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PubMed1987

[Potentials of invasive cardiological diagnosis and therapy in West Germany. A comparison with other European states and the USA].

On the basis of a market analysis on the part of industry, the cardiological and cardiosurgical investigation and treatment capacities in 13 West European countries and in the USA are examined. With 2.0 adult left-heart catheter centers per million inhabitants or about 500,000 inhabitants per center, West Germany takes fourth place behind the USA (4.0), the Netherlands (3.2) and Switzerland (2.3). With regard to cardiac surgery, West Germany takes last place in the European comparison with less than 0.6 cardiac surgery centers per million inhabitants. The widespread use of transluminal coronary angioplasty (PTCA) is limited by the fact that only 28% of all cardiological centers in West Germany can ensure preparedness for emergency cardiac surgery operations in the same hospital. However, experience in the United States shows that less a proliferation of cardiac surgery centers than additional instruments and staff in the available facilities in West Germany would be desirable for economic and medical reasons.

Adult↗
PubMed2005

Time series of metals in mosses and their correlation with selected sampling site-specific and ecoregional characteristics in Germany.

GOAL, SCOPE AND BACKGROUND: The UNECE Heavy Metals in Mosses Surveys provide exposure data (Predicted Environmental Concentrations--PEC) for ecotoxicological risk assessments by measuring the accumulation of several metals in naturally growing mosses throughout Europe. Germany took part in the monitoring campaigns 1990, 1995 and 2000. The article deals with the description and application of the extensive methodical design developed to investigate the following three hypotheses: 1. The metal accumulation in mosses measured at up to 1000 sites may be geostatistically extrapolated from the sampling sites to ecoregions in order to transform the site-specific PEC values to surface PEC values. 2. The metal specific measurement values may be aggregated to metals integrating accumulation indices. 3. The ecoregional situation as well as sampling site-specific topographical features such as altitude, slope gradient or direction influence the accumulation of metals in mosses. METHODS: The methodical design integrates several data sources as well as statistical analysis and GIS techniques: The site-specific data on metal accumulation are geostatistically transformed to valid surface data on metal accumulation. The sampling site-specific measurement data and the estimated surface data on the accumulation of As, Cd, Cr, Cu, Fe, Hg, Ni, Pb, Sb, Ti, V and Zn are aggregated to integrative metal accumulation indices by means of percentile statistics. The metal-specific estimated data and the metals integrating accumulation indices are correlated with site-specific data on altitude, slope gradient and direction as well as with the ecoregional conditions derived from a multivariate ecoregionalisation. The mean multi-metal accumulation index for the whole of Germany over the ten year period from 1990 to 2000 was related to the accumulation indices within each of the ecoregions and each of the monitoring campaigns 1990, 1995 and 2000. In addition to this ecoregionalisation of the temporal trends of metal accumulation, the hot spots of accumulation are mapped. RESULTS AND DISCUSSION: The Heavy Metals in Mosses Survey 2000 reveals low metal concentrations in most European countries. In Germany, all metals decreased about 22% (Cu) to 64% (Pb) from 1990 to 2000. Mapping concentrations as dot maps deliver the most unbiased and detailed picture of the spatial structure of the metal accumulation in mosses. This information, detailed with respect to metal species and sampling site, is spatially generalized by means of geostatistical estimation. According to the cross-validation, the precision of the geostatistical estimation is quite good so that the extrapolation does not bias the spatial structure, but helps to clarify it. By percentile statistics, an ordinally scaled multi-metal accumulation index is calculated and spatially differentiated over time in terms of ecoregions which were calculated by means of Classification and Regression Trees (CART). The integrative statistical analysis reveals declinations of up to 80% of the multi-metal accumulation in some of Germany's ecoregions from 1990 to 2000. CONCLUSION: The monitoring of heavy metal bioaccumulation by means of mosses is an effective and cheap method for the analysis of the environmental concentrations of metals accumulated in terrestrial ecosystems. Geostatistics, percentile statistics, cross-tabulations and ecoregionalisation serve well to clarify the spatial and temporal trends in the large data sets coming out of the UNECE Heavy Metals in Mosses Surveys: By combining these statistical methods and integrating them into a geographical information system (GIS), they allow to detect and map the spatial-temporal trends of metal accumulation, to calculate metal-integrating accumulation indices, to describe temporal trends of metal accumulation within ecoregions, and to detect and map hot spots. RECOMMENDATION AND PERSPECTIVE: The spatial and temporal trends of metal accumulation in mosses should be linked with deposition data and data on the vitality of forest ecosystems, as well as with data on human health. Statistical valid interspecies calibration is needed. The integrated methodology of data evaluation presented in the article at hand should be implemented in the future UNECE Heavy Metals in Mosses Surveys. The hot spot areas should be investigated with special care in the 2005 survey to prove if the PEC values of the metals exceed the Predicted no Effect Concentrations (PNEC values). In addition to the metals, the 2005 survey should monitor the nitrogen accumulation in mosses.

