T2* and quantitative susceptibility mapping in an equine model of post-traumatic osteoarthritis: assessment of mechanical and structural properties of articular cartilage.

OBJECTIVE: To investigate the potential of quantitative susceptibility mapping (QSM) and T2* relaxation time mapping to determine mechanical and structural properties of articular cartilage via univariate and multivariate analysis. METHODS: Samples were obtained from a cartilage repair study, in which surgically induced full-thickness chondral defects in the stifle joints of seven Shetland ponies caused post-traumatic osteoarthritis (14 samples). Control samples were collected from non-operated joints of three animals (6 samples). Magnetic resonance imaging (MRI) was performed at 9.4 T, using a 3-D multi-echo gradient echo sequence. Biomechanical testing, digital densitometry (DD) and polarized light microscopy (PLM) were utilized as reference methods. To compare MRI parameters with reference parameters (equilibrium and dynamic moduli, proteoglycan content, collagen fiber angle and -anisotropy), depth-wise profiles of MRI parameters were acquired at the biomechanical testing locations. Partial least squares regression (PLSR) and Spearman's rank correlation were utilized in data analysis. RESULTS: PLSR indicated a moderate-to-strong correlation (ρ = 0.49-0.66) and a moderate correlation (ρ = 0.41-0.55) between the reference values and T2* relaxation time and QSM profiles, respectively (excluding superficial-only results). PLSR correlations were noticeably higher than direct correlations between bulk MRI and reference parameters. 3-D parametric surface maps revealed spatial variations in the MRI parameters between experimental and control groups. CONCLUSION: Quantitative parameters from 3-D multi-echo gradient echo MRI can be utilized to predict the properties of articular cartilage. With PLSR, especially the T2* relaxation time profile appeared to correlate with the properties of cartilage. Furthermore, the results suggest that degeneration affects the QSM-contrast in the cartilage. However, this change in contrast is not easy to quantify.

European survey on principles of prudent antibiotic prescribing teaching in undergraduate students.

We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology. In-depth interviews were conducted with four lecturers. Thirty-five of 37 medical schools were included in the study. Prudent antibiotic use principles were taught in all but one medical school, but only four of 13 countries had a national programme. Interactive teaching formats were used less frequently than passive formats. The teaching was mandatory for 53% of the courses and started before clinical training in 71%. We observed wide variations in exposure of students to important principles of prudent antibiotic use among countries and within the same country. Some major principles were poorly covered (e.g. reassessment and duration of antibiotic therapy, communication skills). Whereas 77% of the respondents fully agreed that the teaching of these principles should be prioritized, lack of time, mainly due to rigid curriculum policies, was the main reported barrier to implementation. Given the study design, these are probably optimistic results. Teaching of prudent antibiotic prescribing principles should be improved. National and European programmes for development of specific learning outcomes or competencies are urgently needed.

[Stepwise occupational reintegration under the German pension insurance scheme--results of comprehensive routine data analyses and participants surveys]. / Stufenweise Wiedereingliederung zulasten der gesetzlichen Rentenversicherung--Ergebnisse umfassender Routinedatenanalysen und Teilnehmerbefragungen.

This paper presents for the first time research results of a comprehensive analysis on stepwise occupational reintegration (SOR) provided under the German pension insurance scheme. SORs under the German pension insurance scheme directly after medical rehabilitation have recently become possible as legal changes came into force in April 2004; until then, they had been provided by the health insurance funds independent of earlier medical rehabilitation. Against the background of this amendment of the law, the present study was commissioned by Deutsche Rentenversicherung Bund to get information relative to indication, introduction, implementation and results of the new SOR procedure. Analysis of routine data from the German pension insurance scheme pertaining to more than 140 000 insured persons treated in more than 1 083 medical rehabilitation centres, as well as of more than 6 500 participant surveys, resulted in a so far unique database for investigating SOR. This database offers a comprehensive collection of data and experiences relative to the amount of SOR prescribed and realized, to participants, procedure and results of SOR under the pension insurance scheme. This amount of data has never before been available when SOR was provided by the health insurance funds. The data collected suggest pinpoint indication of SOR, a positive rating of participants and an effective contribution to reintegration into working life and prevention of premature retirement. According to the present data, medical rehabilitation centres and their recommendations have an important influence on SOR utilization. Findings suggest major differences in the recommendation behaviours of rehabilitation centres, the possibilities offered by SOR not made use of to the same degree everywhere.

