Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Germany”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1986

The history of pediatric surgery in Germany.

Pediatric surgery as defined today is a very young specialty, and it was not until the middle of our century that pediatric units were established at surgical clinics in Germany. Pediatric surgery in Germany developed first in children's hospitals. The author distinguishes four stages: Stage 1: The pediatrician as operating surgeon; Stage 2: The surgeon as consultant; Stage 3: Pediatric surgical hospitals at children's hospitals; Stage 4: Pediatric surgery as an independent discipline in its own right. This chapter then relates the history of the German Society of Pediatric Surgery and the coming of age of pediatric surgery as a completely independent discipline, in which there are now 55 pediatric surgical units in the Federal Republic of Germany. The publications, textbooks, and journals listed at the end of this chapter show the advance of this discipline.

General Surgery↗
PubMed1997

How many residents shall we train--the situation in Germany.

The situation of training neurosurgeons in Germany is reviewed taking into consideration the current figures of finished residencies, the development in the number of training neurosurgical units in Germany, and the personnel and structure of a neurosurgery unit allowed to train. The jurisdiction for specialist training as well as typical problems encountered in training residents are being discussed. In 1992; 130,364 patients, equivalent to 0.94% of all patients in Germany were treated in 4.792 dedicated neurosurgical beds. A total of 644 working neurosurgeons were registered. Between 1986 and 1993, 349 residents qualified as neurosurgeons, an average of 43.5 per year. 57% of neurosurgical units employ non-trainee junior doctors, 13% have no residents, and 62% of departments trained less than one resident per year on average. Only 57% of units finish residency training always on time and only 79% of major units have full training permission. The figures provided in this article do not substantiate the assumption that we have trained too many specialists in the past. The problems which some residency programmes encounter however do suggest that it could be wise not to continue to train specialists at the same rate as in the past.

Cross-Cultural Comparison↗
PubMed2000

Social inequality and environmentally-related diseases in Germany: review of empirical results.

A literature search was conducted aiming at all empirical studies from Germany till mid 1997 containing data on the association between environmentally-related diseases and the socio-economic status (education, occupation, income, social class) and/or on the association between the exposure to harmful substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to the lower social class as compared with the higher social class. This applies to children as well as to adults and to West Germany as well as to East Germany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that allergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kidney cancer or bladder cancer), however, seem to occur more frequently in the lower social class than in the higher social class. Environmental-epidemiological studies should increasingly integrate socio-epidemiological study approaches and explicitly present their results.

Adolescent↗
PubMed1990

Worksite smoking cessation programs: need in West Germany and recommendations for evaluation.

In distinction from the USA, worksite smoking cessation programs are not yet implemented and their importance is not yet discussed in West Germany. Data from a national survey show that a majority of employees in West Germany are regular or occasional smokers and that about 50% of them are not strongly opposed to joining a smoking cessation program. A review of worksite smoking cessation or reduction programs in the USA reveals necessary characteristics of the implementation and evaluation of such programs in West Germany.

Germany, West↗
PubMed1991

Differences in the risk factor patterns for coronary heart disease in China, Japan, and Germany.

In Asia coronary heart disease mortality is almost 10 fold less frequent than in European countries. These findings attract interest to search for different risk factor patterns. From 1982 to 1985 epidemiologic surveys were carried out in China (n = 2047), Japan (n = 7580) and Germany (n = 6052). Healthy, male subjects, aged 30 to 59 years were enrolled. The prevalence rate of hypertension for the Germans was 20% versus 18% for the Japanese, and 11% for the Chinese. About 69% of Chinese, 55% of Japanese, and 37% of Germans were smokers. About 66% of the Germans were overweight (BMI greater than 25), 17% of the Japanese, and 11% of the Chinese. The highest risk group with cholesterol levels of greater than 300 mg/dl included no Chinese subject, 0.1% of the Japanese, but 5% of the Germans. The lipoprotein profiles among the Japanese and the Chinese collectives typically showed antiatherosclerotic characteristics, whereas most Germans exhibited profiles which support development of atherosclerosis. About 36% of the participants from Germany showed 3 or more risk factors accumulated per person (Japan and China 5%). Multifactorial risk factor reduction for Germany is recommended.

