[Unintentional injuries in the German adult population. Results of the "German Health Update" survey 2010]

In Germany, more than 20,000 people were killed in accidents and 8.7 million people suffered nonfatal unintentional injuries (UI) in 2011. This report gives an overview of the occurrence of nonfatal UI in the German adult population. The representative health survey "German Health Update" 2010 (phone survey) collected data on nonfatal accidents in the adult population within a recall period of 12 months (n = 22,050). Interviewees reporting medically treated UI responded to 19 further questions about accident locations, accident mechanisms, injuries, and consequences of up to three UI within 1 year. Overall, detailed data on 2,117 UI were collected. About 7.9 % of the German adult population suffers at least one medically treated UI within 1 year. Men are more often affected than women and young people more frequently than older people. The majority of all UI occurs at home or during leisure-time activities. One in five UI results from accidents on public footways, roads, and squares. Falls account for almost every third UI and about one in five accidents causes fractures. Two thirds of all UI require inpatient treatment. Two in three UI lead to temporary sick leave averaging 29.7 days of absenteeism. Among UI at home and in leisure-time activities, falls have particularly serious consequences. Moreover, falls play an important role in UI among pedestrians and cyclists. UI affect large parts of the German adult population and are clearly patterned by gender, age, and accident location. Therefore, prevention activities should consider target group-specific needs and setting-specific circumstances of UI.

Gesundheitsmonitoring der Migrationsbevölkerung in der Schweiz

With the health monitoring of the Swiss migrant population, a database was created on migrants' health state, their health behaviour and utilization of health services. Thanks to this database, it is now possible to draw representative conclusions on the health status of migrants compared to the indigenous population. Based on the Swiss Health Survey, a questionnaire was developed and translated into several languages. A survey of the foreign population permanently resident in Switzerland as well as of asylum seekers and those temporarily settled in Switzerland was conducted through phone interviews. The interviewees could choose the survey language: in their mother tongue or one of the Swiss languages. A first description of the data is available. The analyses show that the results found for migrants of West European countries are comparable to those of the Swiss population. All other migrants come off worse with regard to health and social indicators. For example, they assess their self-perceived health state more often as "average" or "bad", they feel emotionally less balanced, or visit a doctor more frequently than the Swiss population does. Significant differences can be found within the data of the surveyed migrant population, for example depending on gender, age, residence status or nationality.

[Migration and rehabilitation of mental diseases -- perspectives and limitations in the reporting of official data of service providers]

Health and social monitoring are important foundations of political decision making. In order to make statements about populations and subgroups different sources of information are generally used. The potential contribution which aggregated official health data of service providers can make is discussed in the exemplary context of the utilisation of medical rehabilitation of mental diseases. Age specific rates and age standardised ratios show a significantly increased utilisation of services for depression and somatoform disorders amongst women in general and the migrant population in particular. It is demonstrated that the interpretation of such results raises new research questions rather than providing explanations that could prove to be conducive for practical measures. In a methodological discussion it is stated that the reason for this has to be seen in the fact that important structures of action within the care system are concealed by the specific method of collecting and processing official health data. Nevertheless, conceivable interpretations are given regarding the psycho-social living conditions of large parts of the migrant population as well as their difficulties in the interaction with the medical system. This enables the formulation of a hypothetical framework for further research which could help to clarify statistical phenomena found in the official data of service providers.

Health monitoring of the migrant population in Northrhine-Westphalia, Germany: experiences, implications, and perspectives

AIM

To describe the benefits and restrictions that emerged in health monitoring of the Northrhine-Westphalian migrant population.

METHODS

Analysis of official register data, description and classification of benefits and restrictions, and systematic derivation of implications of general validity.

RESULTS

The comparison of the native German and migrant populations revealed which health relevant fields with specific problems require political intervention and further research. The results clearly reflected strongly differing socio-demographic structures. Moreover, insufficiencies in the design of official statistics were found, which led to the formulation of general principles of an integrated system for the health monitoring of migrant populations.

CONCLUSIONS

To serve as adequate data sources relevant for health monitoring that takes into account different dimensions of migration, official registers should fulfill certain requirements. Different indicators of migration and socioeconomic situation should be recorded, and classifications, such as national background and age, should be standardized in different statistical sources.

[Incidence of pathologic ammonia concentrations in the plasma in children with seizure disorders treated with Convulsofin/Convulex and other anticonvulsants in comparison with children with brain damage and healthy children]

In healthy children plasma ammonia concentrations show values from 12.3 to 57.2 mumol/l (80%-range) (group I). We also measured plasma ammonia in epilepsy patients with valproate therapy (group II) and epilepsy patients treated with other anticonvulsiva (group III). In a fourth group there were children with various cerebral lesions without episodes and without anticonvulsiva therapy. There were significant differences between group I and group II and group II and group IV respectively. But no significant differences were found between the patients who were treated with valproate and the patients with cerebral lesions. The data does not allow the plasma ammonia concentration to be taken as a control parameter in children treated with valproate. Ammonia estimation at the beginning of therapy, however, may be used as risk indicator.