Bryophyta↗
PubMedDate not supplied

Intake of heavy metals from foods in Finland, West Germany and Japan.

Comparison of heavy metal intakes between Finland, West Germany and Japan suggests that the average oral exposure to lead and cadmium in Finland is 30-40% of that in the other two countries. Environmental contamination is the obvious cause of high heavy metal content of vegetables and liver in West Germany and Japan and this explains a part of the difference observed in the intake rates. For example cabbage and lettuce in West Germany contain on average over 10 times more lead than the corresponding Finnish products. On the other hand a part of the difference is explained by food consumption habits. For example there is a high consumption of fish and seaweed in Japan, and beer in West Germany, and these products also significantly contribute to intake of heavy metals. Since international comparisons of intakes of food contaminants are at present inaccurate and difficult to conduct, a co-ordinated international study should be implemented. The analytical work should be centralized or alternatively an intercalibration of participating laboratories could precede the actual study. The sampling should cover polluted areas in proportion to their yield of crops.

Cadmium↗
PubMed2002

Cost estimation of thyroid disorders in Germany.

To assess the economic effects of thyroid disorder-related morbidity in Germany, a systematic review of national and international literature from 1981-2001 was performed. Data from insurance companies, the government department of public health, and the federal office of statistics helped characterize the situation in Germany. Being the most important thyroid disease, endemic iodine-deficiency goiter causes economic costs of approximately 2.1 billion DM per year or 1 billion Euros or 1 billion U.S. dollars. In recent years iodine supplementation of food became better accepted by the German population. This should significantly reduce the prevalence of goiter from 30%-40% to less than 10%. Functional thyroid disorders are observed in 5%-10% of the German population. A more differentiated view of these conditions should lead to specific guidelines for an economic screening and therapy of subpopulations. Lacking valuable data, an actual economic assessment of autoimmune or malignant thyroid diseases cannot be performed. On the other hand, with respect to the costs of specific thyroid therapy, e.g., radioiodine treatment of thyrotoxicosis (mainly toxic nodular goiter), the economic consequences of a new regulation for radiation protection in Germany have been demonstrated recently. Using the actual maximum permissible level of residual activity on discharge from the hospital after radioiodine therapy, length of hospitalization was shortened to 5.1 days in university hospitals and to 5.8 days in nonuniversity institutions. Payment per patient for radioiodine therapy was 1,856 and 1,530 Euros (median value) in university and nonuniversity hospitals, respectively. In conclusion, better prevention of iodine deficiency and its long-term consequences should effectively reduce direct as well as indirect costs and overall economic impact of endemic goiter as the most important thyroid disease in Germany. Sustainable elimination of iodine deficiency is technically possible, but it needs further commitment and support at all levels.

Costs and Cost Analysis↗
PubMed1998

Quality circles in ambulatory care: state of development and future perspective in Germany.