Adult↗
PubMedDate not supplied

Detection of the tick-borne encephalitis virus (TBEV) in ticks in several federal "Länder" of Germany by means of the polymerase chain reaction (PCR)--characterization of the virus.

The aim of the present study was to analyse the current epidemiological situation with respect to TBE in the new federal "Länder" of Germany and in Saarland through detection of the TBEV genome in unengorged ticks using an RT-PCR technique. 22,273 ticks (Ixodes ricinus) were collected in the five new "Länder" (and some in Bavaria and Baden-Württemberg) and divided into 294 pools. It was possible to detect TBEV RNA in six pools of ticks from Mecklenburg Western-Pomerania [4], Brandenburg [1], Thuringia [1] (and in three pools from Bavaria and Baden-Württemberg). The nucleotide sequence data of the PCR products were analysed and compared. In Saarland 8,780 ticks were collected in 70 habitats from all the geographic regions and analysed using the PCR in 21 pools; two pools produced positive PCR signals (Saarlouis, Perl). We cannot as a result make a general recommendation that TBE-immunization be introduced in Saarland and in the new federal Länder of Germany. In Germany, however, TBE immunoprophylaxis in Bavaria and Baden-Württemberg is very important.

Animals↗
PubMed1994

Salmonella enteritidis phage types in Germany.

In order to monitor the epidemiological situation of S. enteritidis in Germany, in 1990-91 1138 isolates from more than 180 locations in West Germany were phage typed. 1124 strains (98.8%) from all sources were typeable, belonging to 21 different phage types (PT). PT4 strains were isolated most frequently (70.8%). In addition, PT7, 25, 34 and 8 were of epidemiological relevance with incidences of 7.2 to 4.5%. The comparison of data shows that in Germany, like in other parts of Europe, PT4 predominates. This phage type is, however, infrequent in North America, where PT8 has the highest incidence.

Animals↗
PubMed1991

[Education level and participation in early cancer diagnostic studies in the Federal Republic of Germany].

In Germany only a few persons take part in cancer screening programs. In order to raise participation rates one needs to ask which subgroups of the population these efforts should focus on. Studies from other countries unanimously show that participation rates decrease with decreasing education and income. Based on this results it was hypothesized that in Germany participation rates also decrease with decreasing education. In a secondary analysis of data from a population survey conducted in Germany in 1987, the hypothesis could be supported only for employed women, whereas for men a non-significant and for not employed women a significant, association was found in the opposite direction.

Adult↗
PubMed1995

Seroprevalence of hantavirus antibodies in Germany as determined by a new recombinant enzyme immunoassay.

In order to elucidate the epidemiological importance of hemorrhagic fever with renal syndrome in Germany, the prevalence of antibodies against hantaviruses was determined in 13,358 sera from residents of various geographic regions, 1,284 sera from occupational risk groups and 287 sera from chronic hemodialysis patients. Serological investigations were performed using a highly specific transferable solid phase enzyme immunoassay based on the recombinant nucleocapsid proteins of a Hantaan and a Puumala serotype strain. The overall antibody prevalence was found to be 1.68%. In the serum panels from western and southern Germany, it was determined to be 1.83% on average in contrast to only 0.8% in the panel from eastern Germany. An endemic focus revealing an antibody prevalence of 3.12% was detected in a low-mountain area called Suebian Alb, which is located in the federal state of Baden-Württemberg. Occupational risk groups and a group of chronic hemodialysis patients showed a significantly elevated antibody prevalence ranging from 3.3% to 10%. The Puumala serotype was found to be the prevailing virus, but the percentage of sera predominantly recognizing the Hantaan nucleocapsid protein increased towards the south and the east and was significantly elevated in dialysis patients.

Antibodies, Viral↗
PubMed2003

[Prevention of sudden infant death in Germany].

