[Mental disorders in the general population : Study on the health of adults in Germany and the additional module mental health (DEGS1-MH)]. / Psychische Störungen in der Allgemeinbevölkerung : Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH).

BACKGROUND AND OBJECTIVES: The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization. METHODS: A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire. RESULTS: The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses). CONCLUSIONS: Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.

Prevalence and severity of mental disorders in military personnel: a standardised comparison with civilians.

AIMS: Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. METHOD: 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. RESULTS: Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1-0.6; NS: OR: 0.2, 95% CI: 0.1-0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3-0.6; NS: OR: 0.5, 95% CI: 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4-5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3-8.0) were observed in DS with high combat exposure compared with civilians. CONCLUSIONS: Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.

[Pain in the sole of the foot. Differential diagnosis and therapy]. / Fussohlenschmerzen. Differentialdiagnose und Therapie.

Plantar foot pain can be caused by a wide variety of diseases. To facilitate diagnosis and treatment differentiation of two entities is useful. The first group contains those painful disturbances that are due to mechanical overload, the second group has no relation to biomechanical problems. Tightness of the gastrocnemius muscles and hamstrings are the main factors leading to mechanical overload. Therefore, thorough evaluation of these muscles and treatment of shortening by stretching exercises is of paramount importance.

Distal radioulnar joint function after Galeazzi fracture-dislocations treated by open reduction and internal plate fixation.

Nineteen Galeazzi fracture-dislocations were reviewed clinically and roentgenographically at an average of 83 months after open reduction and internal fixation. Radiographic observation of fracture reduction was correlated with clinical results. Patients with anatomic fracture reduction had minimal sequelae and better or equal functional results than patients with imperfect reduction. Manual laborers had no weakness, but nonmanual laborers showed significant deficits in supination strength. Concomitant fractures of the wrist, the hand, or both were associated with significant pronation weakness. The volar approach was associated with a significant deficit of flexion/extension range of motion (ROM). Attention was focused on distal radioulnar joint (DRUJ) function and pain. Distal radioulnar joint function was fully restored by open reduction and internal fixation of the radius and indirect anatomic reduction and functional aftercare of the DRUJ in 16 cases. Open revision, repair of the triangular fibrocartilage complex (TFCC), and immobilization of the wrist are not necessary if anatomic reduction of the joint is obtained by indirect means such as open reduction and internal fixation of the radius.

The treatment of fractures of the femoral neck.

Fifty-four femoral neck fractures in young adults (20-50 years old; Group I) were compared with 397 fractures in the elderly population (older than 60 years of age; Group III). Patients in Group I were more frequently men and had often sustained vertical shear fractures in high-energy injuries. Treatment consisted mostly of open reduction and internal fixation (88%). There were no infections, pulmonary embolisms, or deaths. The rate of avascular necrosis was 10%; the rate of delayed union or nonunion, 17%; and the revision rate, 20%. Reoperation did not preclude an excellent final outcome. Patients in Group III were mostly women who fell at home and sustained an adduction fracture, which was most frequently (80%) treated with a cemented monopolar arthroplasty. Complications included pulmonary embolisms (3.5%), other cardiovascular complications (8%), and respiratory complications (7%). The death rate during hospitalization was 6.5%; for the first year after surgery it was 21%. These complications were not more frequent with either hemiarthroplasty or internal fixation. Local complications required revision of 17% of the cases treated with internal fixation and 1.4% of the patients treated with hemiarthroplasty. In the entire series, the deep infection rate without prophylactic antibiotics was 1.5%; with prophylactic systemic antibiotics it was 0.7%. The incidence of pulmonary embolism without thromboprophylaxis was 3.2%; with fixed-dose, subcutaneous heparin it was 1.1%. Of those treatments tested, open reduction and internal fixation with cancellous bone screws (for the younger patients) and hemiarthroplasty (for the elderly patients) yield the best short-to-midterm results. In addition, thromboprophylaxis with fixed-dose subcutaneous heparin and systemic antibiotic prophylaxis will continue to be used.

The outcome of revision hip arthroplasty in patients older than age 80 years: complications and social outcome of different risk groups.

