[The Situation of Employed Doctors in Outpatient Care in Germany: Results of an Empirical Study]. / Zur Situation der angestellten Ärztinnen und Ärzte im ambulanten Sektor in Deutschland: Ergebnisse einer empirischen Studie.

AIM: At present, there are only a few reliable findings on the ever-increasing number of doctors employed in outpatient care. Therefore, some results of a nationwide quantitative survey of persons in this occupational group will be presented and discussed here. METHOD: The study is a standardized quantitative survey of physicians employed in the outpatient sector. The target population is represented by a disproportionately stratified sample from the databases of the Association of Statutory Health Insurance Physicians of the federal states. A total of 10,580 doctors were contacted and the response rate was 21.8%. The sample design not only allows descriptive analyses for small subpopulations to be carried out but also regional disparities to be taken into account. RESULTS: It can be shown that mainly young female doctors take up employment in the outpatient sector. 59% of doctors work part-time, the average weekly working time is 28.9 h. A medical office employs about 4 doctors and on average (median) about 30 people are treated per day. CONCLUSION: An important reason for the steady growth of this occupational group may be the flexibility of working hours and the possibility of part-time work, which in turn has a positive effect on the compatibility of family and career. Finally, yet importantly, this could be the reason why this occupational group seems to consist predominantly of young female doctors. Often, however, this kind of employment also represents a transitional model towards a private practice or - for former practice owners - into retirement. In general, however, being employed in outpatient care seems to be the desired "normal working model" for many doctors.

Homozygosity of the d3-growth hormone receptor polymorphism is associated with a high total effect of GH on growth and a low BMI in girls with Turner syndrome.

OBJECTIVE: The protein polymorphism of the GH receptor caused by genomic deletion of exon 3 (d3) has been linked to the magnitude of the first-year-growth response to GH in girls with Turner syndrome. Here, we studied the long-term effect of GH therapy in Turner syndrome in correlation to this polymorphism. DESIGN: The study was mainly retrospective. PATIENTS: The women with Turner syndrome (n = 48) had been treated with GH over the past 18 years at our hospital. The mean GH dose used was 38 microg/kg/day (SD 8). MEASUREMENTS: The GHR-exon 3 locus was genotyped using a PCR multiplex assay for both alleles and a second PCR assay for the full length (fl) allele only. RESULTS: The fl/fl, d3/fl and d3/d3 genotypes were present in 24, 17 and 7 women, respectively. Mean Turner height standard deviation scores (SDS) at start of therapy was 0.09 (1.09), mean age was 9.1 years (3). Age, height, target height, age at start of puberty and mode of GH therapy were not different between the groups. Total gain in height (difference between final adult height and initial height) was significantly higher in the d3/d3 group [+1.84 SDS (0.31)] than in the fl/fl group [+0.72 SDS (0.92)] and in the d3/fl group [+0.83 SDS (0.93)] (P < 0.001). A covariance analysis confirmed the effect of the polymorphism. Mean BMI SDS at the start and end of therapy was low in the d3/d3 group and significantly lower than in the fl/fl group (P < 0.04). CONCLUSIONS: Our data suggest that homozygosity for the d3-GHR polymorphism is associated with a unique GH responsiveness and a weight regulation towards a lower BMI in girls with Turner syndrome.

Similar effects of long-term exogenous growth hormone (GH) on bone and muscle parameters: a pQCT study of GH-deficient and small-for-gestational-age (SGA) children.

BACKGROUND AND AIMS: Treatment with GH in short children has focused on height development. Little is known about the concomitant changes in muscle mass, bone structure and bone strength. METHODS: Muscle area as well as parameters of bone architecture (bone mineral content, BMC; volumetric cortical density, total bone area, TBA; cortical area, cortical thickness, CT; and marrow area) were measured by means of pQCT (Stratec) at 65% of the proximal length of the forearm. The strength-strain index (SSI) was calculated as an indicator of bone strength. RESULTS: Prepubertal children with GHD (mean values: age; 7.2 years; height SDS=-2.9 SDS; GH dose: 30 microg/kg/d) were followed at 0, 6, 12 (n=74) and 24 (n=55) months. Prepubertal children with SGA (mean values: age: 7.1 years; height SDS=-3.4 SDS; GH dose: 55 mug/kg/d) were followed at 0, 6, 12 (n=47) and 24 (n=35) months. Both groups showed a similar increase in height. At GH start, muscle mass and bone characteristics were lower than normal but similar in SGA vs. GHD. Muscle area (mean values, SDS) increased from -3.0 to -1.5 in SGA and from -2.4 to -1.0 in GHD. Bone geometry changed in a biphasic mode, with an increase in total bone area and lowering of bone mineral content (BMC) during the first 12 months, followed by an increase of BMC and CT thereafter. SSI (mean values, mm(3)) improved from 78 to 114 in GHD and from 62 to 101 in SGA after 24 months on GH. The increment in terms of SDS did not reach significance in SGA. SSI correlated positively with muscle area before and during GH treatment. CONCLUSIONS: Bone strength and muscle mass are impaired in prepubertal children with GHD and SGA. Exogenous GH can indirectly improve bone structure and strength by inducing an increase in muscle mass. Our findings support the assumption that, in SGA, there is impaired tissue responsiveness to GH.

Growth during the first two years predicts pre-school height in children born with very low birth weight (VLBW): results of a study of 1,320 children in Germany.

Children born with very low birth weight (VLBW) are at risk of impaired growth. We aimed to study VLBW survivors (90.8%) born in 1998/1999 in the state of Baden-Württemberg (n = 2103) for whom growth data were available up to age six. Classification as appropriate for gestational age (AGA) or small for gestational age (SGA) depended on size at birth. Models to predict height SDS at 5 y were developed using data for 1 yr (Model 1) and 2 yrs (Model 2). The data of 1320 (63%) children were available: SGA: n = 730, AGA: n = 590. At 6 yrs, 8.3% AGA and 13.4% SGA children were short (<-2.0 SDS). The following factors explained Ht SDS at 5 (and 6) yrs (order of importance): (a) Model 1 (n = 1033; R2 = 0.52; error: 0.84 SDS): 1st yr Ht SDS, mid-parental height (MPH) SDS, 1 yr weight SDS, birth weight SDS; (b) Model 2 (n = 991; R2 = 0.72; error: 0.65 SDS): 1st yr Ht SDS; change (2nd yr) in Ht and weight SDS; MPH SDS; 1st yr weight SDS; birth weight SDS. Thus, some AGA and SGA children born VLBW remain short and preventive strategies need to be developed for those at risk.