[Health valuations for patients with chronic ischemic heart disease]. / Gesundheitsbewertungen bei Patienten mit chronisch-ischämischer Herzkrankheit.

OBJECTIVE OF THE STUDY: The study deals with the question of how patients with chronic ischemic heart disease assess different health situations that can be achieved by rehabilitation. Furthermore it examines which factors influence these health valuations and whether the predictors vary depending on the level of education. METHODS: The health valuations of n = 331 patients with chronic ischemic heart disease are compiled using visual analogue scales (VAS). In addition to sociodemographic questions, generic and illness-specific scales (SF-12, MacNew) for the health-related quality of life (HRQOL) are used as potential predictors of the health valuations. Additional basic medical data were provided by the physician. Hierarchical regression analyses are conducted; the sociodemographic, medical and HRQOL variables are included stepwise. Since many variables are observed for the regression models, an imputation of missing values is made. RESULTS: The health dimensions "Self-care and domestic life" and "Mobility" are assigned the highest values on the VAS. The lowest preference is assigned to the dimensions "Reduction of symptoms" and "Information about the disease". The differences between the health dimensions are statistically significant. Sociodemographic variables explain up to 3.6% of the variance of health valuations, with level of education and living with a partner being the most important predictors. The medical variables included in the second step explain between 2.1 and 6.8% incremental variance; the most important predictor is the operation performed prior to rehabilitation (bypass, heart valve). The HRQOL variables in the third block provide 7.1-24.9% incremental explanation of variance, by far the highest percentage. This is mainly achieved using the 3 MacNew scales (emotional, social and physical functioning). The overall explanation of variance for the health valuations is 17.1-28.8%. For patients with a higher level of education, the total explanation of variance is about 9.2% higher on average than for the total sample and lies between 21.2 and 44.1%. DISCUSSION: The health dimensions examined are assessed quite differently by the patients. The most significant factor of influence is the HRQOL. In the subgroup of patients with a higher level of education, the predictive strength of the variables examined is considerably higher in comparison with the total sample. Since the health valuations can be predicted to a limited extent only using other data arising during routine care, it is necessary to implement special methods for compiling health valuations.

[Acceptance and understandability of various methods of health valuations for the chronically ill: willingness to pay, visual analogue scale and rating scale]. / Akzeptanz und Verständlichkeit verschiedener Methoden der Gesundheitsbewertung bei chronisch Kranken: Willingness to pay, visuelle Analogskala und verbale Ratingskala.

OBJECTIVE OF THE STUDY: Health valuations are one way of measuring patient preferences with respect to the results of their treatment. The study examines three different methods of health valuations - willingness to pay (WTP), visual analogue scale (VAS), and a rating question for evaluating the subjective significance. The goal is to test the understandability and acceptance of these methods for implementation in questionnaires. METHOD: In various rehabilitation centres, a total of six focus groups were conducted with 5-9 patients each with a mean age of 57.1 years. The illnesses considered were chronic-ischaemic heart disease, chronic back pain, and breast cancer. Patients filled out a questionnaire that was then discussed in the group. In addition to the quantitative evaluation of the data in the questionnaire, a qualitative analysis of the contents of the group discussion protocols was made. RESULTS: We have results from a total of 42 patients. 14.6% of the patients had "great difficulties" understanding the WTP or rated it as "completely incomprehensible"; this value was 7.3% for VAS and 0% for the rating scale. With respect to acceptance, 31.0% of the patients indicated that they were "not really" or "not at all" willing to answer such a WTP question in a questionnaire; this was 6.6% for the VAS, and again 0% for the rating scale. The qualitative analysis provided an indication as to why some patients view the WTP question in particular in a negative light. Many difficulties in understanding it were related to the formulation of the question and the structure of the questionnaire. However, the patients' statements also made it apparent that the hypothetical nature of the WTP questionnaire was not always recognised. The most frequent reason for the lack of acceptance of the WTP was the patients' fear of negative financial consequences of their responses. DISCUSSION: With respect to understandability and acceptance, VAS questions appear to be better suited for reflecting patient preferences than WTP questions. The rating scale for assessing the personally estimated importance was understandable, but had poor distribution properties and was considered by patients to be superfluous.

