Case report: Rhabdomyolysis in children in acute and chronic disease-a challenging condition in pediatric emergency medicine.

Rhabdomyolysis is a challenging condition in pediatric emergency departments (PED): It ranges from asymptomatic illness with isolated elevation of creatine kinase (CK) levels to a life-threatening condition associated with extreme elevations in CK, electrolyte imbalances, circulatory failure (CF), acute kidney injury (AKI), and multi-organ disease. Most common causes of rhabdomyolysis are viral myositis and trauma, hereditary metabolic myopathies must be considered when facing rhabdomyolysis in early childhood. We report two cases of severe rhabdomyolysis with CF in our PED, thereby summarizing first-line management of rhabdomyolysis.

[Evidence-based health services research--a short review and implications]. / Versorgungsforschung--evidenzbasiert Ein Kurzüberblick und Implikationen.

BACKGROUND: Health services research aims to generate knowledge about care processes of people with illnesses who access health-care services. In addition, the consequences of those processes in the care routine concerning the involved persons and the health system are analyzed. CONCEPT OF THE THEORETICAL WORK: In the first part of the manuscript, an overview concerning the current definitions and subsumptions of the concept of health services research is given. The second part of the manuscript focuses on demonstrating how evidence-based health services research can be used to enable optimization of the care system. The concept is called the "circle of care optimization". In the first step the current care situation concerning its deficits and their reasons is analyzed. In the second step a relevant care goal is defined. In the third step an improvement of an existing care process is developed to achieve the defined care goal. In the fourth step, a comparative empirical study with a high-quality study design is carried out, to assess whether the improved care process is superior to the current care as usual. A health economic evaluation will be performed if applicable. If the results show no or only small advantages, the "circle" starts again with step 3. However, if the results show a significant effect in favour of the new care process and are relevant for the delivery of care and efficient in the context of health economics, a fifth step will be performed which involves developing and testing strategies for implementation. Where relevant, the consequences of implementation are investigated in a sixth step. A "best-practice" practical example is demonstrated to illustrate the "circle of care optimization". CONCLUSIONS: conclusions are derived by illustrating future challenges for health services research.

[Voluntary help in dementia - predictors for utilisation and expected quality from a family caregiver's point of view]. / Ehrenamtlicher Betreuungsdienst bei Demenz - Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger.

Although support services are considered cost-effective in the relief of care-giving family members of dementia patients, there has been little research to date on the predictors of use and quality expectations. These two questions are examined for the first time based on cross-sectional data of 404 care-giving family members, users and non-users of voluntary help services. Quantitative data are evaluated using binary logistical regression analysis, qualitative data using content analysis. The rating of how helpful the use of a voluntary help service is in the personal situation was found to be the only significant predictor of use. With respect to quality, it is most important that the persons giving support be punctual and well-trained. To increase the rate of use, care-giving family members must be convinced of the relevant benefits of using a voluntary help service. In addition, attention must be paid to the professional organization and training of voluntary helpers.

[Binge drinking in adolescents and young adults]. / Rauschtrinken bei Jugendlichen und jungen Erwachsenen.

Various studies in industrialised European and non-European countries have expressed concern about the link between alcoholic drinks (e. g. alcoholic sodas, so called "alcopops") and binge drinking in adolescents and young adults. Binge drinking has been shown to be associated with considerable social harm and disease burden. Adolescent alcohol abuse including binge drinking is common, but the extent of the problem and the specific risk factors leading to binge drinking behaviour remains unclear. Although the long-term health of adolescent binge drinking has not been studied in detail, first studies report an elevated risk for physical injury, aggression, violent or driving offences while intoxicated and high-risk sexual behaviour. To date, a variety of socio-demographical characteristics associated with binge drinking have been studied. However, knowledge in this area is limited, as most research has been conducted among specific groups (i. e. North American college students, adolescents in Australia etc.). More and intensive research in Germany and other European countries is urgently needed, as results from other cultural backgrounds are not necessarily transferable.

[Care groups. Predictors for utilisation and expected quality from the dementia caregiver's point of view]. / Betreuungsgruppen. Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger eines Demenzkranken.

BACKGROUND: To relieve family caregivers of dementia patients the utilisation of care groups should be fostered. In order to do this the influencing factors must be investigated. INVESTIGATION: Which variables of the care situation, the family caregivers and their attitudes act as predictors for the utilisation of care groups? What are the views of family caregivers about the quality of care groups? METHOD: A cross-sectional study was carried out as an anonymous, written survey of family caregivers of dementia patients in four regions of Germany. There was a 20 % response rate and the quantitative and qualitative data from 404 family caregivers were analysed. Predictors for utilisation were evaluated using binary logistic regression analysis. The answers about quality were evaluated using qualitative content analysis. Additionally ten telephone interviews with people from managerial positions in care groups, regarding their concept of quality, were carried out. RESULTS: Besides estimating how helpful the support of a care group is for their own care situation, only the level of education of the caregiver is a significant predictor for utilisation--lower education level, higher utilisation. Family caregivers, who had already had experience with a care group, expressed a wish for an adequate form of occupation for the dementia patient such as physical exercise or play followed by "well-trained" staff and a loving atmosphere in the care group. CONCLUSIONS: In order to increase the rate of utilisation, family caregivers must be convinced of the relevant advantages of using care groups.

