Prodromal or mild Alzheimer's disease: Influence of neuropsychiatric symptoms and premordid personality on caregivers' burden.

OBJECTIVE: In Alzheimer's disease (AD), the burden on caregivers is influenced by various factors, including the stage of disease progression and neuropsychiatric symptoms (NPS). To date, there has been limited research examining how patient's premorbid personality could affect this burden. The objective of this study was to investigate the impact of both premorbid personality and NPS in individuals with prodromal to mild AD on their caregivers' burden. METHOD: One hundred eighty participants with prodromal or mild AD drown from the PACO (in French: Personnalité Alzheimer COmportement) cohort were included. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R). Neuropsychiatric symptoms were measured with the short version of the Neuropsychiatric Inventory (NPI-Q), and caregiver burden was evaluated with the Zarit burden scale. Relationships between personality, Neuro-Psychiatric Inventory (NPI) scores, and caregiver burden were determined using multivariate linear regressions controlled for age, sex, educational level, and Mini Mental State Examination. RESULTS: The total NPI score was related to increased burden (beta = 0.45; p < 0.001). High level of neuroticism (beta = 0.254; p = 0.003) et low level of conscientiousness (beta = - 0.233; p = 0.005) were associated higher burden. Extraversion (beta = -0.185; p = 0.027) and conscientiousness (beta = -0.35; p = 0.006) were negatively associated with burden. In contrast, neuroticism, openness and agreeableness were not correlated with burden. When adjusted on total NPI score, the relationship between extraversion and conscientiousness didn't persist. CONCLUSION: Our results suggest that premorbid personality of patients with prodromal to mild Alzheimer influence caregivers's burden, with a protective effect of a high level of extraversion and conscientiousness.

The EU chemicals strategy for sustainability: in support of the BfR position.

The EU chemicals strategy for sustainability (CSS) asserts that both human health and the environment are presently threatened and that further regulation is necessary. In a recent Guest Editorial, members of the German competent authority for risk assessment, the BfR, raised concerns about the scientific justification for this strategy. The complexity and interdependence of the networks of regulation of chemical substances have ensured that public health and wellbeing in the EU have continuously improved. A continuous process of improvement in consumer protection is clearly desirable but any initiative directed towards this objective must be based on scientific knowledge. It must not confound risk with other factors in determining policy. This conclusion is fully supported in the present Commentary including the request to improve both, data collection and the time-consuming and bureaucratic procedures that delay the publication of regulations.

[Polypharmacy after Discharge from Hospital: An Analysis Using Data of the Statutory Health Insurance (AOK) of Saxony-Anhalt]. / Polypharmazie in der nachstationären Versorgung: Eine Analyse mit Daten der AOK Sachsen-Anhalt.

INTRODUCTION AND AIM: The growing number of people suffering from chronic diseases and multimorbidity is associated with an increased risk of polypharmacy. The aims of the study are to estimate the prevalence of polypharmacy and to analyse its determinants in the transition from in- to outpatient care. Furthermore, we estimate the risk of a potential inappropriate medication (PIM) and its determinants. METHODS: The analyses are based on the data of a German statutory health insurance (AOK Saxony-Anhalt) of the third quarter of 2009. The analyses include all insured persons aged 60 years and older who were discharged from hospital within the study period and had filled at least one prescription at the pharmacy (n=21 041). After the analysis of prevalence rates of polypharmacy within 30 days after discharge from hospital, we used binary logistic regression models to estimate the effect of determinants of polypharmacy and PIM. In addition, interaction effects between the number of diseases and the number of practitioners involved in the therapy were calculated. RESULTS: Our analyses show a significant effect of the number of diseases and the number of practitioners on the risk of polypharmacy. Furthermore, patients who are treated with 5 or more drugs have a significantly higher risk of a PIM prescription. The interaction model illustrates a disproportional rise of polypharmacy risk in women with multiple chronic conditions with an increase in the number of doctors treating them. CONCLUSION: The results suggest that polypharmacy is not a result of increasing morbidity alone. Furthermore, the remarkable effect of the number of physicians treating a patient points to an unsolved problem in communication and coordination in outpatient pharmacotherapy and shows the need for centralized medication monitoring.

