Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital-an inventory before structured intervention.

BACKGROUND: In order to improve care for diabetic patients in a developing country at the regional referral hospital for the Northern zone of Tanzania, a specialized clinic was established in November 1996. AIM: The aim of this study was to provide a situational analysis about the problems of the diabetic patient population treated at the hospital. For all patients who registered at the clinic a questionnaire was completed about personal data, diabetes history, symptoms, treatment, eating habits and psycho-social aspects of the disease. Results from patients who registered between November 1996 and December 1998 were analysed. RESULTS: Data from 474 diabetic patients (46% female) were obtained. Mean age was 53.75 (+/- 16; range 4-88 years), 15% were classified Type 1, 75% Type 2 and 10% remained unclassified. A body mass index of < 25 was recorded in > 80% of the Type 1 and approx. 50% of the Type 2 patients. Among complications, numbness of the legs was mentioned by 44%, hypertension was diagnosed in about 25%, retinopathy in 14%, foot ulcers in 10% and nephropathy in 7.5% of the patients. About 50% of the patients saw their disease as a big physical and psychological problem. Monthly cost for an average insulin-treated patient equalled around 25% of the minimal wage. CONCLUSION: Diabetes care in a developing country needs to address the specific background of the patient population, their needs, the medical problems and the social constraints. Active participation of the patients can help to overcome some of the difficulties.

[Environmental concern of clients of an environmental medicine counseling center]. / Umweltbesorgnis bei Klienten einer Umweltmedizinischen Beratungsstelle.

Environmental apprehensiveness and anxiety are often regarded as being responsible for unspecific health complaints in the context of environmental exposures if toxicological findings cannot explain them. However, there is a lack of empirical data on the influence exercised by environmental anxiety. A German adaptation of the American Environmental Worry Scale [1] was developed. The questionnaire has been used in a study on clients of the Consultation Centre for Environmental Medicine (CCEM). These clients (n = 51) were compared with a control group of clients of a vaccination centre (n = 238). As expected, the clients of the CCEM showed higher values of environmental worry. Moreover, the clients of the CCEM revealed scores of trait-anxiety which were more than one standard deviation above the level of the reference group. Environmental worry was weakly associated with a higher degree of trait-anxiety.

Neurobehavioral and neurophysiological outcome of chronic low-level tetrachloroethene exposure measured in neighborhoods of dry cleaning shops.

The effects of chronic low-level tetrachloroethene (TCE) exposure on functions of the central nervous system (CNS) were measured in subjects living in the neighborhood of dry cleaning shops with a mean residential time of 10.6 years. Neurobehavioral tests were performed using a German version of the NES battery. Additionally, a pattern reversal visual-evoked potentials (VEPs) were recorded. the mean blood TCE concentration in the subjects was 17.8 micrograms/liter and the median indoor TCE air concentration measured in the residences was 1.36 mg/m3. The outcome of the NES subtests for vigilance, simple reaction time, as well as visual memory differed statistically significantly between the exposed subjects and the controls, whereas for VEP latencies the differences were statistically not significant. It is concluded that despite the low exposure levels, CNS functions might be affected by TCE in subjects living close to a dry cleaning facility if the exposure lasts for several years.

[Evaluation of environmental medicine counseling by the patient and the physician--a comparison of perspectives]. / Die Beurteilung der umweltmedizinischen Beratung durch Patient und Arzt--ein Perspektivenvergleich.

Counselling in environmental medicine is a new field of medical work. The success of the advisory activity has two aspects: objective results like laboratory findings, measurements and activities as well as the subjective assessment by, and satisfaction of, the patient and the physician. After giving a short presentation of the work of the advisory board for environmental medicine of the Medical Institute of Environmental Hygiene in Düsseldorf we discuss the significance of the communication between patient and physician for this field of medicine. The subject of our study was to compare the views of patients and physicians in regard to the success of the advisory activity. To achieve this goal we asked both patients and physicians to complete a questionnaire to judge the consultation. Our questions considered technical as well as interactional aspects of the advice. We found some clear differences between the view expressed by patients and physicians. This will be demonstrated with the help of the issues "satisfaction", "problem-solving" and "intention" (patient's aim for the consultation.

