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PubMed1997

Perinatal mortality in Bavaria, Germany, after the Chernobyl reactor accident.

As has been shown by the authors of a paper recently published in this journal, a deviation from a long-term trend in perinatal mortality within the former Federal Republic of Germany occurred in 1987, i.e. 1 year following the Chernobyl disaster. It is the aim of this study to make a comparison between the areas of the state Bavaria. Germany, with different fallout levels as well as between the observed and expected numbers of perinatal deaths relating to these areas. The expected numbers of perinatal deaths, defined as external standard, were derived from the remainder of the former FRG. Testing an a priori formulated hypothesis revealed no differences in the temporal development of perinatal mortality between the areas with different fallout levels and subsequent exposure. Including May 1986 into the analysis revealed a significant increase during the first 3 months after the accident, which is due to an excess in May alone. Since no elevated radiation risks for the last days in utero are known, the additional Chernobyl radiation exposure is not plausible as a causative agent. Further analyses on stillbirths showed an increase in Southern Bavaria during the first 2 years following the accident. Later on, the rates were comparable to the expected values again.

Fetal Death↗
PubMed2004

[Cleft lip and cleft palate birth rate in Bavaria before and after the Chernobyl nuclear power plant accident].

BACKGROUND: Cleft lip and palates (CLP) occur with a frequency of between 1 and 2 cases in 1000 live births and thus belong to the most frequent congenital anomalies. In the former German Democratic Republic (GDR), records covering 1967-1989 for CLP newborns show a 9.4% increase of the prevalence of CLP from 1987 to 1989, possibly due to Chernobyl. DATA AND STATISTICAL METHOD: In Bavaria, all congenital malformations in children's hospitals have been recorded from 1984 to 1991. Among these data, 1324 cases with CLP were found. A spatial-temporal analysis aimed at uncovering a possible association of the CLP occurrence with the Chernobyl fallout on a district level, as well as a synoptic analysis of the GDR and Bavarian data, were carried out. RESULTS: In Bavaria, from October 1986 to December 1990, the CLP frequency increased by 9.5% (p=0.10) relative to the trend as computed from the remaining years. The association of CLP rates with fallout on a district level is reflected by a significant relative risk (RR) per kBq/m(2) of RR=1.008 (p=0.03). A synoptic analysis of the Bavarian data and the GDR data restricted to the overlapping time window from 1984 to 1989 discloses a simultaneous significant jump of the CLP prevalence by 8.6% (p=0.02) after 1986. CONCLUSION: The presumption of a long-term increase of CLP after exposure to Chernobyl fallout is corroborated by the analysis of the Bavarian congenital malformation data.

Abnormalities, Radiation-Induced↗
PubMed1988

Surveillance of diagnostic and treatment measures in Bavaria, 1974-1976. Results 2 and 5 years after the start of chemotherapy.

A central surveillance register for all bacillary pulmonary tuberculosis cases reported in Bavaria (population in excess of 10 million) was established from 1974 to 1976. The aim of the study was to discover the quality and efficiency of health services delivery to the population in the field of tuberculosis under routine conditions, and to find out the relapse rate after cessation of chemotherapy in expatients who were found to be negative 2 years after starting chemotherapy. A total of 7850 German patients with bacillary pulmonary tuberculosis were diagnosed in Bavaria from 1974 to 1976 corresponding to an average annual rate of 25.7 per 100,000 population: 71% of them were smear-positive and 29% were positive by culture only. Reactivations formed 25% of all bacteriologically confirmed cases. Most (71%) smear-positive new cases were discovered because of symptoms. Of the 5157 cases of bacteriologically confirmed pulmonary tuberculosis reported during 1975 and 1976, 4% died from tuberculosis, 1% from sequelae of tuberculosis and 9% from causes other than tuberculosis. A further 3% of patients had drug side-effects, 3% were uncooperative, 2% emigrated or had no permanent address and 1% had no chemotherapy or no information on treatment. The overall results of treatment were very satisfactory: sputum conversion among 3991 patients in the group with complete treatment was achieved in 97.4% at 2 years, and in those with incomplete treatment in 96.2%. The duration of chemotherapy was long, i.e. 19 months or more in two thirds of the patients. The average reactivation rate during the 3rd, 4th and 5th follow-up years was 0.8% annually; it was higher among males than females and the rate increased with age. Of the 157 patients found to be bacteriologically positive at 2 years after the start of chemotherapy 46 died during the 3-year observation period and 109 were alive at 5 years, 23 of whom were harbouring tubercle bacilli.

