[Attitudes of chronically-ill patients to telephone health coaching]. / Einstellungen chronisch Kranker zum telefonischen Gesundheitscoaching.

OBJECTIVE: The aim of this study was to assess the general attitudes of health insurants with chronic conditions towards a health coaching and their reasons for participation in or refusal of the telephone health coaching provided by their sickness fund. METHOD: The survey was designed as a cross-sectional study on insurants who had either participated in the coaching (n=834), declined participation (n=530) or were members of a control group (n=544). Furthermore, we investigated whether the reasons and attitudes differed with regard to socio-demographic variables of the participants (age, sex, primary condition). RESULTS: The most common reason for participation in health coaching was the feeling of obligation towards the society to take care of one's own health (80.1%). Further reasons included a general interest in prevention (75.4%) and health-related issues (51.1%). The main reason for declining participation was a sufficient care by family members or a general practitioner (96.4%). This was in particular the case with older insured persons. Most people in the control group estimated health coaching as effective and appropriate for them. Those who had declined to participate were more critical in their appraisal. The younger the insured were, the more positive was their attitude towards health coaching. CONCLUSIONS: The results show that, on the one hand, insured feel obligated to participate in prevention programs but, on the other hand, they are also interested in information about their condition and in the possibility to contribute to their treatment. The telephone health coaching by the KKH-Allianz is a new approach in the German health care and can be regarded as a supplement to medical treatment. Specifically, younger insured are highly interested in this new concept. Further studies on its efficacy are required to show the extent to which expectations and needs of insurants can actually be met.

Secondary Use of Patient Data: Review of the Literature Published in 2016.

Objectives: To summarize recent research and emerging trends in the area of secondary use of healthcare data, and to present the best papers published in this field, selected to appear in the 2017 edition of the IMIA Yearbook. Methods: A literature review of articles published in 2016 and related to secondary use of healthcare data was performed using two bibliographic databases. From this search, 941 papers were identified. The section editors independently reviewed the papers for relevancy and impact, resulting in a consensus list of 14 candidate best papers. External reviewers examined each of the candidate best papers and the final selection was made by the editorial board of the Yearbook. Results: From the 941 retrieved papers, the selection process resulted in four best papers. These papers discuss data quality concerns, issues in preserving privacy of patients in shared datasets, and methods of decision support when consuming large amounts of raw electronic health record (EHR) data. Conclusion: In 2016, a significant effort was put into the development of new systems which aim to avoid significant human understanding and pre-processing of healthcare data, though this is still only an emerging area of research. The value of temporal relationships between data received significant study, as did effective information sharing while preserving patient privacy.

The effects of surgical expansion of the maxillary arch and its consequences for the incisor axis.

PURPOSE: Reduced transverse maxillary dental arch width may be treated either by surgically supported rapid maxillary expansion (SRME) with conservative orthodontic appliances or by means of Le Fort I osteotomy (LFIO). Both are means of transverse maxillary expansion. METHODS: Both surgical methods (SRME and LFIO) were evaluated with regard to the presurgical and postsurgical form of the maxillary dental arch and its consequences for the incisor axis by means of 32 dental casts and cephalometric analysis. RESULTS: In both groups, anterior and posterior dental arch width showed significant changes after surgery, but changes in anterior dental arch width were less significant after LFIO (p = 0.004) than after SRME (p < 0.000; t-test). Cephalometric analysis (OK1/N1) did not show any significant differences between the two surgical methods (p = 0.1266; t-test). Anterior arch length was not reduced after LFIO but significantly reduced after SRME. Thus, the ideal elliptical shape of the dental arch was lost in the SRME group, which may impede esthetic outcome of the maxillary dental arch. CONCLUSION: Le Fort I osteotomy achieving direct transverse expansion should be favored over surgically supported rapid maxillary expansion if transverse expansion does not exceed 7 mm.

Bulky amine analogues of ketoprofen: potent antiinflammatory agents.

