Promoting health literacy in seniors through self-reliant groups. Results of the GeWinn intervention

Background

Health literacy (HL) has been demonstrated to be limited among adults aged 65 and over. However, evidence-based HL interventions are lacking. The objective of this study was to develop and test a community-based HL-intervention in the fields of health promotion and self-management of chronic diseases among elderly people.

Methods

A participatory approach was used to develop and implement a 53-weeks program of self-reliant, peer-moderated groups of people aged 60 and over in 14 municipalities in Germany. HL was intended to be improved by promoting of self-management skills, community participation and media literacy. The intervention’s effect on HL was measured by using the HLS-EU-16 questionnaire three times.

Results

Of 183 older adults who completed the HL questionnaire (mean age 69.8, SD 6.74; 20.1% male), 42.3% had intermediate or low levels of HL. A repeated-measures analysis of variance showed statistically significant effects of time on HL scores (F1.91 = 16.948, p ≤ 0.01, eta squared = 0.085) over the one-year period. HL sub-dimensions showed similar results. 87% of the participants would recommend the intervention to other people.

Conclusions

The results indicate that the structure of the intervention is appropriate to involve older adults in self-reliant working groups to improve HL. This is supported by the high acceptance of the intervention the participants showed. As part of the sustained implementation of GeWinn, special attention shall be paid to reaching out to and engaging vulnerable groups (e. g. elderly people with low socio-economic status, older men, migrants).

Key messages

Self-reliant groups in peer-moderation are effective to engage older adults to improve their HL. The intervention improved all HL rates and even doubled the amount of participants with excellent HL.

The plasma membrane-associated protein RS1 decreases transcription of the transporter SGLT1 in confluent LLC-PK1 cells

Previously we cloned RS1, a 67-kDa polypeptide that is associated with the intracellular side of the plasma membrane. Upon co-expression in Xenopus laevis oocytes, human RS1 decreased the concentration of the Na(+)-D-glucose co-transporter hSGLT1 in the plasma membrane (Valentin, M., Kühlkamp, T., Wagner, K., Krohne, G., Arndt, P., Baumgarten, K., Weber, W.-M., Segal, A., Veyhl, M., and Koepsell, H. (2000) Biochim. Biophys. Acta 1468, 367-380). Here, the porcine renal epithelial cell line LLC-PK1 was used to investigate whether porcine RS1 (pRS1) plays a role in transcriptional up-regulation of SGLT1 after confluence and in down-regulation of SGLT1 by high extracellular D-glucose concentrations. Western blots indicated a dramatic decrease of endogenous pRS1 protein at the plasma membrane after confluence but no significant effect of D-glucose. In confluent LLC-PK1 cells overexpressing pRS1, SGLT1 mRNA, protein, and methyl-alpha-D-glucopyranoside uptakes were drastically decreased; however, the reduction of methyl-alpha-D-glucopyranoside uptake after cultivation with 25 mm D-glucose remained. In confluent pRS1 antisense cells, the expression of SGLT1 mRNA and protein was strongly increased, whereas the reduction of SGLT1 expression during cultivation with high D-glucose was not influenced. Nuclear run-on assays showed that the transcription of SGLT1 was 10-fold increased in the pRS1 antisense cells. The data suggest that RS1 participates in transcriptional up-regulation of SGLT1 after confluence but not in down-regulation by D-glucose.

The transport modifier RS1 is localized at the inner side of the plasma membrane and changes membrane capacitance

Previously we cloned membrane associated (M(r) 62000-67000) polypeptides from pig (pRS1), rabbit (rbRS1) and man (hRS1) which modified transport activities that were expressed in Xenopus laevis oocytes by the Na(+)-D-glucose cotransporter SGLT1 and/or the organic cation transporter OCT2. These effects were dependent on the species of RS1 and on the target transporters. hRS1 and rbRS1 were shown to be intronless single copy genes which are expressed in various tissues and cell types. Earlier immunohistochemical data with a monoclonal IgM antibody suggested an extracellular membrane association of RS1. In the present paper antibodies against recombinant pRS1 were raised and the distribution and membrane localization of RS1 reevaluated. After subcellular fractionation of renal cortex RS1 was found associated with brush border membranes and an about 1:200 relation between RS1 and SGLT1 protein was estimated. Also after overexpression in X. laevis oocytes RS1 was associated with the plasma membrane, however, at variance to the kidney it was also observed in the cytosol. Labeling experiments with covalently binding lipid-permeable and lipid-impermeable biotin analogues showed that RS1 is localized at the inner side of the plasma membrane. Western blots with plasma membranes from Xenopus oocytes revealed that SGLT1 protein in the plasma membrane was reduced when hRS1 was coexpressed with human SGLT1 which leads to a reduction in V(max) of expressed glucose transport. Measurements of membrane capacitance and electron microscopic inspection showed that the expression of hRS1 leads to a reduction of the oocyte plasma membrane surface. The data suggest that RS1 is an intracellular regulatory protein that associates with the plasma membrane. Overexpression of RS1 may effect the incorporation and/or retrieval of transporters into the plasma membrane.

