[Diabetes-specific health literacy: what do Turkish immigrants with diabetes mellitus 2 know about their disease?]. / Diabetesspezifische Gesundheitskompetenz: Was wissen türkischstämmige Menschen mit Diabetes mellitus 2 über ihre Erkrankung?

AIM OF THE STUDY: Only few findings are available for the large group of type 2 diabetics whose origin is not German. This article investigates 1) the degree of diabetes-knowledge among diabetics of Turkish origin, and 2) factors that influence this knowledge and the competencies with handling the disease. METHODS: In cooperation with 15 medical practices 294 diabetics of Turkish origin were interviewed in person by Turkish-speaking interviewers. There is no established concept for this population to measure their health literacy, therefore we adopted some questions from other tests and added our own items. Besides diabetes knowledge tests with closed and open questions the interviewees had to undertake a reading test and a screening test on German language skills. Socio-demographics and the attendance at diabetes trainings were gathered as well, and analysed in principal component analyses and multiple regressions. RESULTS: On average, the respondents had lived in Germany for 32 years, but 40% of them do not speak German. 25% never went to school and 21% cannot read or write (Turkish). Even though 60% took part in a diabetes training course, it appears that knowledge about the disease is scarce: only 15% could sufficiently explain their diabetes disease with their own words. A dimensional analysis helps to differentiate "theoretical" and "behavioural relevant" knowledge about diabetes. Theoretical knowledge is strongly associated with education, German language skills and attending a training course, whereas competencies that are relevant to the behaviour only are associated with participation in diabetes training courses. The educational effects remain on a rather low level and cannot compensate the fact that theoretical knowledge about diabetes depends on education. Hence, the overall (too) low level of knowledge on health and diabetes is only marginally improved. CONCLUSIONS: Education, attending a diabetes training course and language skills are the main factors for explaining poor knowledge about diabetes. A tailor-made training course--considering people's educational background--for the large group of people of Turkish origin could lead to improvements. Moreover, the neglected potential of self-help groups should be developed, as only one person of the reviewed population reported to search for support here.

[Recruitment and activation of members in self-help organisations. Results of a survey of self-help organisations at the national level]. / Mitgliedergewinnung und -aktivierung in Selbsthilfeorganisationen. Ergebnisse einer Befragung von Selbsthilfeorganisationen auf Bundesebene.

The majority of the German population can envisage a membership in self-help groups or organisations when this should become relevant. As a matter of fact, only relatively few people are attending joint self-help activities. However, a significant number of members is important for self-help organisations (SHO) for self-organisation, lobbyism and (political) influence. Many SHOs in Germany are dissatisfied with their membership development and are therefore looking for better recruitment and activation strategies. The project "Activating Potentials for Joint Self-help Activities" (funded by the statutory health insurance fund BKK BV 10/2006-04/2009) is a participative collaboration between scientists, practitioners and SHO representatives to develop strategies and methods to promote access to joint self-help activities. In co-operation with the BAG SELBSTHILFE (a National HCPO Alliance) and the NAKOS (the National Clearing House for the Encouragement and Support of Self-Help Groups) 322 boards of national level SHOs were contacted in late 2007 and asked to complete a questionnaire on membership development, recruitment strategies and measures to activate members for voluntary commitment. 50% returned the questionnaire. The results were fed back in a transfer workshop in August 2008 and discussed with 60 representatives of SHOs. Their views are integrated in this paper. Despite all claimed stagnation or decline in membership development, the results show stability or increases over the last two years. Furthermore, the majority of SHOs was founded from the 1990 s until today, specifically in the areas of rare and chronic diseases. This development is based on a better socio-political recognition and promotion of self-help activities, self-help groups and SHOs as well as in better communication technologies. The views on the co-operation between SHOs and social service and health care providers are controversial: Positive and negative experience is more or less balanced. Then the openness and self-reflection of the workshop and survey participants is remarkable. In the context of a growing patient orientation in the health-care system participative co-operation in research and development will become more meaningful.

[Health-related self-help of immigrants in Germany. Chances, barriers, potential]. / Gesundheitsbezogene Selbsthilfe bei Menschen mit Migrationshintergrund. Chancen, Barrieren, Potenziale.

Migrants in Germany participate in health-related self-help groups nearly as frequently as native-born Germans--as long as they have good German language skills and are widely integrated into the main society. However, the situation is different for those migrants who are not or only slightly integrated. Mother-tongue self-help groups of ethnic minorities would offer good chances for health-related self-management and coping; however, these groups are rare. This can partly be explained by the lack of knowledge of many migrants about support possibilities for self-help groups, also because the term "self-help" has no equivalent in many languages. On the other hand, there are many barriers for self-help activities: false shame attributed to certain health problems, fear of de-anonymization in ethnic communities, different concepts of health and illness, a lack of judging the potential of one's own competencies and self-efficacy, and particularly illiteracy. This article describes the relevance of self-help among migrants with special regard to self-organized migrant networks and outlines the current state of discussion within the self-help stakeholders. Finally, potential multipliers, networking examples and qualification measures for promotion of health-related self-help among migrants are presented.