Sources of variation in habitual physical activity of children and adolescents: the European youth heart study.

The present study examined the influence of gender, maturity state, seasonality, type of measurement day and socioeconomic status (SES) on habitual physical activity in 8-10-year-old children and 14-16-year-old adolescents (n=1318). Physical activity was assessed objectively by accelerometry. The results showed a significant effect of the type of measurement day on physical activity with a general pattern of lower activity levels in weekends compared with weekdays. Furthermore, higher physical activity levels were observed during the months of spring/summer compared with the months of autumn/winter for the 8-10-year-olds, whereas no significant effect of months was observed for the 14-16-year-olds, possibly due to exam preparations and lack of physical activity registration during the months of summer for this cohort. SES was unrelated to physical activity in the 8-10-year-olds, whereas an inverse association was observed in the 14-16-year-olds. However, a post hoc analysis provided strong evidence that this latter result was biased by the accelerometers inability to pick up bicycling activities. Finally, boys were more physically active compared with girls, and maturity state was unrelated to physical activity. The results could prove useful for working out strategies to prevent inactivity and for adjusting for temporal sources of variation in physical activity in future studies.

[Predicting gainful employment in a population sample of 4225 statutory pension insurance members covering a prognostic period of five years using a brief subjective prognostic employment scale (SPE Scale)]. / Vorhersage der Erwerbstätigkeit in einer Bevölkerungsstichprobe von 4225 Versicherten der LVA über einen Prognosezeitraum von fünf Jahren mittels einer kurzen Skala (SPE-Skala).

PURPOSE: Vocational (dis-)ability is a key concept in social medicine. It plays a major role in the realm of statutory pension funds (e. g. appraisal of applications for early retirement) as well as in epidemiologic or rehabilitation research. In a former population-based survey reliability of a short scale assessing the subjective prognosis of gainful employment (SPE-Scale, range = 0 - 3) had been tested. We now wanted to explore whether the SPE-Scale allows a prediction of vocational outcomes (early retirement) in the population sample over longer periods of time. METHODS: Statutory pension insurees from Luebeck and surroundings aged between 40 and 55 were surveyed by questionnaire in 1999/2000. For 4225 subjects (= 95% of the original cohort) we obtained the following outcome data from pension fund records: dates of any applications for early retirement and beginning of retirement, date of death. The follow-up period covers 4.75 years on average. During this period 323 applications for early retirement (= 7.6%) were filed, and 200 subjects (= 4.7%) actually retired. RESULTS: First analysis including age and sex as covariates showed a threefold (SPE = 2) and eightfold (SPE = 3) risk of early retirement. Multivariate analysis (covariates: overall health status, number of chronic conditions, approved disability, subjective vocational ability, and length of sick leave measured at study onset) yielded a twofold risk of filing an application for early retirement (SPE = 3). CONCLUSIONS: The SPE-Scale is an appropriate screening instrument for hazards regarding gainful employment. It also can be recommended for use in epidemiologic or rehabilitation surveys.

[Antibiotic treatment of infections in general practice. Effect of audit assessed by prescriptions data from health insurance registry and physicians' own registration]. / Antibiotikabehandling af infektioner i almen praksis. Effekten af audit bedømt ved ordinationsdata fra Sygesikringens register og laegernes selvregistrering.

The aim was to study whether an audit of treatment of infections in general practice resulted in changed prescribing habits. In 1995-1996 forty-six general practitioners (GP's) from the County of Roskilde participated in an audit regarding infectious diseases (incl. course participation and preparation of treatment guidelines). The effect evaluation was done on the basis of 1) two self-registrations of antibiotic prescriptions carried out with one year's interval, and 2) prescribing data from the National Insurance database collected over two periods, before the first and second self-registration respectively. The number of patients not receiving antibiotics increased significantly from 47.2% to 52.4% after intervention. The self-registration did not show any change in choice of antibiotics, while the registry data showed a shift from broad-spectrum to narrow-spectrum penicillin. This change was, however, also found among the GP's, who did not participate in the audit. The study demonstrated that audit can result in changes in prescribing patterns, but at the same time emphasizes the need for inclusion of external data sources and control groups in the evaluation of intervention effects.

