[Uncertainties regarding the ambulatory health care for patients suffering from osteoarthritis of the knee: a review]. / Unklarheiten uber die ambulante medizinische Versorgung von Patienten mit Kniegelenksarthrose: eine Ubersicht.

Joint complaints and pain due to osteoarthritis are among the most common symptoms in the adult population. In elderly patients the osteoarthritis of the knee demands special attention since the resulting mobility impairment may exceed the impact of complaints in other joints and threaten the patients' daily living independence. The aim of this review is to provide an overview of the health care actually provided to patients with osteoarthritis of the knee. There is a lack of national data on health services use and the quality of health care. The transfer of findings of international studies is limited because of differences between health care systems and variable methodological approaches in the studies. Overall, the available data suggest an underuse of recommended health care interventions. A comprehensive research approach is urgently needed. Further studies should focus on causes for non-adherence to guideline recommendations to uncover actual health care deficits and to outline options for an improvement of health care provided to patients with osteoarthritis of the knee.

[Osteoporosis and falls in Germany: health care for the elderly with an increased risk for fractures]. / Osteoporose und Sturz: medizinische Versorgung alterer Menschen mit einem erhöhten Frakturrisiko in Deutschland.

Fractures are a considerable risk, especially in older patients. The fracture of the proximal femur is of particular relevance. Functional deficiency, an increased need for care and assistance and a limitation of the quality of life after a fracture lead to an increase in morbidity and mortality among patients who lived independently prior to the event in most cases. The risk of suffering a femoral fracture mainly depends on two risk factors: osteoporosis and falls. Both can be influenced and are therefore suitable for interventions. National and international guidelines for diagnosis and treatment have so far separately addressed deficiencies in bone stability and neuromuscular function. The current German DVO guideline is the first to consider both aspects simultaneously and develop an individual concept for diagnosis and therapy depending on a risk prediction of a fracture within the following 10 years. The evaluation of the current quality of health care in the field of osteoporosis and falls both nationally and internationally seems to be hardly possible. Merely the delivery of DXA measurements and medication for osteoporosis are assessable. In these sectors a deficiency in the delivery of care is apparent. Standardized evaluations of the implementation of guidelines are needed to assess deficiencies and reveal options for improving quality of care in the future.

Measurement of the initial phase of ozone decomposition in water and wastewater by means of a continuous quench-flow system: application to disinfection and pharmaceutical oxidation.

Due to a lack of adequate experimental techniques, the kinetics of the first 20s of ozone decomposition in natural water and wastewater is still poorly understood. Introducing a continuous quench-flow system (CQFS), measurements starting 350 ms after ozone addition are presented for the first time. Very high HO. to O3 exposures ratios (Rct=integralHO.dt/integralO3dt) reveal that the first 20s of ozonation present oxidation conditions that are similar to ozone-based advanced oxidation processes (AOP). The oxidation of carbamazepine could be accurately modeled using O3 and HO. exposures measured with CQFS during wastewater ozonation. These results demonstrate the applicability of bench scale determined second-order rate constants for wastewater ozonation. Important degrees of pharmaceutical oxidation and microbial inactivation are predicted, indicating that a significant oxidation potential is available during wastewater ozonation, even when ozone is entirely decomposed in the first 20s.

Decomposition of aqueous ozone in the presence of aromatic organic solutes.

The decomposition of aqueous ozone is mainly due to the OH(*) radical chain reaction. Some aromatic compounds have been found to tremendously accelerate ozone decomposition in buffered water although their direct reactions with ozone are very low. Hydrogen peroxide has been detected as an important intermediate product in this process. Therefore, a reaction pathway (aromatic ring=>olefin=>H(2)O(2)=>HO(2)(-)) is proposed in this study. Aromatic rings react with OH(*) radicals or ozone to yield olefins. The olefin formed immediately reacts with ozone and is converted to H(2)O(2). Parts of H(2)O(2) dissociate to HO(2)(-), which strongly accelerates aqueous ozone decomposition. Therefore, a new chain reaction appears. The proposed reaction pathway is much faster than another promotion pathway, such as aqueous ozone decomposition promoted by methanol, formic acid or glucose.

Prevalence of self-reported pain, joint complaints and knee or hip complaints in adults aged ≥ 40 years: a cross-sectional survey in Herne, Germany.

