Heat-related mortality in Freiburg and Rostock in 2003 and 2005 - methodology and results.

In Freiburg and Rostock, heatwaves were compared to control periods for the years 2003/2005. In Freiburg, a long heatwave in 2003 cost 21 lives (equal to a significant excess mortality of 33 %). No or no significant excess mortalities were found for shorter heatwaves in Freiburg and for Rostock. The detection of heat-related mortality depends on the size of the cities (population) and the heatwave characteristics.

[Older workers and employment]. / Der ältere Mensch im Erwerbsleben.

Demographic change with its impact on the employment system and the length of work challenges most of the highly industrialized countries. From the point of health sciences the article will discuss findings about whether a prolongation of employment time seems to make sense and which limitations must be reflected. Therefore labour force participation of older workers will be demonstrated before employability as a construct of physical, psychological and social capacity is discussed. With these reflections in mind, the role of an integrated occupational health care approach will be stressed to discuss in which way this can contribute to healthier working conditions for older workers. The complex nature of the problem makes complex solutions necessary, which are not restricted to simple workplace health promotion campaigns. They have to be part of a sophisticated occupational health management system. The rising number of projects and initiatives in this field suggest that the challenges have been recognized and accepted; however we are not able to speak about the implementation of these models already throughout the country.

[Demands for an internationalisation of German research as illustrated by the example of the journal "Das Gesundheitswesen". A contribution to the quality assurance of applied research]. / Die Forderung nach Internationalisierung der deutschen Forschung am Beispiel der Zeitschrift "Das Gesundheitswesen". Ein Beitrag zur Qualitätssicherung anwendungsbezogener Forschung.

OBJECTIVES: Basing on the recent discussion on internationalisation of German research publications, the most recent volume of "Das Gesundheitswesen" was bibliometrically analysed. METHODS: 125 articles were compared with respect to citing sources, the rate of self-citations, the number of times English or German journals or books were cited in the year 2001, the acceptance rate of the international state of research and of its leading representatives. These are indicators of scientific quality. RESULTS: The interdisciplinary approach by "Das Gesundheitswesen" has proven successful in view of certain indicators of scientific quality. CONCLUSION: Related to scientific quality standards "Das Gesundheitswesen" has achieved a good impact in the scientific community but some details require to be changed.

[Air travel--a disease risk? ]. / Flugreisen--ein Krankheitsrisiko?

Civil air traffic moves in an altitude that is dangerous for human beings without technical aids. Low temperature and humidity, reduced air pressure combined with oxygen pressure, seasonal depending high concentration of ozone and cosmic radiation may also be risk factors. Further risks on long haul flights may be jet lag, risk of economy class syndrome and contact with permethrin, because of disinsection before take-off out of tropical regions. The aim of an airline is to offer good cabin air quality, comfort and security for all passengers, may they be healthy, old, disabled or sick. Medical incidences on board arise and passengers expect modern equipment such as doctor's kit and defibrillators.

[Occupational spinal diseases in employees of nursing services--epidemiological and legal insurance aspects (III). 3: Intervertebral disk-induced diseases of the lumbar spine in health care employees--expert assessment and prevention]. / Berufliche Wirbelsäulenerkrankungen bei Beschäftigten im Pflegeberuf--epidemiologische und versicherungsrechtliche Aspekte (III). Teil 3: Bandscheibenbedingte Erkrankungen der Lendenwirbelsäule bei Beschäftigen im Gesundheitsdienst-Begutachtung und Prävention.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

[Spinal diseases in the nursing profession--a cross-sectional study]. / Wirbelsäulenerkrankungen im Pflegeberuf--Eine Querschnittsuntersuchung.

A cross-sectional study on the profession-specific prevalence rates of back pain symptoms was conducted including N = 3332 nurses as the exposed group and N = 1720 office clerks as a control group. Only participants who had never changed from an exposed to an unexposed profession or vice versa, were included for the results presented here. Severity of symptoms was assessed, dividing into low back pain on the one hand, and lumbago-sciatica/sciatica on the other; frequency of pain episodes was measured using lifetime- and point-prevalence, in all these four combinations of severity and frequency the prevalence rates among nurses were clearly and significantly higher. Multivariate analyses revealed that profession is the most important risk factor among many others that were tested. Estimation of the prevalence rate for the heaviest symptom, the point-prevalence of lumbago-sciatica/sciatica, showed that about 4 out of 5 cases among nursing staff can be attributed to their profession. On the background of this high attributable risk the acceptance rate for LBP diseases of suspected occupational origin among nursing staff by statutory occupational health insurance bodies appears much too low.

[Occupational diseases of the spine in health care professions-- epidemiologic and insurance aspects (I). 1. Review of internationally publicized studies]. / Berufliche Wirbelsäulenerkrankungen bei Beschäftigten im Pflegeberuf epidemiologische und versicherungsrechtliche Aspekte (I). Teil 1: Ubersicht über international publizierte Studien.