Assessment of postabsorptive renal glucose metabolism in humans with multiple glucose tracers.

The contribution of the kidneys to postabsorptive endogenous glucose production is a matter of controversy. To assess whether this could relate to the use of various isotopical methods with different analytical performance capabilities, we measured glucose kinetics in 12 healthy subjects. Blood samples were taken from the femoral artery and the renal vein after 4 h of [6,6-2H2]glucose infusion (for gas chromatography [GC]/mass spectrometry [MS] analysis), and renal plasma flow was determined with paraaminohippurate. In addition, six subjects received uniformly labeled [13C]glucose (for GC/combustion/isotope ratio MS [IRMS]) and [3-3H]glucose (for counting of radioactive disintegrations). Arterial glucose concentrations (means +/- SD) were 4.2+/-0.1 mmol/l, and endogenous glucose production rates using [2H2]glucose were 2.2+/-0.1 mg x kg(-1) x min(-1) or 818+/-50 micromol/min. Dilution of [2H2]glucose across the kidney was 0.79+/-1.32%, and renal glucose production (RGP) rates were 27+/-72 micromol/min. In the six subjects receiving additional tracers, dilutions across the kidney were 2.83+/-0.72 and 0.54+/-1.20 (for [U-13C]glucose and [3-3H]glucose, respectively, the dilution with [U-13C] being higher than that with [2H2] (P = 0.007). Corresponding RGP values were 144+/-39 and 43+/-76 micromol/min for [U-13C] and [3-3H], respectively. In conclusion, we found that the highly sensitive [U-13C] GC/Combustion/IRMS technique showed consistent dilution of label across the kidney, whereas the less sensitive techniques gave some negative values and smaller RGP rates. Thus, depending on which technique is being used, a fivefold difference in calculated RGP values may be encountered. The methodological variability of our data suggests that extrapolation from regional renal measurements to the whole-body level should be perfumed with caution.

[Subjective need for rehabilitation, intention to apply and application for medical rehabilitation--results of a survey of federal insurance office]. / Subjektive Rehabilitationsbedürftigkeit, Antragsintention und Antragstellung auf medizinische Rehabilitation--Ergebnisse einer Befragung von LVA-Versicherten.

The survey "Determinants in Applying for Medical Rehabilitation" intended to examine the interest of using rehabilitation services among workers in need of rehabilitation and clarify the reasons for the decline in applications for rehabilitation since 1995. For this reason 4400 blue collar workers of the regional pension fund (2% of the LVA population aged 40-59 years) were asked with a postal questionnaire. The response rate was 64%. In order to ensure the validity of the intentions stated, the pension fund verified how many workers actually filed an application for medical rehabilitation during the following twelve months. A quarter of the workers answering considered themselves in need for rehabilitation. Of these, 41% intended to file an application, 34% intended not to do so and 25% were undecided. The main reasons for intending to apply were encouragement by the GP and family members as well as the expectation of improving the working capacity. After one year, only 11% of the workers who claimed themselves to be in need for rehabilitation had filed an application for rehabilitation. This low number of applications from workers in subjective need for rehabilitation indicates a deficit in medical rehabilitation provision.

Fuel metabolism, energy expenditure, and thyroid function in growth hormone-treated obese women: a double-blind placebo-controlled study.