Financial impact of a home intravenous antibiotic program on a medicare managed care program

This study quantitates cost savings achieved by a home intravenous antibiotic (HIVA) program in a Medicare managed health care program. In 1998, 66 treatment courses of HIVA therapy were administered for a total of 1542 patient-days of therapy. The calculated cost of HIVA therapy included the actual costs of drugs, supplies, nursing and therapists' salaries, and laboratory studies. Savings were calculated based on the average daily direct variable cost (DDVC) for hospital acute unit or skilled nursing facility (SNF) care associated with the patient's discharge diagnosis-related-group. The number of days on HIVA therapy was assumed to equal the number of days in the hospital acute unit or hospital-based SNF. The average cost per day of HIVA therapy was $122, whereas average DDVC of hospital acute unit care was $798, and the average DDVC of SNF care was $541. In 1 year, the HIVA program saved our health care system $646,000-$834,000, which demonstrates that HIVA programs are powerful tools to reduce costs in Medicare managed health care programs.

Oxaloacetate transport into plant mitochondria

The properties of oxaloacetate (OA) transport into mitochondria from potato (Solanum tuberosum) tuber and pea (Pisum sativum) leaves were studied by measuring the uptake of 14C-labeled OA into liposomes with incorporated mitochondrial membrane proteins preloaded with various dicarboxylates or citrate. OA was found to be transported in an obligatory counterexchange with malate, 2-oxoglutarate, succinate, citrate, or aspartate. Phtalonate inhibited all of these countertransports. OA-malate countertransport was inhibited by 4, 4'-dithiocyanostilbene-2,2'-disulfonate and pyridoxal phosphate, and also by p-chloromercuribenzene sulfonate and mersalyl, indicating that a lysine and a cysteine residue of the translocator protein are involved in the transport. From these and other inhibition studies, we concluded that plant mitochondria contain an OA translocator that differs from all other known mitochondrial translocators. Major functions of this translocator are the export of reducing equivalents from the mitochondria via the malate-OA shuttle and the export of citrate via the citrate-OA shuttle. In the cytosol, citrate can then be converted either into 2-oxoglutarate for use as a carbon skeleton for nitrate assimilation or into acetyl-coenzyme A for use as a precursor for fatty acid elongation or isoprenoid biosynthesis.

Transport of the new chemotherapeutic agent beta-D-glucosylisophosphoramide mustard (D-19575) into tumor cells is mediated by the Na+-D-glucose cotransporter SAAT1

For beta-D-glucosylisophosphoramide mustard (beta-D-Glc-IPM), a new alkylating drug in which isophosphoramide mustard is stabilized, a higher selectivity and lower myelotoxicity was observed than for the currently used cytostatic ifosfamide. Because beta-D-Glc-IPM is hydrophilic and does not diffuse passively through the lipid bilayer, we investigated whether a transporter may be involved in the cellular uptake. A variety of cloned Na+-sugar cotransporters were expressed in Xenopus oocytes, and uptake measurements were performed. By tracer uptake and electrical measurements it was found that beta-D-Glc-IPM was transported by the low-affinity Na+-D-glucose cotransporter SAAT1, which had been cloned from pig and is also expressed in humans. At membrane potentials between -50 and -150 mV, a 10-fold higher substrate affinity (Km approximately 0.25 mM) and a 10-fold lower Vmax value were estimated for beta-D-Glc-IPM transport than for the transport of D-glucose or methyl-alpha-D-glucopyranoside (AMG). Transport of beta-D-Glc-IPM and glucose by SAAT1 is apparently performed by the same mechanism because similar sodium dependence, dependence on membrane potential, electrogenicity, and phlorizin inhibition were determined for beta-D-Glc-IPM, D-glucose, and AMG. Transcription of human SAAT1 was demonstrated in various human carcinomas and tumor cell lines. In one of these, the human carcinoma cell line T84, phlorizin inhibitable uptake of beta-D-Glc-IPM was demonstrated with substrate saturation and an apparent Km of 0.4 mM. The data suggest that the Na+-D-glucose cotransporter SAAT1 transports beta-D-Glc-IPM into human tumor cells and may accumulate the drug in the cells. They provide an example for drug targeting by employing a plasma membrane transporter.

