[Determinants of workplace health promotion in the insurance sector: results of a complete survey of German insurance companies in 2006]. / Determinanten der betrieblichen Gesundheitsförderung in der Versicherungsbranche: Ergebnisse einer Vollerhebung bei deutschen Versicherungen im Jahr 2006.

OBJECTIVES: The present study is aimed to assess the current level of workplace health promotion (WHP) within the German insurance sector and to examine whether and to what extent internal and external factors play a role in implementing non-statutory health promotion measures. METHODS: Firstly, a telephone survey was conducted of German insurance companies fulfilling the inclusion criteria for the survey (n=258). It was enquired whether these companies wish to participate in a written survey on workplace health promotion. A written questionnaire was then sent to those companies meeting the criteria (n=140). The questionnaire contained questions on the company, number and type of workplace health promotion measures as well as the internal and external framework for workplace health promotion measures. In total, 68 questionnaires were filled in and returned. Linear regression analysis was applied to investigate how external and internal variables influence workplace health promotion. RESULTS: The response rate was 48.57%. Workplace health promotion measures undertaken by those insurance companies taking part in the written survey were largely dominated by behavioural and relational prevention measures. Also on offer were measures from areas such as further education and prevention that seek to improve communication and team work. By contrast, diagnostic activities were only of minor importance. Incorporation into workplace health management (beta=0.469; p<0.001), company size (beta=0.340; p<0.001) as well as implementation of management measures with regard to personnel development, organisational development and quality control (beta=0.243; p<0.01) have a significant influence on the number of non-statutory WHP measures implemented (R (2)=62%). CONCLUSIONS: To increase the effectiveness of their non-statutory health promotion measures insurance companies should increasingly incorporate such measures into specific health management programmes as well as general management measures with regard to personnel development, organisational development and quality control. Moreover, workplace health promotion measures should always be evaluated in terms of health and economic indicators. It should also be noted that small and medium-sized companies have the largest potential for improvement.

[Current status of total hip and knee replacements in Germany - results of a nation-wide survey]. / Aktueller Status der Hüft- und Knieendoprothetik in Deutschland - Ergebnisse einer bundesweiten Umfrage.

BACKGROUND: Total hip and knee replacements are very frequently performed operative procedures in German hospitals. Despite the high number of cases, only few data on treatment procedures of the clinical routine and their impact on postoperative length of stay and clinical outcome are available. The aim of our survey was to gain detailed insights of the treatment procedures in patients scheduled for elective hip or knee replacement in order to extract recommendations for improving patient care. METHODS: In a nation-wide survey, we asked leading physicians of 694 trauma surgery and orthopaedic surgery departments and their corresponding colleagues in the departments of anaesthesia for treatment procedures including the process of patient admission, surgical techniques, postoperative analgesia, discharge management and follow-up. We used a multiple linear regression for analysing variables impacting on the postoperative length of stay. RESULTS: Altogether, 303 replies representing 31.8 % of the contacted hospitals could be evaluated. For hip arthroplasty, the anterolateral approach was most commonly chosen. For knee arthroplasty, the parapatellar approach was most frequently used. Tourniquet and wound drainage (mostly removed on the second postoperative day) were widely used with more than 90 %. The avoidance of wound drainage was associated with a lower postoperative length of stay for patients following total hip or knee replacement. Only 70 % of the German departments followed up their patients after discharge checking especially the range of motion of the artificial joint replacement. CONCLUSION: The treatment procedures for elective hip and knee replacement are very heterogeneous in German hospitals. The quality of the clinical outcome cannot be related to a single procedure; in fact the choice and complementary interaction of interventions are essential for improving patient care. These results provide first important evidence to which extent organisational structures and treatment procedures affect patient care and length of stay. Therefore, the analyses show relevant indications for an optimised standard in patient care.

Probiotic-induced suppression of allergic sensitization and airway inflammation is associated with an increase of T regulatory-dependent mechanisms in a murine model of asthma.

BACKGROUND: Microbial intestinal colonization in early in life is regarded to play a major role for the maturation of the immune system. Application of non-pathogenic probiotic bacteria during early infancy might protect from allergic disorders but underlying mechanisms have not been analysed so far. OBJECTIVE: The aim of the current study was to investigate the immune effects of oral application of probiotic bacteria on allergen-induced sensitization and development of airway inflammation and airway hyper-reactivity, cardinal features of bronchial asthma. METHODS: Newborn Balb/c mice received orally 10(9) CFU every second day either Lactobacillus rhamnosus GG or Bifidobacterium lactis (Bb-12) starting from birth for consecutive 8 weeks, during systemic sensitization (six intraperitoneal injections, days 29-40) and airway challenge (days 54-56) with ovalbumin. RESULTS: The administration of either Bb-12 or LGG suppressed all aspects of the asthmatic phenotype: airway reactivity, antigen-specific immunoglobulin E production and pulmonary eosinophilia (mean: 137 vs. 17 and 13 cellsx10(3)/mL, respectively). Antigen-specific recall proliferation by spleen cells and T-helper type 2 cytokine production (IL-4, IL-5 and IL-10) by mesenteric lymph node cells also showed significant reduction, while TGF production remained unchanged. Oral LGG administration particularly suppressed allergen-induced proliferative responses and was associated with an increase in numbers of TGF-beta-secreting CD4+/CD3+ T cells in mesenteric lymph nodes (6.5, 16.7%) as well as nearly 2-fold up-regulation of Foxp3-expressing cells in peribronchial lymph nodes. CONCLUSIONS: Neonatal application of probiotic bacteria inhibits subsequent allergic sensitization and airway disease in a murine model of asthma by induction of T regulatory cells associated with increased TGF-beta production.