[5-Year-Follow-up of the MEmbeR Multicenter Study on Medical-Occupational Rehabilitation]. / 5-Jahres-Follow-Up der multizentrischen Evaluationsstudie zur medizinisch-beruflichen Rehabilitation (MEmbeR).

In Germany, medical-occupational rehabilitation represents an essential link between rehabilitation programs focusing either on medical or occupational rehabilitation. Its main objective is return to work. The current study presents the vocational integration 5 years after medical-occupational rehabilitation and determines possible prognostic factors for long-term occupational integration. To evaluate the effectiveness of medical-occupational rehabilitation, a 5-year-follow-up interview was conducted with participants (n=105) of the multicenter study on medical-occupational rehabilitation (MEmbeR). As a main result, 76% of the participants were still employed 5 years after medical-occupational rehabilitation and the return to work rate was 57%. Prognostic factors for long-term occupational integration could not be identified. However, a low degree of disability, an unrestricted capacity for teamwork as well as an unrestricted ability to judge might be beneficial factors for a successful reintegration. The high amount of participants who returned to work 5 years after medical-occupational rehabilitation, supports the concept of medical-occupational rehabilitation. However, more studies are needed to identify further factors influencing the outcome.

[The MEmbeR Multicenter Study on medical-occupational rehabilitation]. / Multizentrische Evaluationsstudie zur medizinisch-beruflichen Rehabilitation (MEmbeR).

INTRODUCTION: MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Germany. METHODS: 196 neurological, psychiatric, orthopaedic, and internal medicine patients from 21 rehabilitation centres all across Germany have been enrolled and followed-up for 2 years after discharge. Primary outcome parameter was defined as return to work. Further, the SF-12 and a Mini-ICF-Rating have been used. RESULTS: Mean age was 34.1 (9.9) years, length of stay 150.0 (223.5) days. Prior to occupational rehabilitation, 69.9% were unable to work, 2 years after discharge only 5.6%. Rate of participants seeking a job was reduced from 19.7% to 3.1%. In summary, 78.1% returned to work. Employed participants were younger (32.8 [9.7] vs. 38.5 [9.4] years, p=0.001) and less disabled (Degree of Disablement [GdB]: 20.0 [31.2] vs. 36.1 [33.7], p<0.05). CONCLUSION: The multicenter cohort study MEmbeR provides further knowledge about the outcome of medical-occupational rehabilitation in Germany.

Domestic allergens and endotoxin in three hospitals offering in-patient rehabilitation for allergic diseases in the alpine mountain climate of Bavaria - The AURA study.

Endotoxins and allergens represent the major relevant contents of the atmospheric bioaerosol with regard to the triggering and exacerbation of allergic diseases. In this study, mattress concentrations of endotoxin and indoor allergens were measured in three hospitals in the alpine climate of Bavaria and in adjacent homes. Dust was collected from each of 10 mattresses according to a standardized protocol, and endotoxin was analyzed with the Limulus Amebocyte Lysate (LAL) test, indoor allergens Der p 1, Der f 1 and Fel d 1 were analyzed by ELISAs. The concentration of endotoxin in the mattresses did not differ significantly between different cities. The percentiles of endotoxin were significantly higher in hospitals than in homes. The concentrations of mite allergens (Der p 1 and Der f 1) in the dust were significantly lower in all hospitals than in homes. There was no significant difference of mite allergens between different time points. The concentrations of Fel d 1 were significantly higher in the autumn than in the summer (median: 1376 vs. 478ng/g). No significant differences of Fel d 1 were found between hospitals and homes or between different hospitals. As Fel d 1 concentrations reached levels at which cat allergic patients can experience symptoms, efforts had to be made to reduce the concentrations of Fel d 1 especially in hospitals. In contrast, mite allergens were low in hospitals, which can be clinically beneficial for patients with mite allergies.

[Pulmonary rehabilitation in asthma bronchiale]. / Rehabilitation bei Asthma bronchiale.

Pulmonary rehabilitation for patients with asthma is designed to achieve and to maintain an optimal daily functioning at a health-related quality of life and to increase participation in social and professional life. In this context, rehabilitation is defined as a time-limited treatment programme which systematically employs scientifically-based diagnostic management and evaluation options to achieve a normal life irrespective of the chronic disease. This requires therapeutic interventions that are characteristic for rehabilitation and complete the regular medical treatment in order to minimise the physical, psychological and social consequences of the chronic disease. Examples of those bio-psycho-social disease consequences which are not sufficiently treated by antiobstructive medication are secondary deconditioning and anxiety, social withdrawal, reduced physical activity and reduced participation in social and professional life. In order to antagonise these secondary consequences of the chronic disease, pulmonary rehabilitation programmes utilise expertise from various health-care disciplines that are integrated into a comprehensive programme tailored to the needs of each individual patient. The interdisciplinary team of health-care professionals in pulmonary rehabilitation includes physicians, respiratory and physical therapists, psychologists, exercise specialists, social workers and others with appropriate expertise for example in nutritional therapy. Therefore, pulmonary rehabilitation programmes are not only an integral part of the current German asthma guidelines with clearly defined tasks within a comprehensive long-time management, but rehabilitative treatment options are also cornerstones of the recently released national disease management programmes for bronchial asthma.