Between December 1995 and June 1996, we reviewed 53 consecutive patients who were at least 80 years old and had undergone a revision of a hip prosthesis between June 1988 and June 1995. Three patients (6%) had died after the operation in the hospital. Thirty-five patients were still alive with a mean follow-up of 4.0 years (range, 1.0-7.3 years). At follow-up, 15 patients had died, with a mean survival period of 25 months. Thirteen of the 15 (89%) belonged to American Society of Anesthesiologists' (ASA) group 3. Of 50 patients, 40 (80%) returned to their original social environment. Admission to a home for elderly people or to a nursing home was unrelated to the procedure in 9 of 10 cases. Complications occurred in 27 patients (51%). Major complications occurred only in high-risk patients, classified as ASA 3 according to the physical status classification of the ASA.

Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.

PURPOSE: To determine the prevalence and size of presumed Morton neuromas and fluid in the intermetatarsal bursae on magnetic resonance (MR) images. MATERIALS AND METHODS: In 70 asymptomatic subjects, transaxial T1-weighted spin-echo and T2-weighted turbo spin-echo images were obtained of the right forefoot. The prevalence and size of presumed Morton neuromas (diagnosed with MR imaging criteria) were evaluated, and the sizes were compared with those of 16 symptomatic, surgically proved Morton neuromas. The prevalence and diameter of fluid collections in the intermetatarsal bursae were evaluated on the T2-weighted images. RESULTS: Twenty-four Morton neuromas were diagnosed in 21 subjects (prevalence, 30%). The transverse diameter of the neuromas was 3-7 mm (mean, 4.5 mm) versus 4-8 mm (mean, 5.6 mm) in symptomatic subjects; this difference was significant (P = .0075). The prevalence of fluid in the intermetatarsal bursa was 20%, 47%, 49%, and 0% for the first through fourth intermetatarsal spaces. The transverse diameter of the fluid collection was 1-4 mm. CONCLUSION: The diagnosis of Morton neuroma at MR imaging may be relevant only when the transverse diameter is 5 mm or more and can be correlated to clinical findings. Fluid collections in the first three intermetatarsal bursae with a transverse diameter of 3 mm or less can be considered physiologic.

Patient throughput times for orthopedic outpatients in a department of radiology: results of an interdisciplinary quality management program.

The purpose of this project was to employ quality management methods in order to decrease throughput times for orthopedic outpatients sent to the department of radiology. The following intervals were measured at the onset of the study and after 6 and 12 months: (a) between arrivals at outpatient clinic and radiology counter; (b) between arrival at radiology counter and time of last radiograph; and (c) between time of last radiograph and radiology report printing time. After the initial measurement, numerous changes were initiated both in radiology and in orthopedic surgery. The mean interval between arrival at the outpatient clinic and in radiology decreased by one third from 60 min during the first measurement to 40 (p < 0.001) and 41 min during the second and third measurement. The proportion of patients with total radiology times of more than 30 min decreased from 41 to 29 % between the first and third measurements (p < 0.001). The corresponding results for radiology times of more than 45 min were 17 and 11 % (p = 0.03). A standard type of quality management program can be employed successfully in order to reduce radiology throughput times for orthopedic outpatients.

Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions.

PURPOSE: To determine the effect of magnetic resonance (MR) imaging results on diagnostic thinking and therapeutic decisions by orthopedic surgeons in cases of a possible Morton neuroma. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR imaging for 54 feet in 49 patients thought to have Morton neuroma. Clinical diagnosis (Morton neuroma, differential diagnosis), location, diagnostic confidence, and therapeutic decisions were noted before and after MR imaging. The influence of the size of the neuroma on therapeutic decisions was analyzed. MR imaging diagnoses were compared with surgical results for 23 revised intermetatarsal spaces. RESULTS: After MR imaging, the clinical diagnosis of Morton neuroma was withdrawn in 15 of 54 (28%) feet. In 14 of 39 maintained diagnoses, the location or number of neuromas was changed after MR imaging. Confidence levels for Morton neuroma increased substantially after MR imaging. In 31 (57%) feet, a change in treatment plan resulted after MR imaging. Diameters of neuromas on MR images were significantly larger (P = .003) in surgically treated feet than in conservatively treated feet. MR imaging diagnoses were correct in all 23 revised intermetatarsal spaces. CONCLUSION: MR imaging has a major effect on diagnostic thinking and therapeutic decisions by orthopedic surgeons when Morton neuroma is suspected, especially because MR imaging helps in localization and size assessment of Morton neuromas.