[GP medication prioritisation in older patients with multiple comorbidities recently discharged from hospital: a case-based bottom-up approach]. / Hausärztliche Arzneimittelpriorisierung bei stationär entlassenen, multimorbiden, älteren Patienten--Ein Vignetten-Ansatz aus der Hausarzt-Perspektive.

INTRODUCTION: After the hospital discharge of older patients with multiple morbidities, GPs are often faced with the task of prioritising the patients' drug regimens so as to reduce the risk of overmedication. AIM: How do GPs prioritise such medications in multimorbid elderly patients at the transition between inpatient and home care? The experience by the GPs is documented in typical case vignettes. METHOD: 44 GPs in Sachsen-Anhalt were recruited--they were engaged in focus group discussions and interviewed using semi-standardised questionnaires. Typical case vignettes were developed, relevant to the everyday care that elderly patients would typically receive from their GPs with respect to their drug optimisation. RESULTS: According to the results of the focus groups, the following issues affect GPs' decisions: drug and patient safety, their own competence in the health system, patient health literacy, evidence base, communication between secondary and primary care (and their respective influences on each other). When considering individual cases, patient safety, patient wishes, and quality of life were central. This is demonstrated by the drug dispositions of one exemplary case vignette. CONCLUSIONS: GPs do prioritise drug regimens with rational criteria. Initial problem delineation, process documentation and the design of a transferable product are interlinking steps in the development of case vignettes. Care issues of drug therapy in elderly patients with multiple morbidities should be investigated further with larger representative samples in order to clarify whether the criteria used here are applied contextually or consistently. Embedding case vignettes into further education concepts is also likely to be useful.

[Unresolved problems of undocumented migrants in Germany: an analysis of medical consultations in Berlin, Cologne and Bonn]. / Problemlagen von versteckt lebenden Migranten in Deutschland: Analyse der medizinischen Beratungsanlässe in Berlin, Bonn und Köln.

INTRODUCTION: Little is known about health related problems of undocumented migrants in Germany. Patterns for medical consultations and socio-demographic characteristics are only available in isolated reports. This article identifies and compares empirical data from non-governmental organisations (NGOs) who provide medical care for unregistered migrants. METHODS: Annual reports of 2006 and 2007 of the Malteser Migranten Medizin (Berlin, Cologne) and the MediNetz Bonn were selected for this document analysis. RESULTS: We identified similarities and differences in the socio-demographic background and patterns of medical consultations between the explored regions. The number of documented migrants without medical insurance increased during the observed period. DISCUSSION: The patterns of health-care utilisation for undocumented immigrants changed in the observed period which might be caused by the EU enlargement to the East. The heterogeneous quality of the annual reports and the lack of information about the use of alternative health-care facilities limit the results of this analysis.

[The program initiative "general practice" of the Conference of the German Federal Health Ministers. Successes of interventions and possible reasons for the shortage of general practitioners]. / Das Initiativprogramm "Allgemeinmedizin" der Gesundheitsministerkonferenz der Länder. Erfolg der Förderungen und mögliche Gründe für den Hausarztmangel.

The number of general practitioners has clearly decreased over the last 10 years in Germany. The situation is more critical in Eastern Germany compared to Western Germany. The article shows the results of the "program initiative to secure primary care in general practice" of the Conference of the Federal Health Ministers. The authors focus on the situation in Saxony-Anhalt, where they are founders of the Institute of General Medicine at the Universities of Halle-Wittenberg and Magdeburg. They also work as general practitioners.

[IKOP-Infection control in the operating theatreConsensus on the theme "Barrier measures during operations and invasive procedures"]. / IKOP-Infektionskontrolle im OperationsbereichKonsensus-Papier zum Schwerpunkt "Barrieremassnahmen bei Operationen und invasiven Eingriffen"

Postoperative surgical site infections remain frequent despite intensive control programs. With rising numbers of operations and invasive procedures in the outpatient setting and in immunocompromised patients, the prevention of wound infections presents a rapidly growing challenge to the medical community. Barrier measures including drapes and surgical gowns to prevent wound contamination, have clearly reduced the rate of wound infections. The optimal material characteristics for operating gowns and drapes are well defined, but there is still a long running controversy on the use of single-use versus reusable materials. We review the efficacy and ecological impacts of these different approaches. Currently no superiority of any of these approaches with regard to either efficacy or ecological impact can be found. The European Union has recently published a series of mandatory standards to specify material characteristics of barrier materials used in operating theatres (EN 13795). Their scope include production standards of these materials as well as specific processes in auditing their characteristics. The implementation of these norms will clearly present a challenge to European hospitals but will lead to better material characteristics in the end.