In Germany there are several committed which however haven't got together yet in order to set up a systematic health education campaign. So far the knowledge of other professional fields like that of graphic designers, specialists of communication and public health scientists hasn't been sufficiently used to familiarize nearly all pregnant women, parents, grandparents and babysitters with those known medical subject matters. Hopefully paediatricians, gynaecologists, children's nurses, midwives, breast-feeding consultants, paediatric preventive assistants, consultants for pregnant women who smoke and mothers in general will soon start to get going an effective lasting and possibly nationwide preventive campaign which will be supported by the competent social ministries and financing authorities, self-help groups, graphic designers, specialists for communication and public health scientists. The aim should be to reduce the amount of sudden infant death cases to or even below the level of The Netherlands (minimum figure in 2002: 0.11 SID cases per 1.000 live births). Already in 1972-15 years before the beginning of the Dutch preventive campaign--in former East Germany a ministerial instruction had advised mothers not to let infants sleep on prone position. Historically, the promotion of infants sleeping on prone position seems to have been a tragic break of tradition in the western world in between 1970 and 1990, as infants had been put to sleep almost only on their back during the past centuries. If we compare East and West Germany concerning the influence on the ways of looking after infants since the 1960th of the last century it has become clear that the advice of medical authorities mainly effects the way of nursing regardless of the political system. More and more, paediatricians, gynaecologists, midwives and children's nurses should become aware of this responsibility.

Cross-Sectional Studies↗
PubMed2003

[Restructuring cardiovascular exercise therapy in Germany with reference to current international guidelines].

BACKGROUND: Exercise therapy has a well-established place in the primary and secondary prevention of cardiovascular disease. But its evidence-based application, or even its development, within the framework of planned disease management programs in Germany is hampered by the limitations in the structural quality of the health/fitness facilities. METHOD: Review of the literature concerning the current structure of cardiovascular exercise therapy in Germany and the USA, including current guidelines for exercise therapy in primary and secondary prevention. RESULTS: The "heart groups" represent the only organization in Germany to adhere to certain quality standards, although certain limitations in the procedural quality of their programs must be acknowledged (the evidence-based securing of the programs is relatively restricted), and their overall capacity is limited. Alternative organizations, such as fitness centers or sports clubs, do not yet offer standards of quality or safety. In the USA, in particular, there are established guidelines for exercise therapy which are edited, evidence-based, peer-reviewed and applicable to all suppliers of exercise therapy. CONCLUSION: We suggest that such standards should be brought into operation within the German context and that,as far as possible, they should be extended to include statements of mode and duration of training. The resulting guidelines, after being implemented as standards, could serve as the basis for a certification procedure applicable to all health/fitness facilities.

Adolescent↗
PubMed2002

[Deficits in management of patients with colorectal carcinoma in Germany. Results of multicenter documentation of therapy algorithms].

BACKGROUND: Adjuvant chemotherapy for patients with UICC III (Dukes C) colorectal cancer (consensus statements NIH 1990, German Cancer Society 1994) and palliative chemotherapy for metastatic disease have long been recognized to provide a survival benefit in colorectal cancer. However, it remains unclear if these concepts have made inroads into clinical practice. PATIENTS AND METHODS: Therefore, we asked 74 institutions treating colorectal cancer patients in Germany to document the treatment algorithms of all patients with colorectal cancer seen in the third quarter of 1998. Clinical careers of 1,001 patients (m/f 465/536; median age 62.9 years [28-93]; colon 596, rectum 405; UICC I 117, II 206, III 407, IV 218) were documented. RESULTS: Only 63.4% of patients with UICC III colorectal cancer received adjuvant therapy with a significant difference between hospitals with (67.1%) and without (42.6%) oncological departments (p < 0.01). Higher age appeared to be the most important factor for withholding treatment since 196 of 286 (68.5%) patients < 70 years, but only 57 of 121 (47.1%) > 70 years underwent adjuvant therapy. 78.4% of patients with UICC IV colorectal cancer (91.8% university hospitals, 76.8% hospital with, 50% without oncological departments, 66.7% rehabilitation clinics, 82.4% private practices) received palliative chemotherapy (first line: 5-FU/FA bolus 57%, 5-FU/FA infusion 20%, 5-FU mono 15%). CONCLUSION: Considering an annual incidence of colorectal cancer in Germany of 52,000 with 30% UICC III, discounting patients > 80 years or ECOG status > 2, and estimating a survival benefit of 10% after adjuvant chemotherapy, approximately 530 lifes are lost annually in Germany due to insufficient treatment of UICC III colorectal cancer based on our survey. In addition, substantial financial demand is generated by the subsequent palliative treatment of potentially curable patients.--In conclusion, survey-based analysis of treatment algorithms can provide valuable insights into clinical practice in oncology and can disclose deficits in patient care as demonstrated here in colorectal cancer.