Adult↗
PubMed2001

Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study.

BACKGROUND: Occupational skin diseases (OSDs) account for a large portion of occupational diseases in Europe, but population-based epidemiological studies are missing. OBJECTIVES: We analysed the initial reports of OSDs in our register of OSDs in Northern Bavaria (BKH-N). METHODS: A total of 5285 cases were assessed prospectively and registered from 1990 to 1999. As the German Federal Employment Office provides specific occupational data in relation to the total employed population of Northern Bavaria, it was possible to conduct a population-based study that investigated the trend in incidence rates between two study periods (1990-92 and 1993-99) in 24 different occupational groups. RESULTS: A total of 3097 cases of OSD (median age 25 years) were recorded in the 24 occupational groups. There was a significant decline (P < 0.001) in the overall incidence rate of OSD with 10.7 cases per 10,000 workers per year for the first study period and 4.9 cases per 10,000 workers per year for the second study period. This general trend in incidence rates was also significant for hairdressers and barbers, bakers, health-care workers, cooks and metal processors. CONCLUSIONS: The BKH-N provides national data based on the notification of OSDs in Germany. The results demonstrate the rank of occupations hazardous for the skin and are helpful for defining target groups for prevention.

Adult↗
PubMed2002

[Death by illegal drugs in Bavaria-data from 1990 up to 2000].

Abstract. Mortality has often been regarded as a measure for overall outcome and both treatment and drug policy effectiveness. The number of deaths by illegal drugs from the years 1990 - 2000 in Bavaria were analysed using statistical trend tests (Spearman rho and Kendall tau). In Bavaria in general (p = 0.014) as well as in 5 out of seven counties a significant increase in drug related mortality was found.

Cause of Death↗
PubMed2004

[Surveillance of notifiable infectious diseases in Bavaria - results in 2002].

In 2002 nearly 36 000 cases of notifiable infectious diseases were reported in Bavaria representing a 10 % increase compared to 2001 (33 000 cases). As in 2001, around 75 % of reported cases were gastrointestinal infections. Every third infection was due to salmonella. As compared to last year, the incidence of Norwalk-like virus infections increased fivefold. These infections occurred mostly as outbreaks in nursing homes, hospitals or other institutions, affecting as many as 200 persons. Other frequently reported infections in Bavaria are tuberculosis and hepatitis. The relatively high incidence of measles is mainly due to an outbreak in Coburg. The decline in the incidence of tuberculosis observed over the last years has ceased. Around 70 % of reported hepatitis cases were due to hepatitis C. It should be noted that these cases were a mixture of new infections and ongoing infections diagnosed for the first time. Of great epidemiological importance are diseases caused by meningitis pathogens. The incidence of meningococcal infections was practically unchanged as compared to last year. Around half of them were caused by serotype B, which is currently not preventable by vaccination. Meningitis caused by Haemophilus influenzae B is continually declining due to the high vaccination rate and is very rarely reported. Several cases of FSME were described. According to investigations carried out by health departments these infections were acquired in countries not yet classified as FSME risk areas. Hence, the endemics maps of FSME have to be revised. Two years of reporting according to IfSG (infectious disease control law) yielded very encouraging results, i. e. rapid accessibility of data, flexibility, complete and standardised reporting with high quality of data. We thank all the reporting physicians and laboratories and the staff of the Bavarian health departments for their continuous support.

Adolescent↗
PubMed2004

[Radiation exposure and image sharpness of mammographic units in bavaria with respect to the European guidelines].

In a survey including all mammography units in Bavaria, entrance doses in air and other quality-relevant parameters were measured with standard settings and under comparable conditions. The study was aimed to discover discrepancies between practical mammographic imaging techniques and the demands established in the European Guidelines. Test images were made by the operators themselves with phantoms used for constancy checks. Entrance dose values were measured with official film dosimeters. The survey showed that more than 95 % of all mammographic units in Bavaria comply with the European guidelines with respect to radiation exposure and imaging sharpness.

Female↗
PubMed2004

[Death by illegal drugs in Bavaria 1990 up to 2002].

OBJECTIVE AND METHOD: In our paper we report about drug mortality in Bavaria in the years 1990 up to 2002, using statistical trend tests (Spearman rho, Kendall tau). RESULTS: We observed an increase of deaths by illegal drugs in Bavaria as whole, on the other hand also decreases in different parts of the country.

