[Significance of regional variations in the prevalence and treatment of depressive disorders and implications for health-care research]. / Stellenwert regionaler Variationen in der Prävalenz und Behandlung depressiver Erkrankungen und Implikationen für die Versorgungsforschung.

Providing mental health care to patients with depressive disorders is accompanied by deficits in the diagnostics and in the access and adequacy of treatment. Analyzing regional variations in mental health care is of increasing importance in order to detect and explain these supply shortfalls. This paper discusses different explanatory approaches to the regional variations in diagnosed depressive disorders and their treatment. Differences in demographic structures and in patients' attitudes toward mental disorders as well as in their preferences in the choice of treatment may explain regional variation. Furthermore, the number and distribution of care providers between regions may have an effect on variation. In addition to the density and availability of care givers, the quality of care may differ because of factors such as sensitivity to the detection of depressive disorders, coding quality of diagnosis and treatment, guideline-oriented treatment, as well as treatment outcome. Small-area analyses should consider all perspectives in order to understand the complexity of regional variation in the provision of health-care services and to derive recommendations for health-care services that meet people's needs.

[Gemcitabine/cisplatin vs. MVAC. 5 year survival outcome of the phase III study of chemotherapy of advanced urothelial carcinoma in Germany]. / Gemcitabin/Cisplatin vs. MVAC. 5-Jahres-Ergebnisse der Phase-III-Studie zur Chemotherapie des fortgeschrittenen Urothelkarzinoms in Deutschland.

Of 405 patients with stage IV transitional cell carcinoma from an international multicenter phase III trial, 70 were randomized in Germany to receive either gemcitabine/cisplatin or standard MVAC systemic chemotherapy for locally advanced or metastatic urothelial cancer. Overall survival as the primary endpoint of the study was similar in both arms (median survival GC 15.4 months vs MVAC 16.1 months), as were tumor-specific survival and time to progressive disease. In the intent-to-treat analysis, the 5-year overall survival rate was 10% for patients randomized to GC and 18% randomized to MVAC. Tumor overall response rates (GC 54%, MVAC 53%) were similar. The toxic death rate was 0% in the GC arm and 3% (one patient) in the MVAC arm. Significantly more GC than MVAC patients experienced grade 3/4 anemia (GC 52%, MVAC 20%) with significantly more red blood cell transfusions in the GC arm.Significantly more GC than MVAC patients had grade 3/4 thrombocytopenia (GC 54%, MVAC 17%) without grade 3/4 hemorrhage or hematuria in either arm. More MVAC patients experienced grade 3/4 neutropenia (GC 56%, MVAC 61%, p=1.000), neutropenic or leukopenic fever (GC 0%, MVAC 10%, p=0.237), mucositis (GC 0%, MVAC 7%, p=0.495), and alopecia (GC 6%, MVAC 36%, p=0.004). GC represents a reasonable alternative for the palliative treatment of patients with locally advanced and metastatic transitional cell carcinoma. Sustained long-term survival was only found for patients with locally advanced cancer, lymphatic metastases, or solitary distant metastasis but not for visceral metastatic disease.

All-optical sampling with a monolithically integrated Mach-Zehnder interferometer gate.

An all-optical sampler consisting of a polarization-independent monolithic Mach-Zehnder interferometer with integrated semiconductor optical amplifiers and a temporal resolution of 1 ps is presented. As an example, a simple 320-Gbit/s pattern has been successfully sampled, demonstrating the functionality of this scheme for high-bit-rate waveform characterizations in light-wave systems.

Imaging precessional motion of the magnetization vector.

We report on imaging of three-dimensional precessional orbits of the magnetization vector in a magnetic field by means of a time-resolved vectorial Kerr experiment that measures all three components of the magnetization vector with picosecond resolution. Images of the precessional mode taken with submicrometer spatial resolution reveal that the dynamical excitation in this time regime roughly mirrors the symmetry of the underlying equilibrium spin configuration and that its propagation has a non-wavelike character. These results should form the basis for realistic models of the magnetization dynamics in a largely unexplored but technologically increasingly relevant time scale.

1999 rerun of the 1996 German Urinary Incontinence Survey: will doctors ever ask?

The German Incontinence Relief Society and supporting companies have been conducting numerous urinary incontinence awareness and continuing medical education campaigns. However, comparison of results from an epidemiologic survey involving 6,607 over-50-year-old patients in 1996 and a similar investigation among 6,481 patients in the same age group in 1999 reveals that German physicians are now even less likely to address this taboo subject, thus withholding appropriate care from incontinent patients. Possible reasons for this alarming development include the financial restraints imposed on German doctors in private practice and a lack of appreciation of the problems associated with incontinence among health policymakers.

Passively Q-switched 0.1-mJ fiber laser system at 1.53 mum.

We demonstrate a passively Q-switched fiber laser system generating pulses with as much as 0.1 mJ of pulse energy at 1.53 mum and a >1-kHz repetition rate. These results were achieved with a simple master oscillator-power amplifier scheme with a single pump source, realized with large-mode-area fiber and multiple reflections upon a semiconductor saturable-absorber mirror.

Passively Q-switched 1.34- mum Nd:YVO(4) microchip laser with semiconductor saturable-absorber mirrors.

We demonstrate a passively Q -switched diode-pumped 1.34- microm Nd:YVO(4) microchip laser. We achieved single-frequency, 230-ps pulses by using an InGaAsP semiconductor saturable-absorber mirror. We can vary the pulse width and the repetition rate from 230ps to 12ns and from 30 kHz to 4 MHz, respectively, by changing the design parameters of the saturable absorber, the thickness of the crystal, and the pump power.