Thalidomide neuropathy: an electrophysiologic study

Thalidomide is effective in the treatment of such disabling dermatologic diseases as aphthosis, discoid lupus erythematosus, and prurigo nodularis, in which other drugs fail. However, its use can induce neuropathy necessitating caution in its administration. It was found in this electrophysiologic study of 13 patients that the data best revealing neuropathy, even when clinical abnormalities were not apparent, were reduction of sensory nerve action potential amplitude on the sural nerve, increase of somatosensory evoked potential latency following sural nerve stimulation, and reduction of sensory action potential amplitude on stimulating the median nerve at the wrist. In two patients, electrophysiologic abnormalities had increased after withdrawal, suggesting a prolonged action of thalidomide. Timely reduction of dosage, after detection of changes indicating the onset of side effects, could reduce the risk of the sometimes rapid emergence of clinical symptoms.

Pharmacokinetics and pharmacodynamics of pentopril, a new angiotensin-converting-enzyme inhibitor in humans

In a single, ascending-dose tolerance study, nine healthy volunteers were given oral pentopril 50 to 750 mg (CGS 13945) in groups of three each. Disposition characteristics of pentopril and its active metabolite (CGS 13934) were determined using plasma concentration and urinary excretion data. The drug was absorbed rapidly following zero-order kinetics. The drug has an apparent volume of distribution of 0.83 L/kg and an oral clearance of about 0.79 L/hr/kg. Urinary excretions, calculated after 125- and 250-mg doses, showed a dose proportional urinary recovery of 21% (+/- 5%) for pentopril and 40% (+/- 5%) for CGS 13934. In the multiple-dose study of 125 mg orally q12h in six healthy subjects, the plasma concentrations for both drug and metabolite showed no appreciable accumulation of either compound, which was expected from their short pharmacokinetic half-lives (pentopril, less than 1 hr; CGS 13934, approximately 2 hr). In a separate pharmacodynamic study, drug and metabolite concentrations were evaluated against angiotensin-I (AI)-induced changes in blood pressure and plasma angiotensin-converting-enzyme (ACE) activity in healthy volunteers after single oral doses (range, 10-500 mg). The pharmacodynamic half-life for plasma ACE inhibition increased with the dose (10 mg, 1.5 hr; 500 mg, 9.8 hr). There was a close relationship between the plasma level of the metabolite and the inhibition of plasma ACE activity and AI-induced pressor response. A hyperbolic function adequately described the dependence of plasma ACE activity on plasma metabolite concentration with a concentration at half-maximal inhibition of 53 ng/mL.

Effect of food on the bioavailability of pentopril, an angiotensin-converting-enzyme inhibitor, in healthy subjects

Pentopril (CGS 13945) was administered in 125-mg capsules to eight healthy men on two occasions according to a randomized schedule; on one occasion in the fasting state and on the other occasion immediately following the ingestion of a standardized meal. Unlike captopril, a prototype angiotensin-converting-enzyme inhibitor, there was no significant difference in the peak plasma concentration for either the drug or its active metabolite (CGS 13934) between the fasting and the fed states. There was also no appreciable change in the area under the plasma curve for the drug and its metabolite after administration of drug in the presence of food compared with a fasting state. There was, however, a lag time in drug absorption after ingestion of food, which resulted in a significant increase in peak time for the active metabolite in plasma. Food delays the body's absorption of the drug and hence the appearance of its active metabolite in plasma without any significant effect on the relative bioavailability. Because relative bioavailability is not affected in the presence of food, such a delay may not have any therapeutic importance on chronic administration.

[Systemic scleroderma]

The etiology of systemic scleroderma is still unknown. This disease is well individualized by its usual forms, i.e. acrosclerosis and diffuse form, whose features and prognosis differ. The description of new entities has generated further interest, particularly through a different diagnostic and therapeutic approach. No specific biologic or immunologic criteria of the disease have as yet been discovered. Prognosis depends mainly upon the severity of visceral involvement. There have been little improvements in therapy which rests upon presumptive physiopathological hypotheses.

[Bullous pemphigoid. Current aspects]

Bullous pemphigoid is characterized, since the use of cutaneous immunofluorescence as a routine technique, by a linear deposition of IgG and C3 in the basal membrane zone. This has led to the description of unusual clinical aspects and onset forms which were formerly unrecognized. Insight into the intricate mechanism of dermo-epidermal separation, which is the basic defect of the disease, has very lately been gained by immunologic and electronic microscopy studies. However, at present, the nosologic position of bullous pemphigoid in relation to herpes gestationnis and cicatricial pemphigoid cannot be satisfactorily specified. The exact outcome is still poorly known. This is probably due to a poorly standardized management. Systemic corticotherapy, although not the only treatment, still provides the best results.

Clinical trial of iopamidol for lumbosacral myelography

The results of the initial North American trial of the nonionic, water-soluble contrast medium iopamidol for lumbosacral myelography are reported. The iopamidol was easily visualized by fluoroscopy during introduction, and the radiographic quality of all 12 conventional myelographic examinations was excellent. The diagnoses were herniated nucleus pulposus (seven), traumatic dislocation (one), metastasis (one), and normal (three). One patient had a repeat myelogram with a different hydrosoluble contrast medium 2 months after his iopamidol examination and surgery and showed no radiographic evidence of arachnoiditis. The adverse reactions were all mild and transient: headache (four cases), nausea (two), and leg pain (one). There were no diaphoresis, fever, seizures, hallucinations, agitation, or vital sign changes. Electrocardiography, hematology, and blood chemistries were all normal. In two patients, electroencephalogram changes, three to four bursts of diffuse intermittent rhythmic delta activity with no spiking, were present at 6 hr with return to normal at 24 hr.