OBJECTIVE: To survey the quantitative development of quality circles (peer review groups; QC) and their moderators in ambulatory care in Germany, to describe approaches to documentation and evaluation, to establish what types of facilities and support is available and to assess opinions on the future importance of QC. DESIGN: Cross-sectional survey using a standardized questionnaire and supplementary telephone interviews. SETTING: All 23 German regional Associations of Statutory Health Insurance Physicians (ASHIP) were surveyed. RESULTS: The total number of QC in ambulatory care in Germany increased rapidly from 16 in 1993 to 1633 in June 1996, with about 17% (range 1.0-52.1%) of all practicing physicians (112 158) currently involved. Throughout Germany, 2403 moderators were trained in 168 training courses by the qualifying date. Follow-up meetings were held or being planned in 20 ASHIP, with approximately 39% (23-95%) of the moderators participating. Systematic documentation of QC work was undertaken or planned in all 23 ASHIIP, and 10 ASHIP carried out comparative evaluation, with at least five others planning to start it. The ASHIP promoted the work of QC by providing organizational (22) or financial (20) support, materials (20) or mediation of resource persons (16). Eleven ASHIP received grants from drug companies. ASHIP rated the future importance of QC as increasing (18) or stable (four), but in no case as decreasing. CONCLUSIONS AND RECOMMENDATIONS: The quantitative growth of QC in Germany is encouraging, but the extent of support and evaluation appears insufficient. Increased methodological support and facilitation, follow-up meetings on a more regular basis, improved documentation and evaluation of individual QC, and problem oriented evaluation of their impact on health care are essential for further successful development. Principles, problems and solutions discussed may be relevant for similar QI activities in other countries.

Ambulatory Care↗
PubMed2002

No difference in the incidences of vasculitides between north and south Germany: first results of the German vasculitis register.

OBJECTIVE: To register all newly diagnosed patients with primary systemic vasculitis (PSV) in two large regions in north and south Germany. METHODS: Between 1 January 1998 and 31 December 1999, all newly diagnosed cases of PSV, as defined by the Chapel Hill Consensus Conference 1992, were identified in two large mixed rural/urban regions in north and south Germany with a combined population of 4,880,543, for a population-based prospective study. The following sources were used: (i) all departments of every hospital, including their out-patient clinics; (ii) all departments of pathology; and (iii) all reference immunological laboratories serving the catchment area. All cases were re-evaluated by the authors. RESULTS: Over the whole period, 473 individuals were registered as having a new PSV. The incidence rates for all PSV were 54 cases per 1,000,000 inhabitants in the north and 48 in the south in 1998, and 48 and 41 respectively in 1999. People 50 yr and older had a three- to five-fold higher risk of getting PSVs than those under 50 yr. The incidences of antineutrophil cytoplasmic antibody (ANCA)-associated PSVs [Wegener's granulomatosis (WG), microscopic polyangiitis (MPA) and Churg-Strauss syndrome (CSS)] remained stable in both regions, at about 9.5 per 1,000,000 annually. The incidence of WG was two to three times greater than those of MPA and CSS. There was no difference in incidence rates between north and south Germany. CONCLUSION: First results from a population-based vasculitis register serving nearly 5,000,000 inhabitants in north and south Germany revealed no regional differences in the incidence of all PSVs between north and south. The incidence rates of ANCA-associated PSVs, such as WG and MPA, were lower than those in the UK and Norway but higher than that in Spain.

Adolescent↗
PubMed2005

A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury.

OBJECTIVE: Symptom expectation for whiplash injury has been shown to be low in countries with low rates of chronic whiplash when compared with countries like Canada, where chronic whiplash is common. The objective of the current study is to compare the frequency and nature of expected "whiplash" symptoms in Germany with that in Canada. METHODS: A symptom checklist was administered to two subject groups selected from local companies in Germany and Canada. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle collision and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both groups, the pattern of acute symptoms anticipated closely resembled the symptoms of acute whiplash victims, but 50% of Canadians also anticipated symptoms to last months or years, whereas few German subjects selected any symptoms as likely to persist. CONCLUSIONS: In Germany, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. The current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Germany may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.

Adult↗
PubMed2005

The impact of the Women's Health Initiative Randomized Controlled Trial 2002 on perceived risk communication and use of postmenopausal hormone therapy in Germany.