[Skin lipids in seborrhea- and sebostasis-associated skin diseases]. / Hautlipide bei mit Seborrhoe-und Sebostase-assoziierten Hauterkrankungen.

Recent studies suggest that epidermal skin lipids play an important role in the pathogenesis of skin diseases associated with seborrhoea or sebostasis. Depending on the state of the skin, various lipids are found in varying quantities and proportions. In some sebostatic diseases, in particular, altered enzyme activities relevant to the synthesis of lipids have been identified, which may account for alterations in epidermal lipid fractions. This concept represents a substantial modification of earlier ones, according to which sebostatic or seborrhoeic skin diseases were attributed solely to decreased or increased sebum lipids, respectively. This provides an important rationale for a new approach to the therapy of certain skin diseases with specific lipid fractions, such as ceramides.

[Stratum corneum and nail lipids in patients with atopic dermatitis. Decrease in ceramides--a pathogenetic factor in atopic xerosis?]. / Stratum-corneum- und Nagellipide bei Patienten mit atopischer Dermatitis. Verminderung der Ceramide--ein pathogenetischer Faktor bei atopischer Xerosis?

Dry skin is seen in many patients with atopic dermatitis and correlates with a disturbed epidermal barrier function demonstrated by such features as increased transepidermal water loss and diminished stratum corneum hydration. With regard to the importance of stratum corneum lipids for the permeability barrier, we have analysed plantar (n = 8) and lumbar (n = 20) stratum corneum and nail lipids (n = 15) of atopic subjects by high-performance thin-layer chromatography (HPTLC). Compared with controls our investigations show a decrease in the ceramide fraction as a percentage of total lipid and a diminished ratio of ceramides and free sterols in atopic subjects. This implies that impaired ceramide synthesis may be a factor in the pathogenesis of atopic xerosis.

Relationship of sulfated glycosaminoglycans and cholesterol content in normal and arteriosclerotic human aorta.

Sulfated glycosaminoglycans were extracted from arteriosclerotic and adjacent nonarteriosclerotic areas of human aortas from persons ages 28 to 83 years; the glycosaminoglycans were compared with the cholesterol and triglyceride content of the tissues. Sulfated glycosaminoglycans were isolated after proteolytic digestion of defatted arterial tissue and were quantified after reductive labeling with NaB3H4. The amount of glycosaminoglycans in the aorta increased with the age of the person and the cholesterol content (degree of arteriosclerosis) of the aorta. The proportion of chondroitin sulfate/dermatan sulfate increased significantly with age and cholesterol content, whereas the corresponding amounts of heparan sulfate decreased.

Microanalytical screening of all major stratum corneum lipids by sequential high-performance thin-layer chromatography.

For rapid and sensitive screening of lipid biochemical abnormalities of scaling skin disorders a sequential, one-dimensional high-performance thin-layer chromatographic method (HPTLC) has been developed. All major human stratum corneum lipid classes, i.e., cholesterol sulfate, glucosylceramides, six major ceramide fractions, free sterols, free fatty acids, triglycerides, sterol esters, squalene, and n-alkanes, are separated and quantitated after a stepwise development of a single silica gel 60 HPTLC-plate using three consecutive solvent systems. Reproducible results have been obtained by degradative charring as well as fluorescence detection. By fluorescence detection the method is particularly suitable for the determination of minor amounts of cholesterol sulfate and other sterols.

Autosomal dominant lamellar ichthyosis exhibits an abnormal scale lipid pattern.

Autosomal dominant lamellar ichthyosis (ADLI) is a recently recognized genetic skin disorder. Clinically and histologically, it cannot be distinguished with certainty from the more frequent autosomal recessive lamellar ichthyosis (ARLI), which in itself may still be heterogeneous. By ultrastructural examination of ADLI a prominent transforming zone between the stratum granulosum and stratum corneum and lipid inclusions in the stratum corneum have been observed. Using sequential high-performance thin-layer chromatography, we studied the plantar scale lipid pattern of two patients, mother and daughter, affected with ADLI. We found a distinctive alteration in the relative composition of the scale lipid pattern characterized by excessive amounts of free fatty acids, triglycerides, elevated n-alkanes, reduced free sterols and decreased total ceramides. This scale lipid profile clearly differs from that of the erythrodermic and non-erythematous variants of ARLI and confirms that this disorder is a distinct entity of the heterogeneous group of lamellar ichthyoses.

[Venous thrombolysis and venous angioplasty]. / Venöse Thrombolyse und venöse Angioplastie.