Replacement of the carboxyl group of 2-(3-benzoylphenyl)propionic acid (Ketoprofen) with various bulky amines has produced a series of highly active antiinflammatory agents that have reduced intestinal ulcerogenicity and have better therapeutic ratios in the 21-day adjuvant arthritis assay in rats than currently marketed nonsteroidal antiinflammatory drugs. Activity is maintained on reduction of these 2-(3-benzoylphenyl)propyl bulky amines to the corresponding alcohols or methylene analogues, on conversion of the ketone function to a primary amine or oxime, and on introduction of a 4-halo substitutent (Cl or F) on the terminal aromatic ring. Removal of the alpha-CH3 group greatly reduces the antiinflammatory activity of the series. These compounds have been synthesized by the reductive amination of 2-(3-bromophenyl)propionaldehyde with the respective amine followed by lithiation of this product and condensation with the appropriate benzonitrile.

The effectiveness of monoenergetic neutrons at 565 keV in producing dicentric chromosomes in human lymphocytes at low doses.

The induction of dicentric chromosomes in human lymphocytes from one individual irradiated in vitro with monoenergetic neutrons at 565 keV was examined to provide additional data for an improved evaluation of neutrons with respect to radiation risk in radioprotection. The resulting linear dose-response relationship obtained (0.813 +/- 0.052 dicentrics per cell per gray) over the dose range of 0.0213-0.167 Gy is consistent with published results obtained for irradiation with neutrons from different sources and with different spectra at energies lower than 1000 keV. Comparing this value to previously published "average" dose-response curves obtained by different laboratories for (60)Co gamma rays and orthovoltage X rays resulted in maximum RBEs (RBE(m)) of about 37 +/- 8 and 16 +/- 4, respectively. However, when our neutron data were matched to low-LET dose responses that were constructed several years earlier for lymphocytes from the same individual, higher values of RBE(m) resulted: 76.0 +/- 29.5 for (60)Co gamma rays and 54.2 +/- 18.4 for (137)Cs gamma rays; differentially filtered 220 kV X rays produced values of RBE(m) between 20.3 +/- 2.0 or 37.0 +/- 7. 1. The results highlight the dependence of RBE(m) on the choice of low-LET reference radiation and raise the possibility that differential individual response to low-LET radiations may need to be examined more fully in this context.

Relative biological effectiveness of 144 keV neutrons in producing dicentric chromosomes in human lymphocytes compared with 60Co gamma rays under head-to-head conditions.

The RBE for neutrons was assessed in a head-to-head experiment in which cultures of lymphocytes from the same male donor were irradiated simultaneously with 144 keV neutrons and with 60Co gamma rays as the reference radiation and evaluated using matched time, culture conditions, and the end point of chromosomal aberrations to avoid potential confounding factors that would influence the outcome of the experiment. In addition, the irradiation time was held constant at 2 h for the high-dose groups for both radiation types, which resulted in rather low dose rates. For the induction of dicentric chromosomes, the exposure to the 144 keV neutrons was found to be almost equally as effective (yield coefficient alpha(dic) = 0.786 +/- 0.066 dicentrics per cell per gray) as that found previously for irradiation with monoenergetic neutrons at 565 keV (alpha(dic) = 0.813 +/- 0.052 dicentrics per cell per gray) under comparable exposure and culture conditions (Radiat. Res. 154, 307-312, 2000). However, the values of the maximum low-dose RBE (RBE(m)) relative to 60Co gamma rays that were determined in the present and previous studies show an insignificant but conspicuous difference: 57.0 +/- 18.8 and 76.0 +/- 29.5, respectively. This difference is mainly due to the difference in the alpha(dic) value of the 60Co gamma rays, the reference radiation, which was 0.0138 +/- 0.0044 Gy(-1) in the present study and 0.0107 +/- 0.0041 Gy(-1) in the previous study. In the present experiment, irradiations with 144 keV neutrons and 60Co gamma rays were both performed at 21 degrees C, while in the earlier experiment irradiations with 565 keV neutrons were performed at 21 degrees C and the corresponding reference irradiation with gamma rays was performed at 37 degrees C. However, the temperature difference between 21 degrees C and 37 degrees C has a minor influence on the yield of chromosomal alterations and hence RBE values. The large cubic PMMA phantom that was used for the gamma irradiations in the present study results in a larger dose contribution from Compton-scattered photons compared to the mini-phantom used in the earlier experiments. The contribution of these scattered photons may explain the large value of alpha(dic) for gamma irradiation in the present study. These results indicate that the yield coefficient alpha(dic) for 144 keV neutrons is similar to the one for 565 keV neutrons, and that modification of the alpha(dic) value of the low-LET reference radiation, due to changes in the experimental conditions, can influence the RBE(m). Consequently, alpha(dic) values cannot be shared between cytogenetic laboratories for the purpose of assessment of RBM(m) without verification of the comparability of the experimental conditions.