OBJECTIVE: The purpose of this representative, nationwide telephone survey was to collect information about postmenopausal hormone therapy (HT) use in relation to women's knowledge about the Women's Health Initiative Randomized Controlled Trial 2002 (WHI-RCT) in Germany. DESIGN: During July 2003, telephone interviews were conducted with randomly selected women aged 45 to 60 years (N = 10,030; response 59.9%; completed interviews n = 6,007). They were asked about information sources regarding the WHI-RCT, and use of HT in conjunction with it. RESULTS: Most women stated that they knew about the WHI-RCT (88.6%), and those with high educational status appeared to have more information than those with middle or low educational status. Among informed women (uninformed excluded), 46.6% continued, 25.7% stopped, and 14.2% ceased use of HT before the WHI-RCT. The prevalence of lifetime use of HT was higher in West Germany (37.4%) than in East Germany (29.2%), the highest prevalence of use was in the group aged 55 to 59 years. The most common reason to continue HT was the benefit risk assessment by physicians (58%); the most common reason to stop HT were women's perceptions that the risks of HT exceeded the benefits (56%). If information was solely given by physicians, women were more likely to continue HT (60.4%), compared with mass media (46.1%), as a source of information. CONCLUSIONS: The survey demonstrates the impact of the WHI-RCT in Germany, and shows that both the media and advice given by physicians were important. Women who continued to use HT did so largely because of their physician's advice. Women who discontinued were mainly those who had a negative subjective perception about risk of HT.

Age Distribution↗
PubMed1999

Seroprevalence of Bartonella henselae in cats in Germany.

Bartonella henselae and B. quintana infections in man are associated with various clinical manifestations including cat-scratch disease, bacillary angiomatosis and bacteraemia. While cats are the natural reservoir for B. henselae, the source of B. quintana is unclear. In this study, the sera of 713 cats from Germany were examined for the presence of antibodies against B. henselae, B. quintana or Afipia felis by an indirect immunofluorescence assay (IFA). Bartonella-specific antibody titres of > or =50 were found in 15.0% of the cats. There was substantial cross-reactivity among the various Bartonella antigens, although single sera showed high titres against B. henselae but not against B. quintana and vice versa. Antibodies against A. felis were not detected in any of these cats. Statistical analysis indicated that there is no correlation between Bartonella infections and the sex, age or breed of the cat or its hunting behavior. There was also no correlation between bartonella and toxoplasma infections in cats. However, whereas 16.8% of cats from northern Germany had B. quintana-specific antibodies, only 8.0% of cats from southern Germany were seropositive for B. quintana. No statistically significant difference was found for B. henselae. IFA-positive and IFA-negative sera were used for immunoblot analysis including B. henselae and B. quintana. Marked reactivity was observed with protein bands at 80, 76, 73, 65, 37, 33 and 15 kDa. The results of this study suggest that B. henselae, and possibly a B. quintana-related pathogen, but not A. felis, are common in cats in Germany, and that there are differences in the geographic distribution of bartonella infections in cats.

Animals↗
PubMed2004

Empirical data on the varicella situation in Germany for vaccination decisions.

As epidemiological data concerning varicella in Germany were not available, a retrospective study was conducted to investigate the impact of the disease, focusing also on economic aspects. A representative German-wide sample of 1334 unvaccinated varicella cases was obtained in 1999 from randomly selected paediatric (P) and general, as well as internal, mainly adult (A), practices. Following representative weighting, the median age was 5 years, with 90% of cases aged < 12 years. The highest incidence was in children aged 5-6 years. Varicella-related complications occurred in 5.7% of patients, and accounted for 0.1 hospital days/case on average. Certificates of sick leave were issued for 1.3 sick days/case, with 0.6 days paid by health insurance funds to parents caring for their sick child, and 0.7 days paid by the employer. With an annual incidence of 760,000 diagnosed cases in Germany for the year 1999, this amounts to an annual cost of c.150 million Euro, with c. 50 million Euro paid by the statutory health insurance system. It was concluded that universal varicella vaccination in Germany would provide essential clinical improvements for patients and prevent hospital admissions. In addition, significant economic benefits can be expected, mainly because of the high level of indirect health costs in Germany.

Adolescent↗
PubMedDate not supplied

Delivery of medical care for migrants in Germany: delay of diagnosis and treatment.