[Acceptance and understandability of various methods of health valuations for the chronically ill: willingness to pay, visual analogue scale and rating scale]. / Akzeptanz und Verständlichkeit verschiedener Methoden der Gesundheitsbewertung bei chronisch Kranken: Willingness to pay, visuelle Analogskala und verbale Ratingskala

OBJECTIVE OF THE STUDY: Health valuations are one way of measuring patient preferences with respect to the results of their treatment. The study examines three different methods of health valuations--willingness to pay (WTP), visual analogue scale (VAS), and a rating question for evaluating the subjective significance. The goal is to test the understandability and acceptance of these methods for implementation in questionnaires. METHOD: In various rehabilitation centres, a total of six focus groups were conducted with 5-9 patients each with a mean age of 57.1 years. The illnesses considered were chronic-ischaemic heart disease, chronic back pain, and breast cancer. Patients filled out a questionnaire that was then discussed in the group. In addition to the quantitative evaluation of the data in the questionnaire, a qualitative analysis of the contents of the group discussion protocols was made. RESULTS: We have results from a total of 42 patients. 14.6% of the patients had "great difficulties" understanding the WTP or rated it as "completely incomprehensible"; this value was 7.3% for VAS and 0% for the rating scale. With respect to acceptance, 31.0% of the patients indicated that they were "not really" or "not at all" willing to answer such a WTP question in a questionnaire; this was 6.6% for the VAS, and again 0% for the rating scale. The qualitative analysis provided an indication as to why some patients view the WTP question in particular in a negative light. Many difficulties in understanding it were related to the formulation of the question and the structure of the questionnaire. However, the patients' statements also made it apparent that the hypothetical nature of the WTP questionnaire was not always recognised. The most frequent reason for the lack of acceptance of the WTP was the patients' fear of negative financial consequences of their responses. DISCUSSION: With respect to understandability and acceptance, VAS questions appear to be better suited for reflecting patient preferences than WTP questions. The rating scale for assessing the personally estimated importance was understandable, but had poor distribution properties and was considered by patients to be superfluous.

Community and nosocomially acquired respiratory syncytial virus infection in a German paediatric hospital from 1988 to 1999.

UNLABELLED: Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in infants. Since epidemiological data from Germany are scarce, a large retrospective hospital based analysis was performed. In the first part of the study, laboratory records were checked for RSV positive specimens from January 1988 to December 1997. A total of 1664 specimens were positive corresponding to 1171 episodes in 1064 patients; 88% were up to 4 years old and 47% up to 3 months old. The percentage of premature newborns from all patients 0-4 years old was 24%. The rate of nosocomial infection was 38%. The core RSV season began in December, lasted until April, and peaked in January and February. In the second part of the study, from April 1, 1997 to March 31, 1999, which encompassed two RSV winter seasons, patients with the ICD-9 coded discharge diagnoses of lower respiratory tract infections, bronchopulmonary dysplasia (BPD) and prematurity were analysed. Of the premature newborns, 25% were tested RSV positive at least once up to the age of 1 year, as were 52% of those with BPD. The rehospitalisation rate due to RSV infection was 22% in patients with BPD, and 8.9% in all premature newborns. Of patients with community acquired RSV infection, 12% required intensive care and 6% had to be ventilated mechanically. The mortality rates in both parts of the study were 0.8% and 0.7%, respectively. CONCLUSION: Respiratory syncytial virus infection in young children is also of major importance in Germany. Although the mortality rate is low, the high incidence and the severity of the disease in the particular risk group of premature infants with chronic lung disease contribute to a very high disease burden.

Analysis of amatoxins alpha-amanitin and beta-amanitin in toadstool extracts and body fluids by capillary zone electrophoresis with photodiode array detection.

Over 90% of the lethal cases of mushroom toxin poisoning in man are caused by a species of amanita. The amatoxins (especially alpha- and beta-amanitin) found in amanita deserve special attention, because of their high pharmacological potency, their high natural concentration and their high chemical and thermal stability. Measures can be taken to improve the survival rates (aggressive gastroenteric decontamination, liver protection therapy) if the poisoning is diagnosed correctly and as early as possible. The standard assay for alpha-amanitin is a radioimmunoassay (RIA). Among other reagents, this assay uses 125I-labelled alpha-amaintin, which has a low shelf life. The assay is therefore not available at all hospitals and all year round. In this paper, a first attempt to employ capillary zone electrophoresis (CZE) to quantify amatoxins alpha- and beta-amanitin in urine samples of afflicted patients and in toadstool extracts is described. Diode array detection is used for identification of the resolved substances in the electropherogram. An analysis requires 20 min. The detection limit is 1 microgram/ml, i.e., 5 pg absolute. Relative standard deviations are between 1 and 2% for the calibration standards (peak height and area) and ca. 7.5% for the real samples. Advantages of the CZE over the RIA include lower cost, the possibility of quantifying several toxins in one analysis, less consumption of potentially harmful reagents (no radio-labelled substances, no addition of alpha-amanitin as reagent) and, most importantly, all-year-round availability of the assay. The detection limit is still somewhat high and does not cover the entire clinically relevant range. Attempts to lower the detection limit by the necessary order of magnitude are currently under way in our laboratory. These include application of laser-induced fluorescence detection, liquid chromatography-CZE and CZE-mass spectrometry techniques.