Cause of Death↗
PubMed2004

[Prehospital treatment of the acute coronary syndrome in the emergency medical services in Bavaria].

BACKGROUND AND OBJECTIVE: Regarding patients suffering from cardiovascular diseases, the most common reason for call-outs of German emergency physicians is in 37.2 % of cases, the acute coronary syndrome (ACS). Despite substantial improvements in diagnosis and therapy a reduction of mortality rate has not been documented. METHODS: 200,221 protocols of emergency physicians were analyzed regarding the prehospital treatment of ACS by German emergency physicians. It was a retrospective analysis from available protocols of the emergency medical services in Bavaria. RESULTS: Within 15 minutes after the emergency call the physician reached 92.2 % of the patients. The time to treatment averaged 23.2 (+/- 3.3) minutes. In 37.5 % of the call-outs there was only a slight danger, while in 35.6 % an acute life-threatening event was the reason for hospitalization. Hypertension existed in 52 % of the patients. 25.5 % had a tachycardia, with ECG-changes increased with age and severity of the syndrome. In 93.9 % an emergency-ECG was recorded but only in 8.5 % a 12-channel-ECG. Most frequently (39.1 %) analgetics were administered. Vasodilatators followed in 29.1 %, sedatives in 19.5 %. Antiemetics (18.1 %) were associated with the use of opioids. Typical cardiovascular drugs, such as catecholamines (10.6 %), antihypertensives (10.8 %), antiarrhythmics (9.9 %) or diuretics (7.1 %) were given less frequently. In 68.6 % of the cases the condition improved after medical intervention, in 28.1 % it remained unchanged and in 3.3 % it deteriorated CONCLUSION: Structural and logistic conditions for an early care in Bavaria are provided for prehospital treatment of patients with ACS. However, life support provided by paramedic personnel and medical therapy by the emergency physician still can be improved. The actual protocol of emergency physicians does not provide a complete view of the prehospital medical care.

Acute Disease↗
PubMed2003

Phenotypes of macrolide resistance of group A streptococci isolated from outpatients in Bavaria and susceptibility to 16 antibiotics.

The purpose of the present study was to determine the antimicrobial resistance among Streptococcus pyogenes in Bavaria, Germany. Five hundred and forty isolates of S. pyogenes were collected from patients with tonsillopharyngitis. Of these, 425 isolates were obtained from children and 115 from adult patients. All isolates were tested for susceptibility to macrolides, clindamycin, penicillin and 10 other commonly prescribed antimicrobial agents, using broth microdilution tests. All isolates were fully susceptible to penicillin, amoxicillin and cephalosporins; 16.1% of the isolates were resistant to tetracycline. MIC(90) values of erythromycin, clarithromycin, azithromycin and josamycin were 16, 4, 16 and 0.5 mg/L. The overall resistance rate of S. pyogenes to erythromycin, clarithromycin and azithromycin was 13.3%. All isolates resistant to erythromycin were also resistant to clarithromycin and azithromycin, and vice versa. Erythromycin resistance rates were higher in adult patients (19.1%) than in children (11.8%). The resistance rate to josamycin was only 1.5%, a value similar to that of clindamycin (1.1%). Among the 72 erythromycin-resistant isolates the M phenotype of macrolide resistance predominated (78%), while percentages of cMLS(B) (8%) and iMLS(B) (14%) phenotypes were low. Of the iMLS(B) strains (n = 10), the majority were of the subtype C (n = 8). The M phenotype was associated with a low, and the iMLS(B)-C phenotype with a high, rate of resistance to tetracycline. Conclusively, present data point to rising macrolide resistance among S. pyogenes in Bavaria.

Anti-Bacterial Agents↗
PubMed2004

Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.

BACKGROUND AND PURPOSE: Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support. METHODS: The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 hours per day. RESULTS: A total of 106 systemic thrombolyses were indicated via teleconsultations between February 1, 2003, and April 7, 2004. During the first 12 months, the rate of thrombolyses was 2.1% of all stroke patients. Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admission was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred in 8.5% of patients, and in-hospital mortality was 10.4%. CONCLUSIONS: The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to nonurban areas.

Aged↗
PubMed2002

["...so that he himself must use all his energy to control the hallucinations...". King Otto of Bavaria and Munich psychiatry around 1900].