BACKGROUND: Migrants form 9% of Germany's population and 13% of its capital Berlin. Only limited data are available regarding general health status and prevalence of tropical diseases among migrants in Germany. This study was conducted to investigate the spectrum and frequency of tropical diseases among migrants in Berlin and to evaluate the quality of the medical care provided. The necessity of a routine screening for tropical diseases among migrants was assessed. METHODS: Anonymized data of migrants presenting to the Berlin Institute of Tropical Medicine between 1999 and 2004 with a stay in Germany below 1 year (n= 153) were analyzed. RESULTS: Of all examined migrants, 48% needed immediate medical treatment and 38% carried an infectious disease, mainly nematodes and intestinal protozoa. 19% suffered from a noninfectious disease, mainly anemia, and 12% were transferred to other specialists for further investigation. These figures were similar among asymptomatic and symptomatic patients. The median duration of stay in Germany until presentation was 42 days. While 40% of the migrants were examined within the first 4 weeks of their stay, 20% had not received a medical examination after 6 months. Of this population, 50% required treatment upon presentation. CONCLUSIONS: The high proportion of delayed diagnosis and treatment indicates a lack of medical service for migrants. While this clearly translates into increased health risks for the individual patient, it also indicates a potential risk for transmission of communicable diseases in the community. The lack of a correlation between symptoms and detected infectious disease indicates the need for a standardized routine screening examination in all migrants.

Adolescent↗
PubMed2000

International comparisons of child injuries and prevention programs: recommendations for an improved prevention program in Germany.

OBJECTIVES: To compare child injury mortality in Germany with that of four neighboring countries, and to examine injury prevention models in these countries with a view to improving prevention programs in Germany. METHODS: Based on official cause of death certificates, child injury mortality rates in Germany are compared with those of Austria, The Netherlands, Sweden, and Switzerland. The main structures and funding of injury prevention programs in these countries are described. RESULTS: In all five countries, mortality is highest among children aged 1-4 years for home and leisure accidents and drownings. Transport accidents are the main cause of death in the 5-14 age group. Mortality in both age groups has fallen significantly since 1980, most markedly in Sweden and The Netherlands. CONCLUSION: Drawing on the injury mortality data and experience of the comparison countries, the following recommendations are proposed to further reduce home and leisure injuries among children in Germany: (1) establish a soundly funded, central institution responsible for child injury surveillance, research, and the coordination of injury prevention activities, (2) improve product control legislation, and (3) disseminate specific safety information to target groups and the general public.

Accident Prevention↗
PubMed2004

Regional variation and time trends in mortality from ischaemic heart disease: East and West Germany 10 years after reunification.

STUDY OBJECTIVE: Within Europe, a pronounced geographical gradient of mortality from ischaemic heart disease has been observed with the highest burden in the north east and the lowest in the south west. The study objective was to compare mortality from ischaemic heart disease between former East and West Germany since reunification. DESIGN: Analyses of age standardised mortality rates from ischaemic heart disease (ICD-9 410-414, ICD-10 I20-I25) between 1990-1991 and 2000. SETTING: Former East and West Germany. MAIN RESULTS: After a peak in the early 1990s, mortality from ischaemic heart disease has substantially declined in both parts of Germany (from 222 to 169 per 100 000 in the East and from 150 to 116 per 100 000 in the West). The regional difference, however, remained rather constant: the rate ratio between the pooled mortality in the East compared with the West was 1.51 (95% CI 1.46 to 1.56) in 1991 and 1.45 (95% CI 1.39 to 1.50) in 2000. These rate ratios were higher in women (1.63 in 1991 and 1.52 in 2000) compared with men (1.45 and 1.44, respectively). CONCLUSIONS: Within Germany, there has been a pronounced east-west gradient of mortality from ischaemic heart disease since reunification. Further insight into possible underlying reasons may lead to improved preventive strategies.

Adolescent↗
PubMed1994

Kaposi's sarcoma in HIV infected women in Germany: more evidence for sexual transmission. A report of 10 cases and review of the literature.