Adult↗
PubMed2003

[No influence of urinary nitrate excretion on the goitre prevalence in Germany].

BACKGROUND: It has long been known that nitrate combined with iodiduria < 100 micro gI(-)/l has a goitrogenic effect. The cause is a partial blockage of the sodium- iodide symporter together with a hindrance to iodide absorption in the intestine. 90% of the intake of nitrate is excreted in urine. Therefore nitraturia provides information about the population. The rare epidemiological studies of the influence of NO(3)(-) on goitre are limited to a small selection of older, regional samples. Our aim was to investigate the role of nitrate in the occurrence of goitre in Germany. METHODS: Using random samples from 3,059 clinically healthy persons of both sexes between 18 and 70 years old from all over Germany, we examined nitraturia and the prevalence of goitre or nodules, including the corresponding iodiduria. (Sonography: 7.5 MHz linear transducer; nitrate determination: isocratic ion chromatography; iodide determination: cerium-arsenite method.) Both the NO(3)(-) and the iodide excretion in spontaneous urine were measured in relation to 1 g creatinine. Statistical processing: Mann-Whitney U-Test, correlation analysis, multivariate linear regression analysis. RESULTS: Median for nitraturia: 55.2 mg NO(3)(-)/g creatinine (men 61.5, women 51.5; p < 0.03). Significant increase in regional nitrate excretion from North to South and from East to West. No statistical connection between nitraturia, thyroid size and nodules. In the multivariate linear regression analysis relating to thyroid size/focal lesions, NO(3)(-) played the smallest part among the variables age, gender, body mass index, iodiduria, nitraturia. In the case of iodiduria with < 50 micro g I(-)/g creatinine (n = 71), there was a correlation between nitraturia and thyroid size (r = 0.18; p < 0.05). All persons with a nitraturia of > 60 mg NO(3)(-)/g creatinine (n = 1,166) evidenced a correlation with the thyroid size (r = 0.18; p < 0.01). CONCLUSION: Since alimentary iodine shortage in Germany has been overcome to a large extent (iodiduria 100-200 micro gI(-)/l) and the nitrate content lies clearly below the WHO limit, the goitrogenic effect of nitrate is only of individual and not of epidemiological importance. The slight regional differences in NO(3)(-) excretion are the consequence of the nitrate content in drinking water and have no effect on the thyroid gland.

Adolescent↗
PubMed2004

[Cost-effectiveness of atorvastatin in the early treatment of acute coronary syndromes in Germany based on the MIRACL study].

BACKGROUND AND PURPOSE: Cardiovascular diseases are the leading cause of death in Germany and have a huge impact on the resource consumption. Therefore, cost-effectiveness of medical therapies must be evaluated and taken into consideration. The purpose of this study is to assess the short-term healthcare costs associated with intensive lipid lowering with atorvastatin (Sortis, Pfizer) initiated within 24-96 h after the onset of acute coronary syndromes (ACS) in patients from Germany. STUDY DESIGN: Model-based, cost-effectiveness analysis. METHODS: Clinical outcome data from the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study and cost data were used to compare the total expected 16-week cost per patient on atorvastatin 80 mg/day versus placebo. Only direct costs were taken into consideration. All direct medical costs were based on the average values of 116 hospitals in Germany, which were published in December 2002. PERSPECTIVE: The perspective of the German hospitals for the year 2004 was taken. RESULTS: The total calculated cost was euro 1,750 per patient in the placebo cohort and euro 1,910 per patient in the atorvastatin cohort, resulting in incremental cost of euro 161 per patient in the atorvastatin group. The cost per event avoided was euro 4,195. Over 40% of the cost of atorvastatin treatment was offset within 16 weeks by the cost savings resulting from the reduction in the number of events in the atorvastatin cohort compared to the placebo cohort. The validity of this result was substantiated through extensive sensitivity analyses. CONCLUSION: The application of atorvastatin administered early after ACS is cost-effective, and the clinical benefits are available through marginal additional cost.