Effects of aging on the functional outcome of coloanal anastomosis with colonic J-pouch.

BACKGROUND: Many low rectal cancers can be treated radically by proctectomy with total mesorectal excision followed by colonic J-pouch anal anastomosis (CPAA). In elderly patients, the fear of poor function might reduce indications for CPAA in favor of abdomino-perineal excision with end stoma. METHODS: Among 198 patients with CPAA operated on for low rectal cancer between 1984 and 1992, 20 patients over 75 years old were alive without recurrence at the time of telephone interview (July 1995). Minimal follow-up was 3 years (mean 8) for all patients. Their functional results were compared with those of 37 younger patients operated consecutively during the last 5 years of the study period. RESULTS: The two groups were well matched for gender, tumor distance from the anal verge, histologic staging, and use of adjuvant radiotherapy. Follow-up was longer in the elderly group than in the young group (96 versus 63 months, respectively). The elderly group had a median of 1 bowel movement per day and the young group a median of 1.5 (P = 0.13). The presence of irregular intestinal transit was reported in 48% of the aged and in 35% of the young group (P = 0.6), but fragmented defecation was less frequent (25% versus 47%, respectively; P = 0.15). Urgency was noted, respectively, in 15% and 22% of elderly and young patients (P = 0.7) and constipation in 40% and 22% (P = 0.2). Incontinence for feces (15%) and for flatus (40%) in elderly were not significantly different from the younger group (14% and 46%, P = 1.0 and P = 0.8, respectively). Laxatives were used in 32% of elderly and 17% of young patients (P = 0.3). CONCLUSION: Functional outcome may be good to excellent in elderly patients after CPAA and compares well with that obtained in younger patients. Constipation, however, may be more frequent in the elderly. Age is not a contraindication for CPAA if the sphincter tone is clinically normal.

Mutagenic effect of low energy neutrons on human chromosome 11.

PURPOSE: The shape of the dose-effect curve for neutrons, i.e. the question as to whether the curve is linear or supralinear in the low-dose region, is still not clear. Therefore, the mutagenic effect of very low doses of low-energy neutrons was determined. MATERIALS AND METHODS: Human-hamster hybrid A(L) cells contain human chromosome 11, which expresses the membrane protein CD59. This membrane protein can be detected immunologically and quantified by flow cytometry. The A(L) cells were irradiated with neutrons of 0.565, 2.5 or 14.8 MeV and the results were compared with those after 200 kVp X-rays. Before irradiation, cells spontaneously mutated in the CD59 gene were removed by magnetic cell sorting (MACS). RESULTS: The relative biological effectiveness (RBE) for CD59 mutation induction was 19.8 (+/-2.7) for 0.565 MeV, 10.2 (+/-1.9) for 2.5 MeV, and 10.2 (+/-1.6) for 14.8 MeV neutrons. Linear mutation responses were obtained with all radiations except for 14.8 MeV neutrons where a supralinear curve may be a better fit. The deletion spectrum of mutated cell clones showed 29 Mbp deletions on average after irradiation with 0.069 Gy of 0.565 MeV neutrons. This scale of deletions is similar to that after 3 Gy 100 kV X-rays (=34 Mbp). For 50% cell survival, the RBE of the neutrons was 11 compared with 200 kV X-rays. CONCLUSIONS: Neutrons of low energies (0.565 or 2.5 MeV) produce a linear dose-response for mutation in the tested dose range of 0.015-0.15 Gy. The neutron curve of 14.8 MeV can be approximated by a curvilinear or linear function.

Speciation analysis of arsenic and selenium compounds by capillary electrophoresis.

High-performance capillary electrophoresis is applied to the separation of different inorganic and organic arsenic and selenium compounds. In comparison with UV-detection, an approach with conductivity detection is described expecting higher sensitivity and universality. In this case the capillary was statically modified with CTAB before the electromigration procedure. The separation was performed with an electrolyte system consisting of CHES and Triton X-100. Detection limits of 0.06 mg/L or lower were obtained for As(V) and Se(VI). Water samples of an arsenic-polluted tailing of tin mining processes were analysed for anions as well as arsenic and selenium species.

Determination of absorbed dose in the vicinity of a neutron source.