OBJECTIVE: To assess the natural history of Kaposi's sarcoma (KS) in HIV-positive women living in Germany. METHODS: All physicians reporting the diagnosis of KS in a female patient were contacted and asked for detailed information. DESIGN: Descriptive study of clinical, epidemiological and immunological data of ten women with biopsy-proven KS living in Germany were evaluated. The results are compared with those of other previously published studies of women with KS from Italy, France and the USA. SETTING: Five centres in Germany. RESULTS: Of 765 German women with AIDS, only 10 (1.3%) were reported to suffer from Kaposi's sarcoma (KS) compared with 1771 of 8128 men (21.8%). Mean age in these women was 39.7 years. KS was the first AIDS defining event in nine women and the reason for HIV-testing in three. The mean CD4 count was 215/microliters. Two patients were of African origin, had only recently come to Germany and were most likely to have acquired their HIV-infection in Africa. Three patients were i.v.-drug users (IVDU). Two of these (and most likely all three) had worked as prostitutes. Of five women who had contracted HIV via heterosexual contacts, one worked as a prostitute and the other four were married to or were living together with a bisexual HIV-positive man. All four male partners have also developed KS. The course of the disease seems to be particularly aggressive in female patients with eight of 10 women presenting with or progressing to widely disseminated disease with extensive involvement of internal organs. In this cohort survival was longer in females who acquired their HIV infection heterosexually compared to IVDU and was strongly correlated with higher CD4-counts at diagnosis. CONCLUSIONS: KS seems to run a particularly aggressive course in women. Our data are consistent with a sexually transmittable aetiological agent of KS. Prostitution, an issue yet to be addressed by other authors reporting series of women with KS, was reported in four of our patients. Further studies are needed to clarify the significance of this finding.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison.

OBJECTIVE: To assess the negative health consequences and associated costs of cigarette smoking in Germany in 2003 and to compare them with the respective results from 1993. METHODS: The number of deaths, years of potential life lost (YPLL), direct medical and indirect costs caused by active cigarette smoking in Germany in 2003 is estimated from a societal perspective. The method is similar to that applied by Welte et al, who estimated the cost of smoking in Germany in 1993. Therefore, a direct comparison of the results was possible. Methodological and data differences between these two publications and their effect on the results are analysed. RESULTS: In 2003, 114,647 deaths and 1.6 million YPLL were attributable to smoking. Total costs were euro21.0 billion, with euro7.5 billion for acute hospital care, inpatient rehabilitation care, ambulatory care and prescribed drugs; euro4.7 billion for the indirect costs of mortality; and euro8.8 billion for costs due to work loss days and early retirement. From 1993 to 2003, the proportionate mortality attributable to smoking remained relatively stable, rising from 13.0% to 13.4%. The smoking-attributable deaths in men is lowered by 13.7% whereas that in women increased by 45.3%. Total real direct costs rose by 35.8%, and total real indirect costs declined by 7.1%, rendering an increase of 4.7% to real total costs. Accountable factors are changes in cigarette smoking prevalence and in disease-specific mortality and morbidity, as well as a rise in general healthcare expenditure. CONCLUSIONS: Despite the growing knowledge about the hazards of smoking, the smoking-attributable costs increased in Germany. Further, female mortality attributable to smoking is much higher than it was in 1993.

Adult↗
PubMed2001

The experience of breath as a therapeutic intervention - psychosomatic forms of breath therapy. A descriptive study about the actual situation of breath therapy in Germany, its relation to medicine, and its application in patients with back pain.

CONTEXT: Breath is a central element both in Eastern spiritual practice and in breath therapy, a treatment developed in Germany over the last 90 years. Among physicians, little is known about the working methods, goals, basic concepts, providers, and benefits for specific medical diagnoses of breath therapy. OBJECTIVE: To investigate the actual circumstances of breath therapy in Germany, its relation to medicine, and its application in patients with specific diagnoses. DESIGN: Descriptive study. SETTING: Germany. STUDY SUBJECTS: Members of the national association of breath therapists. INSTRUMENT: Questionnaire developed at Berlin Free University Medical Center in collaboration with the national association of breath therapists. OUTCOME MEASURES: Degree of approval/disapproval to given answers to semi-closed questions. RESULTS: Breath therapy, as practiced in Germany, is a therapeutic method distinct from somatic therapy and psychotherapy. It is primarily applied by nonmedical therapists in a private practice setting. Through the experience of physical sensations from the nonmanipulated breath rhythm, this method provides a physically grounded, deep personal experience of an integrated sense of self. Breath therapy appears to be particularly helpful in patients with chronic back pain. CONCLUSIONS: Results suggest that breath therapy brings about its therapeutic effect through enhanced proprioception which, as other studies have shown, is deficient in patients with chronic back pain. This first descriptive study on breath therapy is limited by the use of self-reports from therapists which cannot control for provider bias. This therapeutic intervention deserves further investigation and controlled clinical research.