Acute Disease↗
PubMed2005

[Costs of ambulatory care for RA patients in Germany].

BACKGROUND: In 2000, the Regional Cooperative Center for Rheumatic Conditions in Hannover, Germany, initiated a project to introduce and evaluate a case-based clinical quality management system to enhance the quality of care for patients with rheumatoid arthritis. Building on that, it was possible to combine all resource uses, as paid by the sickness funds, including those in ambulatory care. METHODS: The purpose of this study was to reach average "per-visit prices" for single physician visits, not only for rheumatologists, but also for other specialists as well as generalists. Those visits all had to be connected to the rheumatic condition of the patients. All ambulatory care visits for 1 year (2001) were evaluated. RESULTS: Due to the high number of physician visits of the 338 patients with clinically assured rheumatoid arthritis included in the study (rheumatologist visits 4,488, generalist visits 3,901), statistically significant subgroups could be built. The average costs per visit associated with rheumatoid arthritis are: rheumatologist euro 22.71; generalist euro 8.02; as well as other specialties ranging from euro 5.81 to euro 19.48. The low price for generalists care is due to the selection of the cohort, as all patients are under constant specialist care. The prices were further broken down to certain subgroups of care. CONCLUSION: The prices are calculated under the premises that no budgetary constraints apply to ambulatory care. This is not the reality in Germany. Hence, looking at the average frequency of rheumatologist visits in this cohort (13.2/year), the conclusion has to be that not all rheumatologic ambulatory care is being covered by the reimbursement system within the Statutory Health Insurance in Germany.

Adult↗
PubMed2006

[Assessment of the number of cardio- and cerebrovascular events due to rofecoxib (Vioxx) in Germany between 2001 and 2004].

BACKGROUND AND PURPOSE: After the recall of rofecoxib (Vioxx), there was repeated national and international discussion on the potential number of patients harmed by causally related cardio- and cerebrovascular events. In individual cases, it cannot be determined whether a myocardial infarction or stroke that occurred during rofecoxib therapy was actually directly caused by this drug. On the basis of the results of the Vioxx Gastrointestinal Outcomes Research (VIGOR) trial and German prescription data provided by the Scientific Institute of the Local Health Care Fund, the authors therefore conservatively estimated the number of patients harmed by rofecoxib in Germany between 2001 and 2004. METHODS: Under simplifying assumptions that, as in the VIGOR study, the risk of rofecoxib or naproxen therapy can be described by a Cox model with exponentially distributed event times, it is possible to calculate the daily risk of cardio- and cerebrovascular events in patients treated with these drugs. The estimated number of patients experiencing cardio- and cerebrovascular events under rofecoxib or naproxen therapy can be calculated by multiplying the daily risks by the defined daily doses prescribed in Germany. The difference between these numbers produces the estimated number of patients harmed by rofecoxib. RESULTS: On the basis of the data pool, a total of 7,092 additional diseased or deceased patients due to rofecoxib therapy were estimated (95% confidence interval: 2,004-15,416). The simplifying assumptions made together with the underreporting of events in the VIGOR trial are more likely to lead to an underestimation than an overestimation of affected patients. When assessing the benefit-harm ratio of rofecoxib, it needs to be considered that its protective gastrointestinal effects were not assessed compared with the optimum long-term therapy. It can be assumed that a comparison of rofecoxib with a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and gastric mucosal barrier protectors (e. g., misoprostol) would not have shown an advantage in favor of rofecoxib therapy. CONCLUSION: The example of rofecoxib and the relatively high number of patients harmed by it in Germany indicate that, before widely prescribing a new drug, a more thorough assessment of the benefit-harm ratio of the drug is required as well as a stronger consideration of therapeutic alternatives and a timely conduct of meaningful clinical studies. The results of these studies should be promptly communicated in full to physicians and patients.

