[Education and continued education in public health. Wishes and reality at the present time; demands for the future]. / Aus- und Fortbildung im öffentlichen Gesundheitsdienst. Wunsch und Wirklichkeit in der Gegenwart; Ansprüche an die Zukunft.

Sociomedicine in research and practice, i.e. in universities and in public health services, has experienced an upswing many had not expected. The health requirements of society and not only those of the individual have gained a new topicality as social factors were rediscovered in connection with health. Public health services can be advisors to politicians and defence attorneys for the population by assuming a new role and a new measure of self-understanding in the realisation of old but always fresh topics such as environmental medicine (formerly known as environmental hygiene). To translate the multitude of sociomedical tasks effectively into reality, the practically active sociomedical officer in public health services stands in need of the backing and help by sociomedical researchers in the relevant university departments. It will be imperative to achieve in future a greatly improved and closer cooperation between research and practice in sociomedicine.

[Laboratory controls in long-term treatment with anticonvulsive drugs (author's transl)]. / Laborkontrolle bei Langzeittherapie mit Antiepileptika

In the treatment of epilepsy often several substances with anticonvulsive effect are combined. Possible drug interactions in these cases can change the desired effect of treatment. Simultaneous administration of clonazepam or dipropylacetate (the latter in a short term combination) with diphenylhydantoin can cause a significant increase of diphenylhydantoin serum concentrations and intoxications. The combination of carbamazepin with diphenylhydantoin can cause a decrease of diphenylhydantoin serum concentrations. The simultaneous administration of diphenylhydantoin and phenobarbital can produce a significant increase of phenobarbital levels in the statistical average and in the case of a combination of primidon and diphenylhydantoin an intoxication by the primidon metabolite phenobarbital. These possible interactions which are not obvious at the beginning of therapy are supplemented by other factors as intercurrent diseases or erratic drug intake. With routine measurements of serum concentrations of anticonvulsive drugs some of these interfering factors can be eliminated by realizing them in time. Treatment becomes more effective and side effects are reduced. The development of a new check list for the treatment of epileptic patients should also improve the control and give better informations about the course of the disease.

Studies on photopherapy in newborn infants. Influence on protein binding of bilirubin and salicylate and on activity of acetylsalicylic acid esterase.

Phototherapy of newborn infants with hyperbilirubinemia was shown to result in an increase in hematocrit values and in the activity of the erythrocyte enzyme acetylsalicylic acid esterase. The elevation of the enzyme activity also could be produced in light-treated rabbits and in vitro after illumination of blood from adult volunteers. The binding of bilirubin to serum albumin and of salicylate to plasma proteins did not alter, nor did the concentrations of albumin or total proteins in plasma. It is concluded that light does not increase the unbound fraction of bilirubin in blood.

[The importance of the albumin bilirubin binding in drug therapy in the newborn]. / Uber die Bedeutung der Albumin-Bilirubin-Bindung bei der medikamentösen Therapie im Neugeborenenalter

Bilirubin encephalopathy in the newborn is caused not so much by the level of total serum bilirubin but rather by the level of free bilirubin not bound to albumin. Compared to adults prematures and newborns show a higher tendency towards separation of bilirubin from the albumin bond which is statistically significant as could be demonstrated by measurements in serum and plasma. This might be due to a lower bilirubin binding capacity of the neonatal albumin or a competitive displacement of the bilirubin from the albumin bonds by unknown endogenous substances. The influence of several drugs, of blood exchange transfusion and of light in phototherapy on the cleavage of bilirubin from its albumin bond was examined. Some drugs, but not the phototherapylight, enhanced displacement.