[Analysis of current costs of pain disorders in Schleswig-Holstein]. / Kostenanalyse von Schmerzerkrankungen in Schleswig-Holstein.

In times with limited financial resources quality of treatment and costs of treatment must be considered equally. The AOK has analysed the costs of in-patient treatment of pain patients in Schleswig-Holstein in 1995. The number of patients, mean duration and costs of in-patient treatment were calculated. Altogether 16.614 patients were treated, the mean duration of in-patient treatment was 14.3 days, the mean costs of in-patient treatment were 6911 German marks. Target of a specialised pain therapy must primarily be to alleviate pain, but cost efficiency must be regarded as well.

[Value of specialized pain treatment]. / Nutzen spezialisierter Schmerzbehandlung.

The paper describes new forms of specifically organized headache prevention and headache therapy in Germany with the aid of two examples. It provides an overview of the clinical and economic efficiency of facilities with new forms of organization for specialized pain therapy. Their effectiveness can be seen both in a marked reduction in individual suffering and in low-cost provision of services for the institutions bearing the costs and for society. This effectiveness can be seen not only from subjective parameters by interviewing the patients, but also from objective target parameters such as resumption of work, reduction in intake of medication, cost reductions due to reduced demands on the healthcare system, avoidance of premature pensioning. By contrast, patients who do not receive specially organized treatment despite the fact that they need it display either constant suffering or even a worsening of their symptoms and an increased need for financial compensation. In view of this clear situation, specialized headache and pain therapy with a special focus on catering for the needs of chronic headache suffering is called for, both on economic and ethical grounds.

Enhancement of Na(+) uptake currents, time-dependent inward-rectifying K(+) channel currents, and K(+) channel transcripts by K(+) starvation in wheat root cells.

Excessive low-affinity Na(+) uptake is toxic to the growth of glycophytic plants. Recently, several reports have suggested that the interaction between K(+) and Na(+) uptake might represent a key factor in determining the Na(+) tolerance of plants. We investigated the effects of K(+) starvation on Na(+) and K(+) uptake mechanisms in the plasma membrane of wheat (Triticum aestivum L.) root cortex cells using the patch-clamp technique. Unexpectedly, K(+) starvation of wheat seedlings was found to enhance the magnitude and frequency of occurrence of time-dependent inward-rectifying K(+) channel currents (I(K)(+)(in)). We examined whether the transcription of a wheat root K(+)(in) channel gene is induced by K(+) starvation. A cDNA coding for a wheat root K(+) channel homolog, TaAKT1 (accession no. AF207745), was isolated. TaAKT1 mRNA levels were up-regulated in roots in response to withdrawal of K(+) from the growth medium. Furthermore, K(+) starvation caused an enhancement of instantaneous Na(+) currents (I(Na)(+)). Electrophysiological analyses suggested that I(K)(+)(in) and I(Na)(+) are not mediated by the same transport protein based on: (a) different activation curves, (b) different time dependencies, (c) different sensitivities to external Ca(2+), and (d) different cation selectivities. These data implicate a role for I(Na)(+) in Na(+) uptake and stress during K(+) starvation, and indicate that K(+)(in) channels may contribute to K(+)-starvation-induced K(+) uptake in wheat roots.

[Epidemiology and socioeconomic consequences of migraine and headache diseases]. / Epidemiologie und sozioökonomische Konsequenzen von Migräne und Kopfschmerzerkrankungen.

The paper describes the situation of traditional headache therapy on the basis of up-to-date empirical data on headache epidemiology, the habits of the persons affected, and the economic consequences for employers, health insurance funds and society in general. It also describes for the first time the direct costs of in-patient headache therapy in a traditional treatment context without specially organized therapy on the basis of actual invoicing between hospitals and health insurance funds.

[Diagnosis-oriented diagnosis, therapy and fee schedules in oncology. A model trial]. / Diagnose-orientierte Diagnostik, Therapie und Kostenerstattung in der operativen Onkologie. Ein Modellversuch.