King Otto of Bavaria (1848-1916), brother of "Dreamking" Ludwig II., had suffered from a severe psychiatric disorder since he was an adolescent. According to court manners of the time the psychopathological symptoms were at first neglected. After a public scandal in 1875 Otto was treated by the Munich psychiatrist Bernhard von Gudden who used a variety of methods. These changing therapeutic measures reflected the scientific development of psychiatry during the second half of the 19th century. Since 1879 Otto, together with his princely household, was put into Fürstenried Castle near Munich where the so-called "Prinzenärzte" took over responsibility for medical care. In Fürstenried, the neuropathologist Franz Nissl, who served as Otto's "Prinzenarzt" from 1885 to 1887, brought into perfection his famous staining methods for neuronal tissue. Despite his mental incapacity Otto was proclaimed king of Bavaria after the dreamkings's death in 1886. The close connection between the "High Patient" and his doctors strengthened the social position of psychiatry as a public task.

Famous Persons↗
PubMedDate not supplied

[The occurrence of transmissible spongiform encephalopathies in roe deer (Capreolus capreolus), red deer (Cervus elaphus) and chamois (Rupicapra rupicapra) in Bavaria].

Brain samples of 849 free-ranging ruminants (654 roe deer, 189 red deer and 6 chamois) from Bavaria were examined for TSE. In this respect, detections of PrPres were carried out by ELISA technique (BioRad) and immunohistochemistry using the monoclonal antibody (mAb) L42. Validation experiments of the ELISA technique for the detection of prionprotein from free-ranging ruminants showed that the examination of brains of wild ruminants lead to lower extinctions than that of bovine brain samples. Due to the fact that brain samples of 2 known CWD positive wapitis showed definite positive results, all samples were analysed by this test. There were no indications on the occurrence of TSE in any of the sample. In addition, immunohistochemical investigations of 10% of all samples did not show PrPres. Due to the large number of samples, the prevalence of TSE in Bavaria can be quoted under 0.5% for roe deer and under 1.5% for red deer with a certainty of 95%.

Animals↗
PubMed2006

Social structures and social relations--an archaeological and anthropological examination of three early Medieval separate burial sites in Bavaria.

As part of an interdisciplinary cooperation, three early medieval separated burial sites from central Bavaria were subjected to archaeological and anthropological examinations. Separated burial sites are probably an expression of social stratification. This paper focuses on two characteristic aspects of these separated burial sites: (1) structure of the site, and (2) biological manifestation of a social upper class. The separated burial grounds Etting/Sandfeld (31 individuals), Grossmehring (44 individuals) and Kelheim (43 individuals), all located in southern Bavaria, were analyzed. Sex and age at death of all individuals were determined, and dietary behaviour was reconstructed by means of carbon and nitrogen isotope ratios in bone collagen. Local conditions such as climate, soil conditions or the intensity of agriculture can provoke significant variations in plant delta15N-values, which could lead to a shift of the baseline values of the corresponding trophic web. To facilitate the comparison of isotopic data from different sites, delta15N values of cattle bones were taken as a reference for the human data (presuming the diet to consumer chain). The results of dietary reconstruction indicate that the populations enjoyed very good living conditions with a primarily animal protein-based diet. Furthermore, the isotope analysis revealed more detailed indications for certain individuals regarding their social status. Some individuals can even be appointed as possible chiefs of the population, since anthropological and archaeological interpretations were in total agreement: It was possible to identify persons of a higher social status based on the structure of the burial site, grave goods and the isotopic analysis.

Adult↗
PubMed1988

[The biological monitoring of ecologic cadmium exposure in the free state of Bavaria].

In 1984/1985 631 blood-donors settled in different regions of Bavaria took part in a "cadmium-campagne". Due to this project a substantial medical anamnesis was made and blood has been investigated to determine the cadmium level, furthermore, urine was taken for the determination of cadmium, total protein, beta 2-microglobulin, creatinine and density. In conformity with recent epidemiological investigations in Europe it was evident that the actual internal cadmium exposure - in relation to the cadmium level in blood - has not increased. Subsequently a not acceptable accumulation was excluded accordingly to the result of the proofed renal excretion of cadmium. In consideration of the established low cadmium level in biological material there was no impairment of the kidneys due to cadmium. This is also obvious in the total protein- and beta 2-microglobulin-excretions in urine which are in the normal range. By dividing the collective according to smoking habits this study confirmed, that higher values have been linked with the smokers. However, as to the age and sex there were no significant influences. The evaluation of a regional subdivision of the received samples in overcrowded regions, rural and areas far from industry did not show notable differences. Furthermore, a differentiated aspect was seen after the classification into domiciles, whereby 8 different cities, small towns and villages, resp., were considered. Despite of various differences it must be pointed out, that the cadmium level in blood as well as in urine is below the normal levels with some exceptions only. This study did not show criteria for a risk caused by cadmium which effects the general population of Bavaria.