[Dementia caregiver skill training--predictors for utilisation and expected quality from the family caregiver's point of view]. / Pflegekurse--Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger eines Demenzpatienten.

AIM: Which variables are predictors for the utilisation of caregiver skill training and what are the views of caregivers about its quality? METHOD: A written survey of 404 family caregivers of dementia patients was carried out. RESULTS: The estimation of helpfulness of skill training, lower level of education of the caregiver and higher age of the dementia patient are significant predictors. Caregivers most frequently expressed a wish for practical instruction on caregiving activities.

[Dementia patients and levels of care: do symptoms of the illness affect the grading?]. / Demenzkranke und Pflegestufen: Wirken sich Krankheitssymptome auf die Einstufung aus?

OBJECTIVE: As the levels of care within long-term nursing care regulations are defined according to limitations in performing fundamental activities of daily living, the extent to which medically diagnosed cognitive, emotional and behavioral dementia symptoms are taken into account in the grading, should be investigated. METHOD: 390 patients with mild to moderate dementia from the Mid-Franconia region, were included into the IDA ("Initiative Demenzversorgung in Allgemeinmedizin") study by specially trained general practitioners. The GPs had diagnosed dementia and noted the accompanying signs at baseline. In an interview with the caregiver, the Barthel Index was used to measure the level of help required with fundamental daily tasks. Predictors for grading were set down using logistic regression analysis. RESULTS: Where one accompanying sign is present, about half the patients had not been assigned a grade. Besides the Barthel Index, the presence of agitation and agnosia and the absence of depression are the only independent predictors for grading. All other symptoms, impairment of the executive function, loss of orientation, aphasia, anxiety, sleeplessness, aggressiveness and tendency to wander, have no significant predictive value. CONCLUSION: In the future development of nursing care insurance, the need for nursing care should be redefined using symptoms associated with dementia, particularly sleeplessness, aggressiveness and the tendency to wander as inclusion criteria. This is a prerequisite of improving the care available to dementia patients in the long term and also of expanding relief measures for family caregiver.

Social contexts in adolescent smoking: does school policy matter?

According to an ecological perspective in psychology and in line with social cognitive theory, smoking behaviour is determined by different social contexts (for example, peers, family and school) providing adolescents with important role models. This paper investigates the effects of personal characteristics as well as family, peer and school context variables on youth smoking behaviour. We hypothesize that school smoking policy variables predict adolescents' smoking in addition to other context variables. Data were obtained from a self-report survey administered to 3364 students in 40 secondary schools in Bavaria, Germany. For both younger (10-15 years) and older (16-21 years) students, strong associations were found between smoking behaviour and (i) smoking best friends and friends in general, (ii) other substance use and (iii) school performance. In the younger age group, the non-existence of smoking bans for students was associated with an increased risk of being smoker. For the older students, a positive association was found between the presence of smoking teachers on school grounds and smoking behaviour. Results are discussed considering methodological aspects and public health concerns.

[Proportion of smokers, stages of preparedness to change and utilisation of a smoking cessation intervention in mother-child rehabilitation]. / Anteil von Raucherinnen, Stadien der Veränderungsbereitschaft und Inanspruchnahme von Tabakentwöhnung in der Mutter-Kind-Rehabilitation.

BACKGROUND: Smoking mothers put their own health as well as that of their children at risk. Mother-child inpatient rehabilitation centres can be a suitable setting for reaching this target group and providing support for smoking cessation. AIM: The aim of the study is to describe for the first time the smoking prevalence and motivation to change of patients in German mother-child inpatient rehabilitation centres and to investigate the actual utilisation of an offered smoking cessation programme. METHOD: In a cross-sectional field study with a consecutive sample from 22 mother-child inpatient rehabilitation centres (N=4329 mothers) smoking prevalence, stage of preparedness to change according to the transtheoretical model and consideration to seek help for cessation were assessed via a questionnaire. In addition, the number of smokers who can be reached by the offer of a quit-smoking programme was assessed by means of reports of the course instructors. RESULTS: 29.2% of patients in mother-child rehabilitation are smokers. Compared to the female general population, a higher proportion of the women were in an advanced stage of preparedness to change (19.4% are in preparation) and the majority of smokers are willing to seek help to quit smoking. 37.6% of smoking mothers participated in the offered smoking cessation intervention. CONCLUSION: There is a high proportion of smokers and a high readiness to change in German mother-child rehabilitation centres. The actual participation rate in an offered smoking cessation programme is quite remarkable, but nevertheless has to be enhanced further. One possible approach is measures to enhance smoking mothers' motivation to quit.

Differential expression of immediate early genes after transection of the facial nerve.