Venous thrombosis of the upper extremities was successfully lysed in 7 patients using selective infusion of urokinase. Selective lysis requires a lower dosage of urokinase and has a lower rate of side effects. Venous angioplasty was applied in 2 patients with stenoses of the subclavian vein, 3 with stenosis in dialysis shunts, and 1 patient with a long stenosis of the iliac vein. Venous angioplasty was successful and particularly useful in dialysis shunt stenoses.

Tyrosine O-sulfate ester in proteoglycans.

Tyrosine O-sulfate residues were detected in the protein core of sulfated proteoglycans. When cultured skin fibroblasts and arterial smooth muscle cells were incubated in the presence of [35S]sulfate, dermatan sulfate proteoglycan and chondroitin sulfate proteoglycan isolated from the culture medium contained tyrosine [35S]sulfate ester which accounted for 0.03%-0.82% of total 35S radioactivity incorporated into the sulfated proteoglycans. This corresponds to a tyrosine sulfation of every second (fibroblasts) and every 10th (smooth muscle cells) dermatan sulfate proteoglycan molecule. [3H]Tyrosine labeling of fibroblast dermatan sulfate proteoglycan gave a similar stoichiometry. However, the relative proportion of tyrosine [35S]sulfate in proteoglycans from arterial tissue was about 10 times higher than in that from cultured arterial cells. Pulse chase experiments with [35S]sulfate revealed that tyrosine sulfation is a late event in the biosynthesis of dermatan sulfate proteoglycan from fibroblasts and occurs immediately prior to secretion. Cultured skin fibroblasts from a patient with a progeroid variant (Kresse et al. 1987, Am. J. Hum. Gen. 41, 436-453) which exhibit a partial deficiency to synthesize dermatan sulfate proteoglycan were shown to form and to secrete a tyrosine-sulfated but glycosaminoglycan-free protein core, thus confirming a selective and independent [35S]sulfate labeling of the protein core.

[Simultaneous bilateral catheterization of the inferior petrosal sinus in Cushing's syndrome. ACTH determination for the diagnosis and location of the side of a hypophyseal microadenoma before and after administration of corticotropin-releasing hormone]. / Bilaterale und simultane Katheterisierung des Sinus petrosus inferior beim Cushing-Syndrom.Bestimmung nach ACTH zur Diagnostik und Seitenlokalization eines hypophysären Mikroadenoms vor und nach Gabe von Corticotropin-Releasing-Hormon.

ACTH concentration was measured in simultaneously drawn blood samples from the left and right inferior petrosal sinuses before and after administration of corticotropin-releasing hormone (CRH). Such samples were successfully obtained in 20 of 21 patients with ACTH-dependent Cushing's syndrome on whom it was attempted. In 11 of the 20 patients there was no concentration difference between petrosal sinus and peripheral blood. But 13 of 19 patients had a unilateral central to peripheral concentration gradient greater than 1.4 after CRH administration. In the other six patients no ipsi- to contralateral gradient was demonstrable. Two of these patients had a proven ectopic ACTH-producing tumor; no adenoma was found at operation in three; on patient is awaiting operation. In 10 of 13 patients with unilateral gradient a microadenoma was found on the same side at operation. One patient had a hemi-hypophysectomy on the side of the higher gradient: hypocortisolemia developed in her postoperatively. Two other patients are awaiting operation. The results indicate that simultaneous bilateral catheterization of the inferior petrosal sinus with CRH stimulation is a highly informative examination with few side-effects and will contribute to better diagnosis and treatment of Cushing's syndrome.

Glycosaminoglycan-free small proteoglycan core protein is secreted by fibroblasts from a patient with a syndrome resembling progeroid.

A male patient, 4 years 9 mo old and having progeroidal appearance, exhibited delayed mental development and multiple abnormalities of connective tissues including growth failure, osteopenia of all and dysplasia of some bones, defective deciduous teeth, loose but elastic skin, delayed wound healing with formation of thin atrophic scars, scanty scalp hair, hypotonic muscles, and hypermobile joints. Skin fibroblasts of the patient converted only about half of the core protein of the small proteodermatan sulfate to a mature glycosaminoglycan chain-bearing proteoglycan. The remaining core protein, which contained complex-type asparagine-bound oligosaccharides, was secreted with almost normal kinetics. Xylosyltransferase activity and the synthesis of other proteoglycan types were normal. Normal induction of glycosaminoglycan synthesis occurred in the presence of 1 mM, but there was very little induction in the presence of 0.01 mM p-nitrophenyl-beta-xyloside. An antibody against an N-terminal pentadecapeptide of the core protein recognized the glycosaminoglycan-free core protein from the patient less well than the chain-bearing protein treated with chondroitin ABC lyase. Though these results do not define the basic defect unambiguously, they provide the first report of a disorder being due to an abnormality in small proteoglycan biosynthesis.

