[Factors for ambulant care--first results of a small area comparison of assessment data in the Federal States of Schleswig-Holstein and Mecklenburg-Vorpommern]. / Einflussfaktoren auf die ambulante Pflege--Erste Ergebnisse eines kleinräumigen Vergleichs der Begutachtungsdaten in den Bundesländern Mecklenburg-Vorpommern und Schleswig-Holstein.

This paper shows possible opportunities and analysis potentials to contrast between Federal States--in this case Schleswig-Holstein and Mecklenburg-Vorpommern--with regard to application for and demands on benefits granted by statutory long-term care insurance. It is a further development of an early study. Under the assumption of an equal behaviour as to application for, demands on and distinction of ADL (activities of daily life) variances for defined areas of a Federal State are pointed out. Within a Federal State, definite differences between rural and urban areas are exemplified. Applications for and demands on benefits follow the same trend, but there are differences in profile. Self-assessment of each of the the States concerned, differs surprisingly and is in itself often contradictory. On comparing these States, it was possible to verify individual factors of influence such as infrastructure, housing property conditions and individual self-assessment. Moreover the paper shows the influence of the process of transition taking place in East Germany, e. g. by selective migration and fast suburbanization.

[Documentation in expert evaluation of disability status by the medical service of hospital insurance]. / Berichterstattung zur Begutachtung der Pflegebedürftigkeit durch den Medizinischen Dienst der Krankenversicherung (MDK).

A first survey is given by the documentation of the examination for the statutory nursing care insurance. The first part of the report contains the complete tabulated results of the Federal Republic of Germany. Furthermore a graphical comparison of elected federal states has been statistically evaluated and is commented upon.

[Expert evaluation and rehabilitation of nonspecific pain conditions]. / Begutachtung und Rehabilitation bei unspezifischen Schmerzzuständen.

Daily expertising practice shows that in case of exclusively somatically induced unspecific pain chronification is greatly enhanced. Faced with such phenomena, it is suggested that a dualistic manner of interpretation and treatment taking into consideration in equal measure both somatic and psychosocial factors and their mutual interaction, may initiate a change in the general trend of the patient's complaints towards eventual relief.

[3 years of MDK (Health Insurance Medical Services)--current status and future trends]. / Drei jahre MDK--eine Standortbestimmung und Perspektiven für die Zukunft.

The medical service and medical supply organizations operating in Germany within the framework of compulsory sickness insurance are based on the principles of common self-administration that is monitored via contracts. The partners to these contracts develop reciprocally adequate ideas on the medical and economic structures of the medical supply system and expand their supply and negotiation strategies by discussing the structures of paid benefits and medical supply. This means there is an increasing need for a medical interpretation of the findings and of the data on the course of a disease and its treatment. The need for explaining from a medical point of view why certain contract strategies have been adopted and must be followed, is also on the increase, as is the demand for quality assurance methods that can claim to be adequate for this medical supply system. Medical Advisory Service has become more distinctive wherever compulsory sickness insurance has been making every effort to shoulder its health policy responsibilities and to make quality assurance a declared aim.

[A quality assurance program in social medicine expert assessment]. / Qualitätssicherungsprogramm in der sozialmedizinischen Begutachtung.

Based on results of discussions from various fields of medical expertises, following a preliminary report of necessary essential parameters for a quality monitoring programme in sociomedical expertising, a catalogue of 10 standards is suggested to compare quality analysis. These standards can be used for internal anonymous voluntary specimen random tests (cross-examinations), external quality control and longitudinal studies in case of second or multiple medical opinions requested by the social health insurance. Evaluation can be worked out by an 0-10 point scale, for example by quality assurance committees.

[Medical management--a new responsibility profile of the medical service of health insurance]. / Medizinmanagement--ein neues Anforderungsprofil an den Medizinischen Dienst der Krankenversicherung.

The Federal German Health Insurance Amendment Law provides for reorganisation of the medical advisory service by specially appointed doctors who had so far been engaged in giving their expert opinion to health insurance authorities on health insurance cases. These activities are now being extended by additional tasks, such as management functions. The article reviews the medicosociological and health economy aspects of the revised advisory activities.

Uterine contraction intervals and transcutaneous levels of fetal oxygen pressure.

Continuous intrauterine transcutaneous PO2 (tcPO2) measurement was performed in 30 deliveries. The various characteristics of labor (peak of contractions, duration, and contraction interval) were correlated with the tcPO2 integral. The best correlation was seen between the tcPO2 integral and that of the contraction intervals. As the data show significant correlations with the pattern of labor, continuous tcPO2 measurement is a reliable and sensitive method for recognizing PO2 alterations early, especially in high-risk deliveries.

Alpha-fetoprotein and beta-human chorionic gonadotropin in amniotic fluid.

A series of data on amniotic fluid levels of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG) are presented. Both hormones were observed to decrease with advancing gestational age. The diagnostic importance of AFP levels is confirmed, and the very high levels of beta-HCG in twin gestations are documented. A statistically significant correlation between the concentration of both hormones is demonstrated.