[Sports for children and adolescents with asthma--risk or chance?]. / Sport bei asthmakranken Kindern und Jugendlichen--Risiko oder Chance?

Even though every child suffering from asthma is prone to exercise-induced asthma attacks, avoiding all physical exertion is no solution to the problem. By means of a carefully graded physical training programme every asthma patient is not only able to participate in school sports but can even achieve above average performances in other suitable sports activities. Today, sports therapy is an integral part of successful active rehabilitation programs for chronically asthmatic children and youths. Although it does not lead to a reduction of hyperreactivity--nor does it "train away" exercise-induced asthma--it does however postpone the threshold at which exercise--induced asthma is triggered off. The child's radius of activities is usually considerably enlarged and the child or youth regains self-confidence as well as confidence in his or her performance. This positive attitude influences other educational and scholastic areas as well and is an important starting-point for effectively coping with the ailment.

[Preventive vocational measures for adolescents with asthma and allergies--a model project]. / Berufsvorbereitende Massnahmen für asthma- und allergiekranke Jugendliche--ein Modellprojekt.

The difficulties encountered by asthmatic and allergic youngsters faced with choosing a career represent a problem that is gaining in relevance. The general prohibition of certain trades is, for many of those involved, both unsatisfactory and lacing in future prospects. In a model project supported by the Federal Institute of Labour is intended to help young people with asthma and allergies. By means of an interdisciplinary programme involving psychologists, teachers, instructors and physicians, the youngsters are given advice on how to chose a career/profession on the basis of their personal interests, abilities, job suitability and health situation. Between September 1987 and March 1989, 50 persons, including 43 asthmatics participated in this programme. In contrast to the poor level of schooling, the intelligence test revealed a normal distribution. The psychological stress tolerance was reduced in two-thirds of the subjects. In 7 cases, workplace-associated changes in pulmonary function were established; in 11 cases workplace-related dermatological problems were seen. Only one-third of the youngsters were considered suitable for careers in industry; the majority were advised to take advantage of the training or rehabilitation possibilities offered by the Federal Institute of Labour.

[Bronchial asthma: a comparison of the doctor's assessment and the patient's opinion]. / Asthma bronchiale: Vergleich von Arzteinschätzung und Patientenmeinung - Ergebnisse der AIRLife-Befragung.

OBJECTIVES: The aim of this enquiry was to compare the doctor's attitude with the patient's opinion on asthma treatment, in order to reveal gaps in each other's relationship, which could be the basis of designing a better information strategy and improve disease management. METHODS: General practitioners (n = 202) and Internists (n = 103) in private practice, as well as asthma patients (n = 244) were asked to take part in telephone interviews regarding their treatment beliefs. To accomplish this, a structured questionnaire was used by an experienced interviewer. 50 % of the patients were treated with steroids. RESULTS: Over 90 % of the patients were treated with short- and long acting beta (2)-agonists (alone or in combination). Up to 20% more patients reported suffering from cough, bronchitis, hay fever, and sinusitis than the physician's estimated. Although treated patients reported frequent cough episodes and wheezing. 42 % of all patients (in contrast to 52 % according to their physician had estimated) "side effects" and 21 % (46 % estimated by physicians) named "frequency of application" as their major concern. Patients preferred the oral application form (tablet, capsule) to the same extent as metered dose inhalers (40 % positive answers). Physicians overestimated the preference of the oral application form (62 % positive answers). CONCLUSION: Our inquiry revealed high incidence of typical asthma symptoms despite therapeutic interventions, and a disparity of the physician's assessment of their patient's aversions and preferences of asthma medication and the mode of application. This investigation may help to improve the patient-physician relationship by contributing to a better understanding of patients' individual attitudes, and eventually leading to better asthma control.

[Deficits in school performance in children and adolescents with chronic asthma]. / Schuldefizite chronisch asthmakranker Kinder und Jugendlicher.

At the time of their admission to the Buchenhöhe Jugendorf asthma centre (an institution for medical, professional and social rehabilitation), an investigation was made into the cases of 186 children and youths (average age: 14.0), the majority of whom suffered from severe asthma. The investigation, focused on the patients' ailment symptomatology and its effect on school progress, showed that one third of the children had spent considerable time hospitalized in intensive care (an average of 4.4 x). Amongst other findings were: That one third on the children and youths had not taken part in sports, either at school or in their leisure time, that they had missed a lot of school (33 children had missed over 30%) and that the children and youths were an average of 1.29 years behind the normal school level. The investigation leads to the conclusion that the schooling situation of asthmatic children and youths should be taken into consideration within the chronic asthma treatment plan and that treatment periods that last too long bring about an irreversible school deficiency which could hinder the further development of the youth.

[Occupational training measures for adolescents with asthma and allergy: one-year vocational education]. / Berufsvorbereitende Massnahmen für asthma- und allergiekranke Jugendliche: 1 jähriger Förderungslehrgang.

The "Förderungslehrgang" in our asthma center is a special training program for adolescents handicapped by asthma or allergic diseases who are therefore not able to start apprenticeship. The course takes one year. Besides vocational guidance and tryout of different occupations, medical and psychological diagnostics are performed. Medical service is provided all day, and a hospital with emergency unit is within the area. Though 41% of the participants did finish school without any qualified graduation after their compulsory school attendance, 79% were able to start apprenticeship after the course.