[The concentration of alpha-1-PI in the serum of 55-year-old women from regions with different levels of air pollution in North Rhine-Westphalia]. / Die Konzentration von Alpha-1-PI im Serum 55-jähriger Frauen aus Regionen mit unterschiedlicher Luftbelastung in NRW.

It has been shown that smoking leads to an increase in the serum level of alpha-1-proteinase inhibitor (API). The aim of this study was to examine whether there is an influence of air pollution on the serum level of API as well. Our survey was done on 781 women in the age of 55 years residing in areas differing in outdoor air pollution levels (SO2, NOx, particulate matter, heavy metals). Blood samples were taken for serum analysis. API and several other parameters of the specific and unspecific humoral immunity were measured using nephelometry. Information about respiratory health, active and passive smoking, type of heating and education were obtained by questionnaire. Statistical analysis was restricted to non-smokers (n-s). After adjusting for confounding variables (COPD, ETS, type of heating) we found a statistically significant (p. < 0.0001) difference between the index and the control area. One important function of API lies in the antagonism of the elastase from neutrophil granulocytes. Thus our results--which parallel those seen in smokers--may indicate an impact of environmental air pollution on the non-specific immunity of the bronchi, which are directly exposed to the pollutants. We therefore consider API as a good marker of biological effects in environmental epidemiology.

[Evaluation of the use of an environmental medicine consulting center]. / Auswertung der Inanspruchnahme einer umweltmedizinischen Beratungsstelle.

At the Environmental Medical Consulting Centre 1677 consultations were carried out in 1991. The centre is established at the Medical Institute of Environmental Hygiene in Düsseldorf. There were 1129 (68%) short questions and 309 (18%) detailed consultations by phone or by letter. The most of the questions were asked by the general population. Other questions came from people at health offices, from general practitioners and from hospitals. No detail information about some socio-demographic data of this group was taken. The overwhelming topics of the questions were toxicological problems of harmful substances in indoor air or about the use of some products containing harmful substances. 239 (14%) people of the whole group got an appointment for a detailed medical consultation. Only data from 158 patients--visiting the office during January and September 1991--were evaluated in detail. On average the patients examined were 40 years old and mostly with a higher school degree. The most of the people complained about permanent polysomatic symptoms. A defined exposure was diagnosed for 31 (20%) patients, which resulted from pollution at work, at home or from the environment. The term Sick-Building-Syndrome were used for further 16 (10%) patients. In conclusion, the results of the study reveal a need of consultation with a specific orientation in Environmental Medicine. But, because of lack of data from other consulting offices in order to compare the results, no quantification of the need could be estimated.

[PATIS--a questionnaire-based, PC-assisted patient information system in the field of environmental medicine]. / PATIS--Ein Fragebogen-basiertes, PC-gestütztes Patienten-Informationssystem im Bereich Umweltmedizin.

PATIS was developed as a questionnaire-based, PC-assisted patient-information- and documentation-systems within the framework of the "Umweltmedizinische Beratungsstelle" (advisory board for clinical environmental medicine) at the Medical Institute of Environmental Hygiene at the Heinrich-Heine-University Düsseldorf. PATIS is a substantial element of a planed knowledged-based-system in environmental medicine. This system will further-more consist of databases for chemical substances information, exposition, and literature. PATIS records information about patients concerning personal data, former diseases, symptomatology and complaints, lifestyle, residential and working area, and spare time activities. Furthermore the state of physical examination, performances of diagnostics, and laboratory investigations are documented. A different questionnaire exists for children younger than 12 years. PATIS is able to supply an automatic report based on information of the questionnaire. This system is realized in the relational-database-system dBase IV and is utilized practice since the beginning of 1991.