A computational method is presented that transfers the spectral neutron fluence from the measuring position to a reference point in a biological sample. The method is applied to the determination of the absorbed dose in adult blood irradiated with monoenergetic neutrons of 0.035 and 14.8 MeV.

Quasi-monoenergetic neutron reference fields in the energy range from thermal to 200 MeV.

Well-characterised neutron fields are a prerequisite for the investigation of neutron detectors. Partly in collaboration with external partners, the PTB neutron metrology group makes available for other users neutron reference fields covering the full energy range from thermal to 200 MeV. The specification of the neutron fluence in these beams is traceable to primary standard cross sections.

Starting young: improving the health and developmental outcomes of infants and toddlers in the child welfare system.

The number of infants and toddlers entering out-of-home care has increased dramatically in the past few years, yet few published reports examine their needs. This article describes a collaborative, multidisciplinary developmental follow-up program for infants and toddlers that builds on the community-based family support model described in the Family to Family Foster Care Reform Initiative. The children's health and developmental status, as well as the program's effectiveness, are highlighted.

[Surgical treatment of renal carcinoma and thrombosis of the inferior vena cava]. / Chirurgická liecba karcinómu oblicky s trombózou dolnej dutej zily.

INTRODUCTION: In Slovakia every year some 600 renal carcinomas are diagnosed. This number includes 5 to 10% carcinomas with a tumours thrombus is the renal vein or inferior vena cava. The objective of the present work is to describe diagnostic and surgical methods is patients with this disease. MATERIAL AND METHODS: The authors describe the surgical procedures, depending on the level of the tumours thrombus in the inferior vena cava in a group of 22 patients operated at the Urological department of the F. D. Roosevelt Hospital in Banská Bystrica in 1997 to 2001. RESULTS: In all 22 patients the tumours thrombus was removed along with the tumours kidney. In two instances the thrombus reached as far as the right atrium and in 4 patients with a tumours thrombus in a subdiaphragmatic position extracorporeal circulation was used. There was no death in conjunction with the surgical operation. There was one complication caused by haemorrhage which called for surgical revision. Eight patients died during the investigation period as a result of a relapse and generalization of the disease. CONCLUSION: Based on the authors' experience and data in the literature the authors recommend surgery of the kidney with a tumours thrombus of the inferior vena cava as safe treatment in special hospital departments.

Grafting in dentistry today (author's transl). / Implantate in der Zahnheilkunde von heute

Enossal grafts are common practice in dentistry. The prognosis of such grafts fluctuates between primary failure and 10 years, and is largely determined by the indication: the more accurate the indication, the better the prognosis! In partial diastemata in the lower jaw, satisfactory results for a longer time are to be expected if the concurrently blocked remaining denture is periodontally sound.

Variations in the shape of permanent maxillary lateral incisors in Sundanese.

During a survey in Java we found unusual shaped upper lateral incisors. A total of 110 school children shows 3 cases with pegging, approximately 20% with canine-like shape. In all cases the lateral incisor was present. Compared with other publication the incidence of pegging is low, the canine-like variation never described as far as we know.

Diabetic retinopathy study. Preliminary results from 215 patients treated uniocularly with photocoagulation.

Preliminary results of a controlled study on diabetic retinopathy are reported. Two hundred and fifteen patients with proliferative (PDR) and nonproliferative (NPDR) retinopathy were uniocularly treated by Xenon photocoagulation and followed for a minimum of 6 months--6 years. Intra- and epiretinal new vessel formations (RNF) decreased in treated but increased in untreated eyes at a high statistical significance. A transition of background retinopathy into the proliferative stage was significantly retarded after photocoagulation. An improvement of new vessel formations on the disc (DNF) was not evident after 3 years of follow-up. The progression of preretinal neovascularization (PRNF) was significantly reduced only for 1--2 years after treatment. The incidence of massive vitreous hemorrhages, however, which showed the highest quotient of contingency with PRNF was much lower in treated eyes also after 3 years. The difference was significant only in extensively photocoagulated eyes with more than 100 lesions on average. The effect of photocoagulation on diabetic maculopathy with preservation of a useful visual acuity was highly significant only in diabetics under 60 years of age, the effect increasing with time as the control eyes fared worse. By contrast, in patients over 60 years of age, the course of maculpathy was not influenced, and a linear decrease of visual acuity occurred in both treated and untreated eyes.