Due to spine-loading activities nursing professionals have a relatively high incidence/prevalence of low back pain. As lumbar disc disorders can be regarded as occupational diseases (since January 1993, occupational disease BK 2108, normally more than 10 years of exposition, lumbar disc disorders with pain and reduced motility) international literature is reviewed. Own results of different prevalence-, case-control- and incidence studies (relative risk for lumbago sciatica/odds ratio for disc prolaps appr. 3-6 depending on age and occupational age) are presented. Finally the question of compensation and prevention of disc disorders is discussed.

[Evaluation of the educational curriculum in psychosocial fields and general medicine in human medicine subjects--results of a total Germany pilot study in the 1995 summer semester]. / Evaluation von Lehrveranstaltungen in den psychosozialen Fächern und der Allgemeinmedizin im Studiengang Humanmedizin--Ergebnisse einer bundesweiten Pilotuntersuchung im Sommersemester 1995.

With the discussion of the quality of medical education in Germany the importance of evaluating the curriculum has grown. A working group of representatives of the German scientific societies for general medicine and the so-called "psychosocial" disciplines in medical education had adapted a questionnaire from Harvard Medical School and tested this version for the first time in summer 1995. 56 teachers and 1250 students took part in this pilot study. The instrument proved to be sufficiently valid to evaluate the quality of different types of teaching lessons. The disciplines (Medical Sociology, Medical Psychology, Social Medicine, General Medicine, Psychotherapy/Psychosomatics) were valued equally with concern to their relevance for medical education. They got significantly better values for quality of teaching and teaching engagement of the professors. It is recommended to notice these results in the actual debate on the reform of the medical curriculum and to include other disciplines in further evaluative investigations.

[Occupational medicine in public health service--evaluation results of an continuing education symposium]. / Arbeitsmedizin im Gesundheitsdienst--Evaluationsergebnisse eines Fortbildungs-Symposiums.

The demand for a quality controlled and quality proved continuing medical education (CME) has grown in the past. Especially the German "Bundesärztekammer" (society of physicians of Germany) has developed new models for CME and it's evaluation. This paper presents the background, methodology and results of two evaluations of CME for occupational physicians in health care institutions. The two symposia in 1994 and 1995 were evaluated using the same questionnaire. The comparative analysis of the results indicates the feasibility of the instrument and the validity of the results when used together with the results on an open discussion at the end of the symposium. It also demonstrates the value of the evaluation for future planning of comparable programs.

[Patient counseling by the physician in smoking cessation--conditions and prerequisites]. / Arztliche Gesundheitsberatung zur Tabakentwöhnung--Bedingungen und Voraussetzungen.

The importance of the medical profession for the health consultation, which has been more and more emphasized country-wide but also internationally, has only be reflected regarding possible positive results rather than real circumstances and conditions for realization. This report brings out why the realization of the quite reasonable postulate of a medical involvement in the health consultation for a tobacco withdrawal is hindered especially from requirements on the level of attitude, competence and action which urge to a realistic view of the limits and feasibility of the medical involvement.

[The "Freiburg Spinal Study"--epidemiology of occupationally-induced spinal diseases of health care employees in Germany]. / Die "Freiburger Wirbelsäulenstudie"--Epidemiologie arbeitsbedingter Wirbelsäulenerkrankungen bei Beschäftigten im Gesundheitsdienst in Deutschland.

Musculoskeletal diseases are very common in modern societies. As several international investigations have shown that the etiology of these diseases is correlated with working conditions in some professions. With financial subsidy by the German insurance company for the regulation and compensation of occupational diseases in the health care sector (BGW), we investigated in 6 different projects the possible relation of working conditions and musculoskeletal diseases among health care professionals, esp. nurses. Our contribution describes the design of the different sub-projects and presents some results. The summarising discussion points out that there was a strong tendency in all sub-projects to confirm the hypothesis that nurses run a significantly higher risk to suffer from work-related musculoskeletal diseases and disorders. The results of the sub-project "cohort study in nursing pupils" support this hypothesis. The results do not only supply important background information for the process of compensating occupational diseases in this field but also indicate a tremendous personal and structural need for more and better prevention.

[Epidemiology of spinal diseases in nurses]. / Epidemiologie von Wirbelsäulenerkrankungen im Pflegeberuf.

Epidemiology of spinal pathology among nurses. A cross-sectional study of 3300 German nurses was carried out in the course of an investigation of the prevention of occupation--related back problems. A much higher incidence of lumbar-spinal problems was observed than in a control group of office staff, not required to lift or carry. Evidence of much greater risk, especially of severe sciatic symptoms, was supported by a case-controlled study of patients with the diagnosis of disc-prolapse or disc-protrusion, carried out in two neuroradiology units. Nurses were significantly over represented. A lack of preventive measures for carrying and lifting patients was clearly demonstrated (availability and use of mechanical aids). To what extent the perception of spinal problems is influenced by psychological factors and not only by physical factors will be demonstrated by the recording of stress factors.