Adult↗
PubMed2006

Prescription practice for LH-RH analogs and androgen receptor antagonists in the treatment of advanced prostate cancer in Germany (1993-2003).

INTRODUCTION: Nearly 80% of the patients suffering from advanced stages of prostate cancer in Germany are treated currently with luteinizing hormone-releasing hormone (LH-RH) analogs alone or in combination with androgen receptor antagonists. The aim of this study was to assess whether the prescription practice for LH-RH analogs and direct antiandrogens between 1993 and 2003 parallels the rise in the incidence rates for prostate cancer associated with the proportional rise in daily doses. METHODS: Between 1993 and 2000 a yearly randomly selected number of receipts has been evaluated from official pharmacies in Germany which have been billed to public health insurance companies. Data concerning drug use, number of daily doses, and total cost of the respective drugs have been calculated by the Research Institute of the AOK (Wissenschaftliches Institut der AOK, WIdO). These prescription data have been related to incidence and mortality rates of patients with prostate cancer. RESULTS: Between 1993 and 2003 the age-standardized incidence rate of carcinomas of the prostate has risen by 180%, while the disease-specific mortality practically has remained nearly at the same level. The daily prescribed doses of LH-RH analogs have risen by a factor of 8.5 from 3.9 to 33.5 million daily doses during this time. In contrast, the daily doses of androgen receptor antagonists have remained unchanged between 1997 and 2001, followed by a rise of 50% between 2001 and 2003. CONCLUSIONS: The first analysis of the prescription practice of antiandrogens in the treatment of prostate cancer with respect to the incidence rates in Germany could only be facilitated by the fact that these medications are in exclusive use for this indication in Germany. The rise in prescriptions may be explained by the therapy shift from surgery to LH-RH application until the year 2000; the reasons for a further rise since 2000 remain speculative. In conclusion, only prevalence data would allow the exact calculation of medication needs among prostate cancer patients.

Aged↗
PubMed1989

[Epidemiology of malignant melanoma in West Germany in an international comparison].

The incidence and mortality of malignant melanoma (MM) has markedly increased in the Federal Republic of Germany. The data available show a doubling of incidence in the past 15 years and a doubling of mortality in the past 30 years. Germany holds a middle range in the incidence list of MM compared to worldwide data: 6-8 MM were registered per 100,000 inhabitants and year in Germany during the mid eighties, whereas 5 x higher incidences where reported from Australia and the southern states of the USA; incidences higher than 6-8/100,000 where found in the Scandinavian countries. While sun exposure is regarded as the most important risk factor in the international epidemiology of MM, a relationship between sun exposure and increasing risk of MM could not be clearly established for the German population. In contrast, the total number of melanocytic nevi (MCN) and the occurrence of dysplastic nevi where found to be significant markers of an increased relative risk for developing MM in the German population. The increase of the relative risk was 16 x for persons with greater than 60 MCN compared to individuals with greater than or equal to 10 MCN and there was an additional 7 x increase of the relative risk for persons with greater than or equal to 1 dysplastic nevus. The course of the disease is lethal in most cases of metastatic malignant melanoma. 90% of all patients in the Federal Republic of Germany, however, were first diagnosed in clinical stage I (= primary tumor alone) and the average 10 years survival rate was 70% in the time period since 1970. Multivariate regression analysis revealed that the most important prognostic factors in stage I MM were tumor thickness and sex. This finding should be taken into consideration for a prognostic classification of stage I MM.

Cross-Cultural Comparison↗