Facial motoneurons respond to peripheral transection of the facial nerve with a number of molecular changes. In order to obtain insight into the transcriptional mechanisms underlying the changes induced by axotomy, the expression of a number of immediate early genes was investigated after facial nerve lesion in the rat. Some immediate early genes (such as c-fos, c-jun or jun B) are known to encode transcription factors that bind to DNA at sites that regulate gene expression and they could therefore contribute to long-term changes in motoneurons. Northern blot analysis of RNA extracted from the facial nucleus from postoperative intervals covering hours and days revealed that axotomy results in a unique pattern of immediate early gene induction in the facial nucleus. c-Jun, jun B and 12-O-tetradecanoylphorbol-13-acetate-induced sequence (TIS) 11 messenger RNA, also present in low amounts in the unoperated nucleus, were strongly induced in a long-term fashion after nerve injury. Increased levels of these messenger RNAs were first detectable at 5 h, reaching a maximum (300-500% compared to control) within 24 h followed by a gradual decline during the following week. Elevated levels were maintained at least up to eleven days compared to the unoperated side. On the other hand, c-fos messenger RNA was neither expressed in the unoperated nucleus, nor was c-fos messenger RNA induced by axotomy at any of the time-points studied. Another member of the TIS family of immediate early genes TIS 7 (PC4), however, was detectable at low levels in normal facial nucleus, but its expression was unaffected by lesion. The three axotomy-induced messenger RNAs, c-jun, jun B and TIS 11, were all localized in the facial motoneurons by in situ hybridization histochemistry indicating that their induction occurs as part of the retrograde reaction of the motoneurons in response to lesion. These data suggest that c-jun, jun B and TIS 11 may play a role in triggering the regeneration programme of motoneurons.

Inositol 1,4,5-trisphosphate receptors: distinct neuronal and nonneuronal forms derived by alternative splicing differ in phosphorylation.

We have identified two distinct transcripts of inositol 1,4,5-trisphosphate receptor by using the PCR on first-strand cDNAs from various rat tissues. The longer form, corresponding to the previously cloned adult rat brain inositol 1,4,5-trisphosphate receptor, contains a 120-nucleotide insert between the two cAMP-dependent protein kinase phosphorylation consensus sequences. The shorter form (lacking the insert) predominates in fetal brain and peripheral tissues and appears to represent a nonneuronal receptor, whereas the longer form is found in adult brain and appears to be exclusively neuronal. The phosphorylation kinetics by cAMP-dependent protein kinase and the phosphopeptide maps differ for inositol 1,4,5-trisphosphate receptors purified from tissues predominantly expressing different forms of the transcript.

Isolation and characterization of the porcine nuclear factor I (NFI) gene.

This study describes the isolation of a major portion of the gene for nuclear factor I (NFI) including its 5'-flanking region with transcriptional start sites. We screened a porcine liver, genomic DNA library in phage EMBL3A with synthetic oligonucleotides derived from tryptic and cyanogen-bromide peptide sequences obtained from purified NFI protein. The NFI gene is present as a single copy in porcine DNA.

Point mutations identify the conserved, intron-contained TACTAAC box as an essential splicing signal sequence in yeast.

Our previous deletion experiments have shown that a short region of yeast nuclear gene introns containing the conserved sequence 5'-TACTAACA-3' is essential for splicing. In this report we show that the chemically synthesized decanucleotide 5'-TGTACTAACA-3', when introduced into a hybrid gene forming unspliceable RNA molecules, results in the generation of spliceable transcripts. Single A----C transversions in the fourth or eighth position of this sequence eliminated its intron-generating capacity. The C----T transition in the fifth position, generated by sodium bisulphite mutagenesis, did not affect the efficiency and accuracy of splicing. These results clearly demonstrate the biological significance of this conserved intron sequence and shed further light on its possible functioning.

A yeast gene encoding a protein homologous to the human c-has/bas proto-oncogene product.

Organisms amenable to easy genetic analysis should prove helpful in assessing the function of at least those proto-oncogene products which are highly conserved in different eukaryotic cells. One obvious possibility is to pursue the matter in Drosophila melanogaster DNA, which has sequences homologous to several vertebrate oncogenes. Another is to turn to the yeast Saccharomyces cerevisiae, if it contains proto-oncogene sequences. Here we report the identification of a gene in S. cerevisiae which codes for a 206 amino acid protein (YP2) that exhibits striking homology to the p21 products of the human c-has/bas proto-oncogenes and the transforming p21 proteins of the Harvey (v-rasH) and Kirsten (v-rasK) murine sarcoma viral oncogenes. The YP2 gene is located between the actin and the tubulin gene on chromosome VI and is expressed in growing cells. The protein it encodes might share the nucleotide-binding capacity of p21 proteins.

The nucleotide sequences of the actin genes from Saccharomyces carlsbergensis and Saccharomyces cerevisiae are identical except for their introns.

The actin gene from yeast Saccharomyces carlsbergensis was cloned in Escherichia coli and its complete nucleotide structure was determined. A comparison of its DNA sequence with that of the related yeast species Saccharomyces cerevisiae revealed that the coding as well as the 5'- and 3'-untranslated regions are identical. The intron, although at the same location in the two genes, differs in three positions. There is one deletion (or insertion), one transition, and one transversion. These are clustered within and around an oligo(dA) stretch of 14 (or 13) residues. Our observations identify the intron as the fastest evolving segment of this eukaryotic gene.