Growth hormone (GH) promotes protein anabolism and lipolysis. Its effects on glucose metabolism include suppression of glucose oxidation and may be associated with insulin resistance. In addition, GH stimulates energy expenditure (EE) and peripheral thyroid hormone metabolism. GH secretion is reduced in obese patients, but whether this is of pathophysiological significance is incompletely understood. In a double-blind placebo-controlled crossover design, we studied the effects of GH administration (0.03 mg.kg ideal body weight [IBW]-1.d-1) on fuel metabolism, EE, and thyroid function in 10 obese women (age, 30.4 +/- 2.4 years; body mass index [BMI], 37.0 +/- 2.8 kg/m2, mean +/- SE) with a normal prestudy oral glucose tolerance test (OGTT). Each treatment period (GH or placebo) lasted 5 weeks, separated by a 5-week washout period. At the end of each treatment period, subjects were studied in the basal state (8:00 AM) and during a euglycemic glucose clamp including indirect calorimetry and isotopic measurement of glucose turnover. Lean body mass (LBM) was assessed at the end of each period by dual-energy x-ray absorptiometry. In the basal state, GH induced a significant increase in circulating levels of free fatty acids (FFA), glucose, insulin, and C-peptide. This was associated with a significant increase in resting EE (kcal/24 h, 1,934 +/- 92 placebo v 2,323 +/- 134 GH, P < .001), a decrease in the respiratory exchange ratio (RER), and increased rates of lipid oxidation (mg.kg LBM-1.min-1, 1.55 +/- 0.09 placebo v 2.20 +/- 0.13 GH, P < .01). GH increased the rate of total basal glucose turnover, whereas oxidative glucose disposal was significantly decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

[Daily single-dose aminoglycoside administration. Therapeutic and economic benefits]. / Aminoglykosidadministration én gang i døgnet. En terapeutisk og øokonomisk gevinst.

Aminoglycosides are among the most active antimicrobial agents against Gram-negative infections, but they also share the potential for oto- and nephrotoxicity. Animal studies have shown that dosing aminoglycosides once daily is more efficient and less nephrotoxic than the conventional multiple daily dosing regimens. Pharmacokinetic and microbiological data support this finding. Clinical trials confirm that once-daily dosing is more efficient and less toxic than multiple daily dosing. The two most important risk factors for nephrotoxicity seem to be the duration of aminoglycoside treatment and high trough levels of aminoglycoside. Netilmicin and amikacin are the drugs most often used in clinical trials of once-daily dosing regimens. Recommendations for once-daily dosing of netilmicin are given.

[Therapeutic monitoring of aminoglycoside treatment. The value of early clinical contact]. / Terapeutisk styring af aminoglykosidbehandling. Vaerdien af tidlig klinisk kontakt.

For several years, in the Microbiological Department of Bispebjerg Hospital, it has been the routine practice that the clinical departments were contacted in connection with every sample sent for determination of aminoglycoside. During a period of 14 weeks a prospective investigation of the effect of this practice was carried out. During this period, the department received a total of 77 samples from 60 patients. Concerning 20 of these (26%), no arrangement with the department concerned could be demonstrated. The commonest causes were that the aminoglycoside treatment had been suspended at the time of taking the sample by the department concerned (14), that the sample had been taken too early (2) and the sample was not relevant (2). Considerable uncertainty reigned in the clinical departments about the exact time of taking the sample in relation to administration of antibiotics. Greater attention to these circumstances and possibly altered procedures concerning taking of samples would be useful changes. The annual saving for the department amounts to approximately 14,000 Danish crowns (approximately 1,000 pounds) but the most important advantage is considered to be early clinical contact and thus greater possibilities for therapeutic monitoring.

Federal Republic of Germany: perspectives in school health.

In the Federal Republic of Germany, responsibilities for health and education are held by the 11 German states. Particularly in the health system, a number of tasks are delegated to private organizations under governmental control. In this review, general characteristics of both the public health and education systems are delineated. An overview of school health programs, including instruction, health services, environment, and school-community relations, and school-based research, also are presented.

Contact dermatitis to semisynthetic penicillins in factory workers.

45 workers developed dermatitis after handling semi-synthetic penicillins in a factory. All reacted on patch test, but several agents had to be used. Only 7 reacted to benzyl penicillin. 1/3 reacted to only one allergen, while 2/3 reacted to several. The duration of exposure before symptoms was short, often less than 2 months. 19 had hay fever or asthma, and they developed their symptoms after a shorter exposure time. A survey for airborne antibiotics was performed.