BACKGROUND: Pain and musculoskeletal complaints are among the most common symptoms in the general population. Despite their epidemiological, clinical and health economic importance, prevalence data on pain and musculoskeletal complaints for Germany are scarce. METHODS: A cross-sectional survey of a random sample of citizens of Herne, Germany, aged ≥ 40 years was performed. A detailed self-complete postal questionnaire was used, followed by a short reminder questionnaire and telephone contacts for those not responding. The questionnaire contained 66 items, mainly addressing pain of any site, musculoskeletal complaints of any site and of knee and hip, pain intensities, the Western Ontario MacMaster Universities (WOMAC) index, medication, health care utilization, comorbidities, and quality of life. RESULTS: The response rate was 57.8% (4,527 of 7,828 individuals). Survey participants were on average 1.3 years older, and the proportion of women among responders tended to be greater than in the population sample. There was no age difference between the population sample and 2,221 participants filling out the detailed questionnaire. The following standardized prevalences were assessed: current pain: 59.7%, pain within the past four weeks: 74.5%, current joint complaints: 49.3%, joint complaints within the past four weeks and twelve month: 62.8% and 67.4%, respectively, knee as the site predominantly affected: 30.9%, knee bilateral: 9.7%, hip: 15.2%, hip bilateral: 3.5%, knee and hip: 5.5%. Pain and musculoskeletal complaints were significantly more often reported by women. A typical relationship of pain and joint complaints to age could be found, i.e. increasing prevalences with increasing age categories, with a drop in the highest age groups. In general, pain and joint pain were associated with comorbidity and body mass index as well as quality of life. CONCLUSIONS: Our data confirm findings of other recent national as well as European surveys. The high site specific prevalences of knee and hip complaints underline the necessity to further investigate characteristics and consequences of pain and symptomatic osteoarthritis of these joints in adults in Germany.

Bone T-scores and functional status: a cross-sectional study on German elderly.

BACKGROUND: We explore the association between bone T-scores, used in osteoporosis diagnosis, and functional status since we hypothesized that bone health can impact elderly functional status and indirectly independence. METHODS: In a cross-sectional study (2005-2006) on community dwelling elderly (> = 75 years) from Herne, Germany we measured bone T-scores with Dual-energy X-ray Absorptiometry, and functional status indexed by five geriatric tests: activities of daily living, instrumental activities of daily living, test of dementia, geriatric depression score and the timed-up-and-go test, and two pooled indexes: raw and standardized. Generalized linear regression was used to determine the relationship between T-scores and functional status. RESULTS: From 3243 addresses, only 632 (19%) completed a clinical visit, of which only 440 (male:female, 243:197) could be included in analysis. T-scores (-0.99, 95% confidence interval [CI], -1.1-0.9) predicted activities of daily living (95.3 CI, 94.5-96.2), instrumental activities of daily living (7.3 CI, 94.5-96.2), and timed-up-and-go test (10.7 CI, 10.0-11.3) (P < = 0.05). Pooled data showed that a unit improvement in T-score improved standardized pooled functional status (15 CI, 14.7-15.3) by 0.41 and the raw (99.4 CI, 97.8-101.0) by 2.27 units. These results were limited due to pooling of different scoring directions, selection bias, and a need to follow-up with evidence testing. CONCLUSIONS: T-scores associated with lower functional status in community-dwelling elderly. Regular screening of osteoporosis as a preventive strategy might help maintain life quality with aging.

[Age-related differences in functional tests to assess the risk of falling in patients with knee pain]. / Altersabhängige Unterschiede bei funktionellen Tests zur Beurteilung des Sturzrisikos bei Patienten mit Kniegelenksbeschwerden.

In the present cross-sectional study the results of three tests to assess the risk of falling were examined for a correlation with advancing age of the participants. Each of the 188 community dwelling active participants aged 40 years or older with a history of knee pain performed the Timed Up and Go (TUG), the Performance Oriented Mobility Assessment (POMA, "Tinetti Test") and a less established simple test of dynamic balance, the Four Square Step Test (FSST). Age-related differences in performance in the Timed Up and Go and the Performance Oriented Mobility Assessment have been shown in previous studies and are also present in this sample. For the Four Square Step Test an association of test performance and age has been shown for the first time in this study. Further investigation is required to determine the quality of these three tests regarding their ability to assess the risk of falling in patients with knee pain.