Spatial mode filters realized with multimode interference couplers.

Spatial mode filters based on multimode interference couplers (MMI's) that offer the possibility of splitting off antisymmetric from symmetric modes are presented, and realizations of these filters in InGaAsP/InP are demonstrated. Measured suppression of the antisymmetric first-order modes at the output for the symmetric mode is better than 18 dB. Such MMI's are useful for monolithically integrating mode filters with all-optical devices, which are controlled through an antisymmetric first-order mode. The filtering out of optical control signals is necessary for cascading all-optical devices. Another application is the improvement of on-off ratios in optical switches.

[Disorders of bladder function in the elderly]. / Blasenfunktionsstörungen im Alter.

Voiding dysfunction in elderly patients is not a uniform disease entity. Diseases of the cerebrospinal system, metabolic imbalances, detrusor degeneration and bladder outlet obstruction or sphincter impairment can all result in disabilities such as urinary retention and/or urinary incontinence. Although the urodynamic pattern of an uninhibited neuropathic bladder resulting from a poorly functioning corticoreticular system may seem to be normal in these elderly subjects, many of them have lost control of the micturition reflex: the warning to void occurs suddenly at full bladder capacity, and the abrupt sensation that urination is imminent cannot be controlled appropriately. Classifying these symptoms under a simple common denominator, such a detrusor instability can be misleading, because the therapeutic approach in these patients should be more highly differentiate. Detrusor overactivity may be symptomatic and associated with curable diseases of the lower urinary tract, such as bladder outlet obstruction, urinary tract infection or bladder cancer. On the other hand, some of the underlying causes of so-called idiopathic detrusor overactivity have been disclosed recently by Elbadawi et al. (1993), relating detrusor impairment to detrusor degeneration characterized morphologically by a dysjunction pattern. In this setting, it cannot be overemphasized that better knowledge of the underlying disease will result in more successful treatment of the voiding disability in such patients. Urinary incontinence in elderly patients is not always due to an incompetent urinary sphincter, and urinary retention in this age group is not always the result of a bladder outlet obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Overlapping-image multimode interference couplers with a reduced number of self-images for uniform and nonuniform power splitting.

Overlapping-image multimode interference (MMI) couplers, a new class of devices, permit uniform and nonuniform power splitting. A theoretical description directly relates coupler geometry to image intensities, positions, and phases. Among many possibilities of nonuniform power splitting, examples of 1 × 2 couplers with ratios of 15:85 and 28:72 are given. An analysis of uniform power splitters includes the well-known 2 × N and 1 × N MMI couplers. Applications of MMI couplers include mode filters, mode splitters-combiners, and mode converters.

Iomeprol versus iopromide for intravenous urography.

Iomeprol (B16880) is a new non-ionic tri-iodinated radiographic contrast medium. It was the aim of this double blind randomized phase III clinical trial to compare the local and systemic tolerance of iomeprol-300 (300 mg I ml-1) with the commercially available iopromide-300 (300 mg I ml-1) in a group of 198 patients needing intravenous urography. The contrast medium was injected rapidly into an antecubital vein within 2-3 min in most cases, using a standard dosage of 1 ml kg-1 body weight. The proportion of patients with an allergic diathesis was 25% in the iomeprol group and 17.3% in the iopromide group. There were no life-threatening adverse reactions. Eight patients (8%) receiving iomeprol and 6 (6.1%) receiving iopromide had a sensation of heat related to the injection of contrast medium. Only one patient (1%) in the iomeprol group and two patients (2%) in the iopromide group noted pain on injection. Although the incidence of all other side-effects was relatively high (7% after iomeprol and 11.2% after iopromide) these reactions were generally harmless. The most common symptom was nausea and/or vomiting, which occurred with the same incidence (5%) in both groups. Only one patient in each group developed urticaria or erythema. Vital parameters remained essentially unchanged in all patients. The results suggest that iomeprol is a safe contrast medium, with a tendency to produce fewer side effects than iopromide, which is known to be particularly well tolerated.

General self-imaging properties in N × N multimode interference couplers including phase relations.

Self-imaging properties of generalized N × N multimode interference couplers are derived. Positions, amplitudes, and phases of the self-images are directly related to the lengths and widths of the coupler by solving the eigenmode superposition equation analytically for any arbitrary length. Devices of length (M/N) 3L(c), where M is the multiple occurrence of the N self-images, are analyzed in detail. The general formalism is applied to practical N × N couplers used in integrated optics, and simple phase relations are obtained.

Digastric muscle response as a function of knowledge of the task to be performed.

Whether the motor programme executed by the digastric muscles during a forceful bite is modified according to a subject's expectation that the resistance between the teeth will change was investigated. There were two experimental conditions: (1) tracking a ramp (drawn on an oscilloscope screen) by biting (isometrically) on a force transducer and holding it at 120 N, and (2) tracking the same ramp with a sudden unloading at 100 N. There were two groups of experiments: (1) control experiments in which subjects underwent a sudden and unexpected unloading of the jaw, and (2) experiments in which subjects were previously informed whether or not there was to be an unloading. In all experiments the subjects co-contracted their digastric muscles during the bite as compared to the state at rest. The subjects' responses fell into the three different types: (i) those who varied the level of tonic digastric activity only as a function of the experimental condition, (ii) those who co-contracted the digastric muscles at the same time as the masseter muscles, and (iii) those who changed the contraction pattern of the digastric muscles as a function of the experimental condition. If modulation of the digastric muscles occurred this is a 'feedforward' strategy mainly based on immediate past performance.