[Long-term follow-up of vena cava filters: real-time sonography and the native x-ray image]. / Langzeitkontrollen bei Kavafiltern: Real-time-Sonographie und Nativröntgenbild.

In 16 patients with vena cava filters (12 Günther filters, 4 Kimray-Greenfield filters) a follow-up study was performed by ultrasound and abdominal plain film. Ultrasound allows to identify type and location of the filter as well as the entrapment of emboli. Abdominal radiography is useful for exact evaluation of changes in filter position. Combination of sonography and plain films is considered to be most suitable for follow-up studies of caval filters.

[Initial experiences with CO2 as a gaseous contrast medium in digital subtraction angiography]. / Erste Erfahrungen mit CO2 als gasförmiges Kontrastmittel in der DSA.

Electronic contrast enhancement allows the use of CO2 as a contrast material for studying the vascular system with DSA. Its use, safety and the information provided were studied in 40 patients and in 5 animal experiments and the results were compared with iodine-containing contrast media. The available results indicate that CO2 is a safe negative contrast medium for peripheral arteriography and that it provides angiograms with a picture quality comparable to those of iodinated contrast media in the extremities. The method can therefore be used to advantage in patients with allergies to the iodinated contrast media and in patients with renal failure.

[Direct venous thrombolysis and venous angioplasty in the upper extremity]. / Direkte venöse Thrombolyse und venöse Angioplastie im Bereich der oberen Extremität.

Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients.

Increased activity of chondroitin sulfate-synthesizing enzymes during proliferation of arterial smooth muscle cells.

Cultured arterial smooth muscle cells incorporate [35S]sulfate into the extracellular chondroitin sulfate/dermatan sulfate containing proteoglycans at a higher rate in the phase of logarithmic growth than do non-dividing cells. The cell growth-dependent decrease in 35S incorporation with increasing cell density is accompanied by a decrease in the activity of chondroitin sulfate-synthesizing enzymes. The specific activity of xylosyl transferase, N-acetylgalactosaminyl transferase I and chondroitin sulfotransferase declines as the cells proceed from low to high densities. The corresponding correlation coefficients are 0.86, 0.91 and 0.89. The ratio of C-6OH/C-4OH sulfation of chondroitin shows a cell proliferation-dependent decrease indicating an inverse correlation of chondroitin 6-sulfotransferase and chondroitin 4-sulfotransferase activity. The observed changes in the expression of enzyme activities are thought to have some implications in the pathogenesis of arteriosclerosis, the initial stages of which are characterized by proliferation of arterial smooth muscle cells.

Purification and characterization of a 3'-phosphoadenylylsulfate:chondroitin 6-sulfotransferase from arterial tissue.

A 3'-phosphoadenylylsulfate:chondroitin sulfotransferase (EC 2.8.2.5) was purified to homogeneity (about 760-fold) from the cytosolic fraction of calf arterial tissue by Con A-Sepharose, ion exchange and affinity chromatography. The enzyme has a molecular mass of 38000 Da, optimal activity at pH 6.0 (100%) and 7.25 (75%), requires divalent cations for maximal activity (Mn2+ greater than Mg2+, Ca2+) and exhibits specificity towards desulfated chondroitin sulfate and oligosaccharides derived therefrom. The enzyme transfers sulfate groups from [35S]phosphoadenylylsulfate exclusively to C-6 OH groups of N-acetylgalactosamine units of the acceptor substrates. Maximal sulfate transfer occurs at 2mM chondroitin disaccharide units (100%), the transfer rates decreasing with decreasing chain length in the order deca (55%), octa (17%) and hexasaccharides (4%). Lineweaver-Burk plots revealed equal maximal velocities for chondroitin, deca-, octa- and hexasaccharide, but decreasing Km values. Chondroitin 4-sulfate has 21% of the acceptor potency exhibited by chondroitin, whereas dermatan sulfate, heparan sulfate and hyaluronate and the chondroitin tetrasaccharide showed no acceptor properties. Analysis of the reaction products formed by prolonged enzymatic sulfation of a reduced chondroitin hexasaccharide [GlcA-GalNAc]2-GlcA-GalNAc-ol revealed that the preterminal N-acetylgalactosamine from the non-reducing end and the internal N-acetylgalactosamine but not the N-acetylgalactosaminitol were sulfated and that no hexasaccharide disulfate was formed by the action of chondroitin 6-sulfotransferase. Chondroitin 6-sulfotransferase is considered to possess a binding region capable of accommodating a nonsulfated oligosaccharide sequence of at least six sugars and is believed to act in the course of chondroitin sulfate synthesis in cooperation with, but shortly after, the enzymes involved in the chain elongation reaction.