Adult↗
PubMed1977

[The frequency of chronic and terminal renal insufficiency in childhood. Results of an inquiry in Bavaria (author's transl)].

The frequency of chronic renal insufficiency in children and adolescents up to the age of 17 was found by an inquiry addressed to 6625 doctors practising in Bavaria. The survey extended over an observation period of 5 years (1969-1974). According to the results, the frequency of chronic renal insufficiency in the age groups stated was calculated to be 8.7 per million inhabitants. An incidence of 0.83 per million inhabitants per year is to be expected for terminal renal insufficiency. From these figures the annual admissions for dialysis of patients aged between 0 and 17 years in Bavaria can be calculated at 9-13. To cater for these children with terminal renal insufficiency, the capacity must be increased from the present 10 to about 30 dialysis places in the next 5 years.

Adolescent↗
PubMed1979

[Tuberculosis in children and adolescents in Bavaria].

In 1977 in Bavaria, 7,659 cases (incidents) of tuberculosis were reported. 797 of these cases were children under 15 and 636 were youths between 15 and 20 years of age, that is 1,433 together. The first rise in cases takes place in the age bracket up to 5 years, the second, far greater, between 15 and 25. At the end of 1977 statistics showed the existence (prevalence) of 14,642 tuberculars. Of these, 1,128 were children under 15 and 858 youths between 15 and 20. Administrative districts with the most cases were Lower Bavaria (Niederbayern), Upper Palatinate (Oberpfalz), Upper Franconia (Oberfranken), and Middle Franconia (Mittelfranken). In local epidemics 190 youths and children became ill, infected in a dance hall, a discotheque, and a factory, as well as by a kindergarten teacher. Under these unfavorable circumstances a BCG vaccination is imperative. The Bavarian Home Ministry "publicly recommends" the BCG vaccination for infants as well as for all tuberculin negatives who live with people who have tuberculosis or who are otherwise endangered by tuberculosis, However, under the circumstances described, all children and young adults are still endangered by tuberculosis.

Adolescent↗
PubMed1980

[Enteritis salmonellae in man and animal from 1953 to 1975 in Southern Bavaria (author's transl)].

The present paper gives a survey of the enteritis salmonelloses in man during the years from 1953 to 1975 (19400 first isolations) and in animals in the period from 1965 to 1975 (4600 first isolations and identification) in Southern Bavaria. In Southern Bavaria the number of isolations from enteritis salmonellae in man and animal has strongly increased during the last few years and the same holds good for the number of serotypes (Figs. 1, 2 and tables 1, 2). The most frequent serotypes in man are S. typhi-murium, S. enteritidis, S. panama, and S. thompson; in animals they are S. typhimurium, S. abortus-ovis, S. infantis, S. enteritidis and S. dublin. Now as before, most isolations in man and animal occur in late summer or in autumn, especially in september. From 59 group infections in man, only in 21 cases could the source, but not the origin, be gathered from the records. In view of the short incubation time of salmonella enteritis and its prevalent incidence in medically controlled installations this is ununderstandable and critical. As to the regional distribution of the salmonelloses, the incidence in man is higher in the uban areas, in animals in rural areas. For more details please refer to the cartograms and tables (Figs. 5, 6, 7, 8). The regional distributions were analysed under various epidemiological aspects. Thus it was found that roughly a quarter of the salmonella infections in man can be assumed to originate from animals. This is probably due to the fact that selective investigations are missing, although quite frequently in a year far more salmonellae are isolated from animals than from man in some rural districts. Also the present restriction of the inspections to diseased animals is completely inadequate and this is born out by the results obtained e.g. in the Netherlands where animals are slaughtered indiscriminately. The conclusion to be drawn from this and the inadequate entries for samples sent in for analysis is that the health authorities must accelerate and intensify their selective enquiries about the identification and control of the source of infection. This applies particularly to the cooperation with factory physicians and veterinarians.

Animals↗