 to 1:4000. Differences of CH-incidence are more likely due to iodine deficiency thyroid disorders or to the type of screening method than to ethnic affiliation. CH is caused by an absent or defective thyroid gland classified into agenesis (22-42%), ectopy (35-42%) and gland in place defects (24-36%). Although a few cases of thyroid dysgenesis have been described as a result of gene mutations, there is no common link to explain the etiological background of the majority of cases. Neonatal screening is severely affected by iodine deficiency leading to an increasing rate of false positive, transient and permanent cases of CH. Despite of low T4 and T3 levels the majority of low-birth-weight infants are not at risk of transient hypothyroidism. Neonatal screening in early discharged neonates mostly is not recommended before day 4. Since the intellectual outcome of CH seems below normal in Germany a CH registry and monitoring program on a national basis is recommended.

Congenital Hypothyroidism↗
PubMed1993

Neuropsychological effects of chronic exposure to environmental dioxins and furans.

The environmental contamination by dioxins and furans (PCDD/PCDF) of a local area in southwest Germany due to pyrolytic processes led to a survey of health consequences in the exposed population. 2,3,7,8-TCDD (8000 ng/kg TE (ppt)) was found in the soil and up to 585000 ng/kg TE in attic dust in private homes. In a randomized study group of definitively exposed persons, a neuropsychological test battery was applied and its value as a diagnostic tool investigated. A total group of 19 persons participated in a standard neuropsychological examination including common procedures to evaluate mnestic and attentional performance and psychomotor speed (e.g., WAIS, WMS-R, TMT, and symptom and mood checklists). The range of PCDD/PCDF between 16 and 80 (mean 31) ppt did not vary substantially from blood fat values in a national sample. Results of neuropsychological testing showed only slight deviations from the expected range. Nevertheless, in a high-level exposure group, a reduction of verbal conceptualization, mnestic organization of verbal and visual stimuli, and psychomotor slowing was found. Among other correlations visual exploration speed (TMT) was most directly related to TE. Affective symptoms (such as irritability and emotional instability) were also related to exposure. Results indicate that standard neuropsychological testing can be recommended for the routine evaluation of chronic dioxin exposure.

Adolescent↗
PubMed1991

["Adopt a healthy lifestyle..". A motivation program to control risk factors of arteriosclerosis in students].

To reduce coronary heart disease risk factors in children an intervention study among 9-year old students and their 40-year old parents was implemented. 348 subjects were in grade 3 at six elementary schools. All students and some 50% of their parents participated in a comprehensive health instruction and nutrition education program. In addition, an integrated school-based clinic offered facilities to take part in a cholesterol screening activity attracting 89% of students and 50% of parents. As a result, 19% of the students and 51% of the parents whose cholesterol levels exceeded the WHO recommendation of 200 mg/dl were counselled for that reason. Besides that, natural opportunities to lose weight and to reduce fat consumption were trained in an integrated approach. Health knowledge was tested and proved to have increased by 50% at the end of the activities. The programme may reduce chronic disease risk by increased efforts to improve repetition and implementation of health activities.

Arteriosclerosis↗
PubMed1988

[Mental development in congenital hypothyroidism. Results of a survey in 14 European countries].

Although newborn screening for congenital hypothyroidism was introduced into Europe as late as 1975, its high acceptance rate has quickly led to its wide use in most European countries. One would expect early diagnosis with early onset of treatment to result in normalization of previously impaired mental development. One may conclude from results obtained in 790 children up to the age of seven years that normal mental development is assured if levothyroxine is administered within the first four weeks of life. This also applies to children with athyroidism: their mental development is not different from that of children with an ectopic thyroid.

Age Factors↗
PubMed1987

[Significance of iodized table salt on the iodine supply of adults and children].

In 42 families from Dortmund iodine intake by dairy products, sea-fish and iodized salt used at home was measured. Urinary excretion of iodine in 24 h-urine samples and spontaneous samples before and after the use of iodized salt was estimated in each person. TSH levels were measured in 71 persons before and after the introduction of iodized salt. Mean daily intake of iodine by milk and sea-fish was calculated as 53 micrograms/d in adults and adolescents (greater than 12 years, n = 95), 57 micrograms/d in pupils (greater than 6- less than 12 years, n = 36) and 40 micrograms/d in small children (less than 6 years, n = 20). The median of iodine excretion in 24 h-urine samples before the use of iodized salt (after 6 months of use) was 61 micrograms/d (77 micrograms/d) in men, 30 micrograms/d (49 micrograms/d) in boys aged more than 12 years, 39 micrograms/d (49 micrograms/d) in women and girls aged more than 12 years, 21 micrograms/d (33 micrograms/d) in pupils and 21 micrograms/d (28 micrograms/d) in small children. There was a corresponding increase of iodine excretion in spontaneous urine samples. These data agree with our estimation of an additional intake of about 20 micrograms iodine/d. In 11 children and adolescents with stage I goiter serum levels of TSH tended to be lower after using iodized salt for 6 months. An adequate additional intake of iodine of about 100 micrograms/d in German adults can not be met by the exclusive use of iodized salt (20 micrograms/g) at home, as the intake of iodized salt is far below the 5 g/day necessary to meet this goal.

Adolescent↗
PubMed1986

Regional variations of iodine nutrition and thyroid function during the neonatal period in Europe.

In order to evaluate further the possibility that transient hypothyroidism and hyperthyrotropinemia in newborn infants could result from a state of relative iodine deficiency, the urinary concentration of iodine, used as an index of the dietary intake of iodine was determined in casual urine samples collected in 1,076 full-term infants aged 3-6 days in 16 cities in 10 different European countries and in Toronto, Canada. In addition, the results obtained by programs of systematic neonatal screening for congenital hypothyroidism in the same areas were compared. There were marked regional differences in iodine nutrition during the neonatal period in Europe (median urinary iodine: 16.2 micrograms/dl in Rotterdam, the Netherlands, and 1.1 micrograms/dl in Freiburg, FRG. A low iodine supply in newborn populations was accompanied by, and probably explained, an elevated frequency of transient disorders of thyroid function in young infants. Iodine prophylaxis is urgently needed in some European countries not only for the prevention of goiter, but mostly for the prevention of impairment of thyroid function during the critical period of brain development.

Canada↗
PubMed1981

[Neonatal screening for hypothyroidism in the Federal Republic of Germany (author's transl)].

Screening for neonatal hypothyroidism was introduced in 1979 in nearly all West German provinces on a regional basis as an additional preventive investigation. In February 1980 provincial control was replaced by uniform financing of screening for the whole country by public sick funds. Eleven out of 14 regionally organised screening laboratories took part in an enquiry into the incidence, clinical symptoms and causes of inborn hypothyroidism. Among 427 430 newborn infants tested 137 children with inborn hypothyroidism were detected in 1979/80. The incidence of 1:3100 corresponds to European figures. On average treatment could be instigated by the 12th day of life. Clinical symptoms of hypothyroid newborns differed in part markedly from classical signs of hypothyroidism. About 30% of the mothers had goitre. The cost-benefit relationship of newborn hypothyroidism screening is 1:10.

Germany, West↗