Enterotoxigenic Escherichia coli, rotavirus, porcine epidemic diarrhoea virus, adenovirus and calici-like virus in porcine postweaning diarrhoea in Hungary.

In order to obtain data about the significance of enterotoxigenic E. coli (ETEC), and of the different enteric viruses in the aetiology of porcine postweaning diarrhoea, bacteriological, electron microscopic and ELISA studies were made on dead and live pigs. E. coli from the small intestine of diarrhoeal weaned pigs that died were tested for serogroups, pili (fimbriae) and toxin-geno-type. The 108 haemolytic E. coli representing 14 farms and 42 pigs were typed as follows: 0149:K88+ETEC (56.5%), OX:K88+ETEC (21.3%), O141:F18ac+ ETEC (4.6%), O147:F18ac+ETEC (3.7%), OX and O157:F18ac+ETEC (9.3%), verotoxigenic O141:F18ac (2%). In another study, when faecal samples of 92 live diarrhoeal weaned pigs (representing 19 farms) were tested, rotaviruses (18.6%), porcine epidemic diarrhoea virus (PED) (5.5%) and calici-like viruses (5.5%), and adenovirus (two pigs) were detected, besides K88+ETEC (12%) and K99+ or 987P+ETEC (one of each). Combined infections were detected in 9% of the samples. Sequential studies of diarrhoeal and nondiarrhoeal weaned and unweaned pigs indicated that PED virus and group A rotavirus were related to diarrhoea but adeno- or calici-like virus were not. It was concluded that K88+ETEC was the overwhelming aetiologic agent of porcine postweaning diarrhoea in Hungary, but F18ac+ETEC, group A rotavirus and PED virus were also significant.

Pathological and immunological study of goose embryos experimentally infected with duck plague virus.

A total of 240 embryonated goose eggs obtained from two susceptible flocks were used. Half of the eggs were inoculated into the allantoic cavity with a virulent strain (7593) of duck plague virus isolated from an acute outbreak, and the other half were inoculated with the attenuated vaccine virus (KAPEVAC). Ten, 100 or 1000 CPU/0.1 ml virus were given on days 12 and 20 of incubation. Embryos that died and surviving embryos killed at 5-day intervals were examined by light and electron microscopy. The yolk and the serum of embryos that survived until hatching were assayed for antibody content. Lymphocytes separated from the blood were used for the immuno-rosette formation and lymphocyte stimulation tests. Pathomorphological changes indicative of virus replication occurred in the liver, kidney, myocardium, gizzard muscle and chorioallantoic membrane (CAM) of the embryos in the case of both virus strains. The time of onset and severity of these changes and the time and rate of embryonic mortality depended on the virulence of the strain used for inoculation, the virus dose and the time of inoculation. Virus-neutralizing (VN) antibodies were demonstrable neither in the yolk nor in the serum of goslings exsanguinated after hatching. The lymphocytes recognized the virus antigen in the in vitro cellular tests and responded to it with blastogenic transformation. As opposed to adult birds, in the embryos duck plague virus infection did not cause damage to the digestive tract mucosa and the lymphoid organs.

Aujeszky's disease of sheep: experimental studies on the excretion and horizontal transmission of the virus.

Five 5-month-old merino lambs were nasally inoculated with 10(5.0) TCID50 of Aujeszky's disease virus (ADV). The dynamics of virus excretion in the nasal discharges--in agreement with the histologic findings--indicated that ADV also replicates in extraneural sites, in the upper and lower parts of the respiratory tract. The virus was excreted continuously in the nasal discharges, even during the incubation period. The titres, with certain fluctuations, increased gradually up to the final stage of the fatal disease. Following the onset of the clinical disease, the titre of excreted virus (ranging from 10(4.0) to 10(6.0) TCID50/0.1 ml) was comparable with the ADV content found in the nasal discharge of naturally infected piglets. However, the horizontal transmission of ADV to contact lambs failed.