[Acceptance of preventive vaccinations by physicians and the general population]. / Zur Akzeptanz von Schutzimpfungen bei Arzten und bei der Allgemeinbevölkerung.

The acceptance of vaccinations depends on the quality of information on effects and side effects. This publication deals with the results of three questionnaire studies: Questionnaire 1 was directed to the general population and contained questions on vaccination history and acceptance of vaccinations, questionnaire two and three were addressed to practitioners (general medicine/paediatrics/internal medicine) with additional questions on the number of vaccinations performed per year. An average of 50% of the persons taking part in the questionnaire study had been vaccinated within the last 10 years against diphtheria, tetanus, polio and/or influenza. The acceptance of these vaccinations was quite satisfactory whereas opinions on mumps and measles vaccinations were quite negative. In the course of the questionnaire study with practitioners it could be demonstrated that vaccinations against diphtheria, tetanus, polio and influenza were regarded as useful while immunisation against mumps, measles, tuberculosis, pertussis and chicken-pox were not regarded as useful. Information programes on vaccinations and the need for further investigations are discussed as well as the problem of mandatory vaccinations.

[Role of the school in vaccination and prevention of infection]. / Die Rolle der Schule beim Impf- und Infektionsschutz.

628 pupils from both the northern and southern parts of West Germany (Baden-Württemberg, Bavaria, Lower Saxony, Schleswig-Holstein) were interviewed via an "infectious diseases" questionnaire: 44 questions dealt with vaccination (vaccination history, opinions of efficiency of different vaccines), 38 with problems concerning AIDS/HIV. The results indicated significant lack in the acceptance of most of the common immunisations. Improvement of AIDS/HIV-information, especially on HIV-transmission and psychosocial, economical and political consequences seems to be necessary. Possibilities of future health education for pupils are discussed.

[The status of preventive medical examinations based on labor safety regulations for adolescents--results of a survey in 129 students]. / Zur Situation präventivmedizinischer Untersuchungen nach dem Jugendarbeitsschutzgesetz--Ergebnisse einer Erhebung bei 129 Auszubildenden.

The implementation of laws governing the protection of the health of adolescent workers has rarely been investigated scientifically. The paper presents results of an investigation probing into the opinions of 129 students of vocational schools regarding their expectations, experiences and assessments in respect of preventive medical examinations based on this legislation. The results are discussed with the consequence that improvements either in content and organisation of these examinations may increase the acceptance among the adolescents. This acceptance seems to be the crucial factor for a higher efficacy of the protective function of legislation.

[Substitution therapy in alpha 1-protease inhibitor deficiency (alpha 1-antitrypsin deficiency)]. / Substitutionstherapie bei Alpha 1-Proteaseinhibitor-Mangel ("Alpha 1-Antitrypsin-Mangel").

Deficiency of alpha 1-protease inhibitor is a dominant autosomally inherited error of metabolism leading to destruction of alveolar septa by proteolytic enzymes mainly released by neutrophils often before the fifth decade. Diagnosis and determination of phenotype are achieved by serologic tests. Affected individuals have to be informed about the accelerated evolution of the lung disease by smoking and the possibility of therapy by substitution. The latter aims at maintenance of anti-proteolytic serum levels compatible with arrest of emphysema by weekly to monthly injections of human alpha 1-protease inhibitor as we illustrate with a case-report. In the future antiprotease produced by gene-technology, the application via aerosols or an infection of endothelial cells with viruses transferring genes for antiprotease may be possible.

[Role of the school in preventive vaccination and infection control]. / Die Rolle der Schule beim Impf- und Infektionsschutz.

628 pupils from both the northern and southern parts of West Germany (Baden-Württemberg, Bavaria, Lower Saxony, Schleswig-Holstein) were interviewed via an "infectious diseases" questionnaire: 44 questions dealt with vaccination (vaccination history, opinions of efficiency of different vaccines), 38 with problems concerning AIDS/HIV. The results indicated significant lack in the acceptance of most of the common immunisations. Improvement of AIDS/HIV-information, especially on HIV-transmission and psychosocial, economical and political consequences seems to be necessary. Possibilities of future health education for pupils are discussed.

[Health and disease in single homeless men: a secondary analysis of findings in a deaconess facility in the Federal German Republic]. / Gesundheit und Krankheit bei alleinstehenden wohnungslosen Männern: Eine Sekundäranalyse von Daten einer diakonischen Einrichtung in der Bundesrepublik Deutschland.

Only few empirical investigations on living conditions and health status of single homeless men have been conducted in Germany. The secondary analysis of a sample of 342 homeless men in a welfare hotel was conducted to describe the health status of this group and to gather informations for a possibly higher illness-risk in this group. For this purpose the medical documents and other socio-demographic data were evaluated at one point (one day in February 1985) along the ICD. A relatively high multi-morbidity for the homeless men, especially for the elder ones, could be stated. The results emphasize in etiological perspective the need to take a deeper insight into factors of workload before getting homeless and to strengthen socioepidemiological, socio-therapeutical and political efforts.