Adult↗
PubMed2001

The ESTRO-EQUAL Quality Assurance Network for photon and electron radiotherapy beams in Germany.

BACKGROUND: In 1998 an ESTRO Quality Assurance Network for radiotherapy (EQUAL) has been set up for 25 European countries for photon and electron beams in reference and non-reference conditions. MATERIAL AND METHODS: Measurements are done using LiF powder (DTL937-Philitech, France) that is processed with the PCL3 automatic reader (Fimel-PTW). The participating centers irradiate the TLDs with an absorbed dose of 2 Gy according to the clinical routine. RESULTS: Until September 2000 EQUAL has checked 135 photon beams (including the beams rechecked) from 51 radiotherapy centers in Germany out of 86 accepted centers. The results show that 2% of the beam outputs in reference conditions and 3% of the percentage depth doses are outside the tolerance level (deviation > +/- 5%). 6% of the beam output variations and of the wedge transmission factors show deviations > +/- 5%. The global analysis of results shows deviations > +/- 5% in at least one parameter for 18 beams out of the 135 beams checked. Five rechecked beams present one "real dosimetric" problem in one or more parameters, corresponding to 4% of the 114 beams for which the deviations cannot be attributed to set-up errors.--The EQUAL network has checked 89 electron beams in Germany. The results show that all beam outputs checked are within the tolerance level. The standard deviation for the beam output in reference conditions is 2.0% and 2.2% for the beam output for the others field sizes. The percentage of deviations > 3% and < or = 5% for the reference beam output is higher for electron beams than for photon beam checks. Therefore the electron beam calibration and the TPS algorithms should be improved to increase the accuracy of the patient dosimetry for radiotherapy. CONCLUSION: EQUAL program demonstrates a consistency in radiotherapy dosimetry for photon and electron beams resulting in a satisfying accuracy of the dosimetry in Germany.

Cobalt Radioisotopes↗
PubMed2004

Radiation therapy for nonmalignant diseases in Germany. Current concepts and future perspectives.

BACKGROUND: Radiotherapy (RT) of nonmalignant diseases has a long-standing tradition in Germany. Over the past decade significant theoretical and clinical progress has been made in this field to be internationally recognized as an important segment of clinical RT. This development is reflected in a national patterns-of-care study (PCS) conducted during the years 2001-2002. MATERIAL AND METHODS: In 2001 and 2002, a questionnaire was mailed to all RT facilities in Germany to assess equipment, patient accrual, RT indications, and treatment concepts. 146 of 180 institutions (81%) returned all requested data: 23 university hospitals (UNI), 95 community hospitals (COM), and 28 private institutions (PRIV). The specific diseases treated at each institution and the RT concepts were analyzed for frequencies and ratios between the different institution types. All data were compared to the first PCS in 1994-1996. RESULTS: In 137 institutions (94%) 415 megavoltage units (mean 1.7; range 1-4), and in 78 institutions (53%) 112 orthovoltage units (mean 1.1; range 0-2) were available. A mean of 37,410 patients were treated per year in all institutions: 503 (1.3%) for inflammatory disorders, 23,752 (63.5%) for degenerative, 1,252 (3.3%) for hypertrophic, and 11,051 (29.5%) for functional, other and unspecified disorders. In comparison to the first PCS there was a significant increase of patients per year (from 20,082 to 37,410; +86.3%) in most nonmalignant diseases during the past 7-8 years. Most disorders were treated in accordance with the national consensus guidelines: the prescribed dose concepts (single and total doses) varied much less during the period 2001-2002 in comparison with the previous PCS in 1994-1996. Only five institutions (3.4%) received recommendations to change single or total doses and/or treatment delivery. Univariate analysis detected significant institutional differences in the use of RT for various disorders. CONCLUSION: RT is increasingly accepted in Germany as a reasonable treatment option for many nonmalignant diseases. The long-term perspective and research plan will have to include various updates of PCS, re-writing of consensus guidelines, introduction of registries for rare nonmalignant disorders, and clinical controlled studies even for so-called established indications, as international acceptance is based on the criteria of evidence-based medicine.

Forecasting↗