Electrophysiological assessment of impulsive behavior in healthy subjects.

The different concepts of impulsivity cover a wide range of divergent behaviors. In clinical terms, aspects of impulsivity are both an important feature in several psychiatric conditions related to a low central serotonergic neurotransmission like aggressive behavior and suicidality, and a core symptom of frontal lobe syndromes of various etiologies. Assessment of the different forms of impulsivity so far relies on clinical observations and self-rating questionnaires. Measurements of a distinct brain function associated with impulsive behavior are not available yet, however, electrophysiological parameters of cognitive response control elicited with the execution (Go-condition) and the inhibition (NoGo-condition) of a prepared motor response within the Continuous Performance Test (CPT) might be suitable candidates. By means of a spatial analysis method the centers of gravity (centroids) of the brain electrical fields evoked with Go- and NoGo-responses can be localized and quantified. In the present study, the Go- and NoGo-centroids and the impulsivity score in Eysenck's I(7)-scale were determined in 22 healthy subjects (10 women, 12 men, mean age 42.0+/-10.1 years). Impulsivity was correlated with both, a more anterior location of the Go- (r=0.58, P<0.01) and the NoGo-centroid (r=0.53, P=0.01). These results indicate, that in healthy subjects the amount of I(7)-impulsivity is associated with differences in the prefrontal brain activation pattern during cognitive response control. However, a replication study with a larger sample and an investigation of psychiatric patients with pathological levels of impulsivity are necessary to qualify these topographical ERP-parameters of cognitive response control as valid measures of the brain electrical basis of impulsive behavior.

Americans' health priorities: curing cancer and controlling costs.

In this paper we provide a comprehensive examination of Americans' priorities within both health and health care. We find that Americans do have a clear set of priorities in each of these areas. Americans rated cancer, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and heart disease, and medical research to address these conditions, as top priorities among eighty health problems. However, they did not rank many leading causes of death very high as serious problems. On the issue of health care, problems of costs, prescription drugs, and the uninsured top the list. Americans are very concerned about emerging international infectious diseases that they believe threaten their health.

[Ambulatory/partial inpatient neurologic-neuropsychologic rehabilitation. I: Results of a demand analysis in South Germany]. / Ambulante/teilstationäre neurologisch-neuropsychologische Rehabilitation. Teil I: Ergebnisse einer Bedarfsanalyse in Süddeutschland.

This study presents a survey on the demand for out-patient neurological-neuropsychological rehabilitation. Neurologists working in acute care and in in-patient rehabilitation settings as well as neurologists and neuropsychologists with out-patient practice were asked to rate the demand for and the present means to realize out-patient neuropsychological rehabilitation. The results show a great demand for out-patient rehabilitation. The preferred concept and model of out-patient rehabilitation depends on the setting where the participants of the study work with a tendency to favour flexible programs close to patients' habitation.

[Ambulatory/partial inpatient neurologic-neuropsychologic rehabilitation. II: Results of an analysis of patient management characteristics in South Germany]. / Ambulante/teilstationäre neurologisch-neuropsychologische Rehabilitation. Teil II: Ergebnisse einer Analyse der Versorgungssituation in Süddeutschland.

Neurological-neuropsychological out-patient rehabilitation in Southern Germany is realized mostly by neurologists and neuropsychologists in out-patient practice. However, profile and quantity of treatment as well as the structure of the health system fail to meet the requirements of out-patient rehabilitation as described in the first part of the study.

[Determining patient staff with regard to needs and requirement profile for neuropsychologists, speech therapists and occupational therapists of acute care neurologic clinics in Germany]. / Erhebung zu Ausstattung mit, Bedarf an und Anforderungssprofil von Neuropsychologen, Logopäden und Ergotherapeuten an neurologischen Kliniken der Akutversorgung in Deutschland.

The directors of neurological emergency-care departments were asked about the number and work profile of psychologists, occupational and speech therapists in their institutions. A majority of departments in West Germany employed their own speech and occupational therapists. In East Germany, a majority had their own psychology service. Work profiles and demands for personnel did not differ between the East and West. On the basis of the results, recommendations are made for the number of therapists required in neurological emergency-care departments.