In 1996 the project "operative oncology" was initiated by the Department of Surgery University of Kiel in order to guarantee a solid and longterm financing of surgical oncological interventions with a high quality standard. First step was to determine the detailed costs of the diagnostic and different surgical procedures in order to calculate flat rates per case. Covered by these comprehensive prices per case are also the psychooncological support, prospective evaluation of quality of life and molecular-oncological diagnostics (determination of micrometastasis). The development of project was primarily financed by the AOK health insurance company of Schleswig-Holstein. It was calculated by the GSbG and is supported since April, 1st, 1998 by all health insurance companies of the region.

Over-expression of plant 14-3-3 proteins in tobacco: enhancement of the plasmalemma K+ conductance of mesophyll cells.

Two cDNA clones encoding 14-3-3 homologous proteins were isolated from Vicia faba. Deduced amino acid sequences share different degrees of homology with other plant 14-3-3 proteins. Both clones, under the control of the CaMV 35S promoter, were transformed into tobacco plants. Immunoblotting showed three different forms of ca. 31, 34, and 37 kDa, indicating a covalent modification of the expressed 14-3-3 proteins. These forms were mainly present in the microsomal fraction. Patch-clamp studies of mesophyll protoplasts of the transformants revealed a strongly enhanced K+ conductance compared to the wild type. This indicates the involvement of 14-3-3 proteins in ion channel regulation, presumably by modulating kinase activities or binding the channel.

[Surgical oncology: possible methods for financing complex oncological therapy procedures]. / Operative Onkologie: Mögliche Wege zur Finanzierung komplexer onkologischer Therapieverfahren.

The AOK Schleswig-Holstein actually finances the evaluation of treatment costs for the project "Operative Oncology". After the primary conceptual phase, the project will be financed for several years and will be accompanied by quality-control studies. In addition to the procedure of the BMG, the costs of psychological support/therapy as well as for new molecular biological tests for the detection of micrometastases are calculated. The reason for this calculation is that these additional costs might be included into a specific, oncological resource-based value system of payment.

Oscillatory interactions between voltage gated electroenzymes.

The activities of the major ion pathways in the plasma membranes of plants are sensitive to the membrane voltage, V. Therefore, these 'electroenzymes' interact with each other via the free running voltage under physiological conditions. A physical background is given here, of how to calculate these interactions on the basis of experimental data on these electroenzymes. Simplifying model calculations with five major electroenzymes from plant cells (H(+) pump, inward and outward rectifying channels for K(+), a Cl(-) channel, and a 2H(+)/Cl(-) symporter) show that osmotic relations are balanced in the long-term not by an appropriate steady-state, but by alternation between a state of salt uptake at V < < E(K) (the Nernst equilibrium voltage for K(+) diffusion) and a state of salt loss at V > E(K). Several specific properties of the model are discussed numerically, e.g. minimum configuration for oscillations (with two electroenzymes), temperature-compensation, the physiological impact of fast gating in plant membranes, and solution of possible paradoxes, such as flux stimulation by conductance inhibition.

Modeling plasmalemma ion transport of the aquatic plant Egeria densa.

Fresh-water plants generate extraordinarily high electric potential differences at the plasma membrane. For a deeper understanding of the underlying transport processes a mathematical model of the electrogenic plasmalemma ion transport was developed based on experimental data mainly obtained from Egeria densa. The model uses a general nonlinear network approach and assumes coupling of the transporters via membrane potential. A proton pump, an outward-rectifying K+ channel, an inward-rectifying K+ channel, a Cl- channel and a (2H-Cl)+ symporter are considered to be elements of the system. The model takes into consideration the effects of light, external pH and ionic content of the bath medium on ion transport. As a result it does not only satisfactorily describe the membrane potential as a function of these external physiological factors but also succeeds in simulating the effects of specific inhibitors as well as I-V-curves obtained with the patch-clamp technique in the whole cell mode. The quality of the model was checked by stability and sensitivity analyses.