Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries.

Backround: The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment. Patients and methods: A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version. Results: From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included. Conclusion: This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.

[Early health promotion and prevention at the beginning of the 20th and 21st centuries. Data and thoughts on the 100th anniversary of the opening of the Empress Auguste Victoria House in Berlin]. / Frühe Gesundheitsförderung und Prävention am Beginn des 20. und des 21. Jahrhunderts. Daten und Gedanken zum 100. Jahrestag der Eröff nung des Kaiserin Auguste Victoria Hauses zu Berlin.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

[Perspectives of psychiatric care in Leipzig--deinstitutionalization from the viewpoint of neurologist/psychiatrist in private practice and the work of consortium of community psychiatric services]. / Perspektiven psychiatrischer Versorgung in Leipzig. Deinstitutionalisierung aus der Sicht des Niedergelassenen Nervenarztes und die Arbeit des Verbundes Gemeindenahe Psychiatrie.

Two perspectives of mental health care in Leipzig are outlined. Critical aspects of deinstitutionalization are discussed from the point of view of an office-based Nervenarzt (neurologist and psychiatrist). The limitations of office-based practice in providing care for the severely mentally ill (SMI) are described, i.e. lack of a multidisciplinary community mental health team, community psychiatric nursing and social work back-up in particular. Residential service and nursing homes are often under-staffed and ill-prepared for caring for people with SMI. A second view-point describes the Verbund Gemeindenahe Psychiatrie, a community psychiatric service for the just under 500,000 population of Leipzig in seven community mental health centers each combining day hospital, out-patient clinics and multidisciplinary community psychiatric care. This service is unique in Saxony and well accepted by service users and professionals.

Refined exposure assessment for ingestion of tapwater contaminated with hexavalent chromium: consideration of exogenous and endogenous reducing agents.

Laboratory studies were conducted to determine how rapidly and completely chromium (VI) [Cr(VI)] is reduced upon contact with common beverages mixed with tapwater. Studies were performed for five common beverages (coffee, tea, orange juice, Kool Aid, and powdered lemonade) spiked with either 10 or 50 mg Cr(VI)/l. The concentrations of Cr(VI) were measured at several time intervals for up to four hours. It was demonstrated that each of these beverages had the capacity to reduce a concentration of > or = 8 mg Cr(VI)/l within a 15-minute time frame, and that continued monitoring of the beverages revealed greater reduction of the Cr(VI). These findings are consistent with the observation that many foods and beverages, as well as endogenous body fluids such as saliva and gastric juices, are capable of reducing substantial quantities of Cr(VI) to Cr(III). Our exposure assessment shows that the estimated high-end ingested dose of Cr(VI) from tapwater at both 1 and 5 mg Cr(VI)/l is generally two to three orders of magnitude below doses shown to have no adverse health effect in animal studies. When considered in conjunction with studies demonstrating that the reductive capacity of gastric juices may exceed 50 mg Cr(VI) daily, these observations suggest that little or no Cr(VI) is likely to be absorbed orally at a reasonable water concentration of Cr(VI), since tapwater is bright yellow at 5 mg Cr(VI)/l.

Assessment of airborne hexavalent chromium in the home following use of contaminated tapwater.

Field studies were conducted to estimate the plausible uptake of hexavalent chromium [Cr(VI)] aerosols inhaled during indoor residential use of a shower or an evaporative cooler supplied with water containing Cr(VI). In the evaporative cooler study, water concentrations of 20 mg Cr(VI)/L did not produce an increased concentration of airborne Cr(VI). The indoor air concentration of Cr(VI), measured over 24 hours of use, was 0.3-2.7 ng/m3, about the same as the concurrent outdoor concentrations. In the shower study, the average airborne concentrations of Cr(VI) aerosols at breathing-zone height ranged from 87 to 324 ng Cr(VI)/m3 when the water concentration of Cr(VI) was 0.89 to 11.5 mg/L. The Cr(VI) concentration in air was correlated directly to water concentration. The lifetime average daily doses and incremental cancer risk estimates corresponding to 30-year residential exposures were calculated using the measurements in this study and published exposure guidelines. The plausible upperbound lifetime cancer risk associated with continuous exposure to "background" Cr(VI) in outdoor air was estimated at 6.9 per million for a person exposed during ages 0-30, and 4.0 per million for ages 30-60. Similarly estimated upperbound cancer risks due to inhalation of shower aerosols from water containing 2-10 mg Cr(VI)/L over the same exposure period ranged from 0.9 to 5.5 per million. Our calculations demonstrate that shower aerosols do not contribute appreciably to background Cr(VI) exposures and risks, even at concentrations exceeding 2 mg Cr(VI)/L, which exhibit a discernible and unaesthetic yellow color that may limit the potential for long-term exposures of this type. We conclude that exposure to indoor aerosols from water containing Cr(VI) is unlikely to create a health hazard at concentrations up to 10 mg Cr(VI)/L. Furthermore, these aerosol measurements may be relevant to estimating airborne exposures to other nonvolatile chemicals.

["The most ill go into psychoanalytic treatment"? Critical comments on an article in Report Psychologie]. / "Die Kränkesten gehen in eine psychoanalytische Behandlung"? Kritische Anmerkungen zu einem Artikel in Report Psychologie.

Thomas and Schmitz claim that they "deliver a proof for the effectiveness of humanistic methods" (p. 25) with their study. However, they did not or were not able to verify their claim due to several reasons: The authors did not say if and if so to what extent the treatments carried out within the framework of the TK-regulation were treatments using humanistic methods. The validity of the only criterium used by the authors, the average duration of the inability to work, must be questioned. The inferential statistical treatment of the data is insufficient; a non-parametrical evaluation is necessary. Especially missing are personal details concerning the treatment groups (age, sex, occupation, method, duration and frequency of therapy), which are indispensable for a differentiated interpretation. In addition there are numerous formal faults (wrong quotations, mistakes in tables, unclear terms etc.). In view of this criticism we come to the conclusion that the results are to a large degree worthless, at least until several of our objections have been refuted by further information and adequate inferential statistical methods. This study is especially unsuitable to prove a however defined "effectiveness of out-patient psychotherapies", therefore also not suitable to prove the effectiveness of those treatments conducted within the framework of the TK-regulation and especially not suitable to prove the superiority of humanistic methods in comparison with psychoanalytic methods and behavioural therapy.

The Harlem regional stroke program: an overview.

The Harlem regional stroke program has been a demonstration model designed to detect, treat, and follow up stroke and hypertension patients through collaboration with a municipal teaching hospital, community practitioners, local service organizations and a major medical school. Many aspects of the stroke program appear suitable for replication at the local or regional levels in varied settings. In particular, the program has demonstrated the need to link community outreach programs, stressing early detection and preventive-care education, with sustained treatment and follow-up programs. The stroke program has also suggested ways in which specialized programs can be incorporated into long-term comprehensive health planning and care facilities at local and regional levels.