Evaluation of menstrual bleeding patterns: a new proposal for a universal guideline based on the analysis of more than 4500 bleeding diaries.

OBJECTIVE: To develop a universal guideline allowing the comparison of interventions like oral contraceptives and hormone replacement therapy with an impact on menstrual bleeding pattern. METHODS: Literature analysis and cluster analysis of 4612 bleeding diaries. RESULTS: We summarized key definitions needed for the evaluation of menstrual bleeding patterns from the literature. We developed a methodology to systematically evaluate menstrual bleeding patterns that distinguishes between cyclical and continuous hormonal regimens. CONCLUSION: This universal guideline can be applied to all prospective clinical studies that affect menstrual bleeding patterns. It allows regulatory agencies and prescribing physicians to make meaningful comparisons of different products.

Hospital care of patients with ST-elevation myocardial infarction in four different European regions. Data from four regional myocardial infarction registries in Berlin, Dijon, Florence, and Tartu.

National surveys as well as European comparative studies suggest that differences in treatment of patients with ST-elevation myocardial infarction (STEMI) exist. The extent to which these variations influence the outcome of hospital care delivered to STE-MI patients in everyday routine is mostly unknown. In this study data representative of hospital care received by STEMI patients in four European regions (Berlin, Dijon, Florence and Tartu) were compared. The four registries are population based. The percentage of women and the mean age of the patients differed among the registries. Risk factors such as hypertension and hypercholesterolaemia also differed among the different regions, whereas a history of diabetes mellitus was similar among the registries. The percentage of patients receiving reperfusion therapy ranged from 47 to 81%. An appreciable difference also resulted after breaking down reperfusion therapy into thrombolysis and primary percutaneous coronary intervention (PCI). Hospital mortality as an outcome measure was very similar among the regions. After adjustment for age, the comparative magnitude of hospital mortality proportion was also very similar among three registries. Only the patients from Florence demonstrated a comparatively lower death rate, with a ratio of 0.81. In summary, there are important differences among baseline characteristics and hospital care of STE-Ml patients in the four study regions. Nevertheless, it was interesting to ascertain that the outcome measured in hospital mortality was very similar among the four registries compared.

[Domestic violence against women and health care demands. Results of a female emergency department patient survey]. / Häusliche Gewalt gegen Frauen und Versorgungsbedarf. Ergebnisse einer Befragung von Patientinnen einer Ersten Hilfe/Rettungsstelle.

Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.

[Postgraduate qualifications in epidemiology in Germany. Experiences in Berlin, the current situation and future prospects]. / Epidemiologische Masterstudiengänge in Deutschland. Erfahrungen aus Berlin-aktueller Stand und Perspektiven.

The postgraduate Masters Program in Epidemiology (MSc) was established in 2001 in Germany in Bielefeld, Munich and Berlin. The study program is conducted with a common curriculum. Its aim is the qualification of new scientists for jobs in the field of epidemiological research, as well as the training of scientists working in this area. This article reports the experiences of 3 years of classes at the Berlin center. It shows the structure of the program and gives a vision for the future of epidemiological education in Europe.

Influence of gender on treatment and short-term mortality of patients with acute myocardial infarction in Berlin.

AIMS: Previous studies have shown higher hospital mortality rates in women, especially younger women, than in men. In light of the fact that myocardial infarction therapy is rapidly developing, and since gender-specific aspects have been discussed in detail during recent years, it was our goal to re-evaluate factors influencing hospital mortality rate, especially those involving gender-specific differences, in the city of Berlin, Germany. METHODS: We prospectively collected data from 5133 patients (3330 men and 1803 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin during the years 1999 to 2002. RESULTS: During hospitalization the overall mortality rate was 18.6% among women and 8.4% among men. Women were older (mean age for men 62 years; women 73 years) and less likely to be married (men 74.6%; women 36.9%) than men. Women generally took longer to arrive at the hospital after infarction than did men (median time: men 2.0 h; women 2.6 h). Women furthermore demonstrated a higher proportion of diabetes (men 22.8%; women 36.5%) and hypertension (men 58.0%; women 69.3%). Reperfusion therapy (men 68.8%; women 49.7%) and administration of beta-blockers (men 76.0%; women 66.0%) took place less often for women than for men. A multivariate analysis revealed the following factors to be independent predictors of hospital mortality: age, gender, diabetes mellitus, hypercholesterolemia, pre-existing heart failure, pre-hospital cardiopulmonary resuscitation, cardiogenic shock and pulmonary congestion on admission, admission to a hospital with >600 beds, ST-elevation in the initial ECG, reperfusion therapy, as well as beta-blocker and ACE inhibitor treatment within 48 h of hospitalization. CONCLUSION: Even after adjustment in multivariate analysis, women with acute myocardial infarction still demonstrate a higher risk for in-hospital death than men.

[Human granulocytic ehrlichiosis. New tick bite disease lies in wait also in German forests]. / Die humane granulozytäre Ehrlichiose. Neue Zeckenbiss-Erkrankung lauert auch in deutschen Wäldern.

HGE is an uncommon zoonosis, transmitted to humans by ticks (Ixodes ricinus). Heavily exposed persons, such as foresters and forestry workers, are most at risk of infection. HGE usually runs an asymptomatic and self-limiting course. Symptoms include acute pyrexial illness, frequently accompanied by muscle pain, headache, nausea and vomiting. Treatment is with doxycycline/tetracycline or rifampicin. In a study in Hesse of 128 heavily exposed subjects, 19.5% had serum antibodies (IFA test) against HGE versus 4.4% in a control group. This difference is statistically significant. The prevalence of both symptoms and the seropositivity differ significantly between locations. HGE should be considered in the differential diagnosis of fever of unknown origin following tick bite exposure, at least in the North Hesse region.

[Once daily administration of isoconazole as a cream, solution and spray: comparative studies of patients with dermatomycoses]. / Einmal tägliche Anwendung von Isoconazol als Creme, Lösung und Spray: Vergleichsuntersuchungen an Patienten mit Dermatomykosen.

In 3 controlled multi-center studies, 372 patients suffering from dermatomycoses were treated with isoconazole as cream, solution, and spray either once or twice daily. Neither with regard to the duration of healing nor the healing rates were observed statistically significant differences between the two modes of treatment. As to the forms of preparation, there were no differences of efficacy either. At the end of treatment, the cure rates amounted to 90-94%. Follow-up examinations carried out two weeks later gave no indications of relapses.