Risk of human immunodeficiency virus (HIV) transmission by anti-HIV-negative blood components in Germany and Austria

In order to estimate the residual risk of transfusion-transmitted HIV infection we have analyzed the data from two transfusion centers in Austria (Vienna) and Germany (Göttingen) from 1985 to 1994. In Vienna, an incidence of 1:42,000 positive anti-HIV tests in repeat donors and a prevalence of 1:7000 in first-time donors were found in 1993. In Göttingen, the indicence was 1:67,000 and the prevalence 1:7900 from 1985 to 1993. Based on a mathematical model which takes (a) the window period and (b) the false-negative rate of anti-HIV tests, as well as (c) human and operational errors into consideration, we have calculated the residual risk of HIV infection. The residual risk (third generation anti-HIV test) was found to be 1:520,000 (95% confidence interval 1:1340,000-1:210,000), and 1:900,000 (95% confidence interval 1:2340,000-1:380,000) for Vienna and Göttingen, respectively, in 1993. Look-back studies from 1985 till 1994 revealed transfusion-transmitted HIV infections in three recipients (for 1.9 million donations in Vienna) and one recipient (for 160,000 donations in Göttingen) of blood components. Based on our model, as well as on prevalence and incidence rates of HIV infection, it is also possible to predict the efficacy of additional measures introduced to further decrease the risk of transfusion-transmitted HIV infection through blood components.

The prevalence of moderate and severe FXII (Hageman factor) deficiency among the normal population: evaluation of the incidence of FXII deficiency among 300 healthy blood donors

Factor XII (FXII) deficiency has been reported to be a risk factor for the development of arterial and venous thromboembolism. However, no data are available on the prevalence of FXII deficiency within the normal population. Measuring APTT and FXII activity, seven FXII deficiencies could be detected among 300 healthy blood donors. This corresponds to an incidence of FXII deficiency of 2.3%. On the basis of these data the prevalence of severe and mild FXII deficiency in the normal population can be estimated to be 1.5-3.0%. Assessment of FXII antigen levels revealed, that all seven FXII deficient individuals had FXII antigen levels matching the activity. One presented a severe FXII deficiency (1/300, 0.3%) without detectable FXII activity and an APTT prolongation of more than 120 s. The remaining six FXII deficiencies (6/300, 2.0%) were moderate variations with FXII activities ranging from 20-45% and less prolonged APTTs. Among the 300 healthy donors 16 (5.3%) subjects with prolonged APTTs were identified. Causes for APTT-prolongation were FXII deficiency (7/16), lupus anticoagulant (6/16), mild FVIII deficiency (1/16) and hepatic disorder (1/16). In the remaining sample (1/16) the cause for the prolongation of the APTT remained unexplained. Although 8.7% (26/300) of the donors had a positive family-history of thromboembolism (TE-FHx), none of the FXII deficient subjects were among those with positive TE-FHx.

[AIDS and blood transfusion]

In May, 1985, the Red Cross Blood Donation Center of Vienna, Lower Austria, and Burgenland started routine screening for HIV 1 antibodies; by summer 1989, about 750,000 blood donors and donations had been examined. During this period, 59 donors have been proved positive for HIV 1; they have been interviewed and the origin of the infection was explored. Since there were donors within this group, who had repeatedly given blood for many years, we carried out a follow-up study in order to find out whether the recipients had been infected by these donors before May, 1985. In addition, we give the test results of about 200,000 donors screened for HIV 1 antigen and discuss the value of such tests. Recently, 80,000 donors were screened for anti-HIV 1 and 2 antibodies; there has been no donor positive for HIV 2, so far. A much higher number of donors than those marked for confirmed western blot had to be regarded as questionable positive. In such cases, details of western blot results are listed; we discuss the problem of the evaluation of such results as well as the question of informing these donors.

[Treatment of tubal pregnancy with prostaglandins: a multicenter study]

In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.

Low-dose ethanol for inhibition of preterm uterine activity

Inhibition of preterm labor by tocolytic agents reduces the incidence of preterm birth. Betamimetic drugs are the most widely used tocolytic. However, they are from time to time contraindicated, their administration involves potential risks for mother and fetus, and their tocolytic effect is sometimes insufficient. Ethanol infused in intoxicating doses was the first clinically useful tocolytic agent, but because of its potential risks to the fetus, its use is now infrequent. We have examined the efficacy of ethanol infused at much lower rates, alone or in combination with ritodrine, to inhibit preterm uterine contractions. Fifty-four women between 20 and 36 weeks of gestation participated in the study. In 14, betamimetics were contraindicated and they were given ethanol alone. In 38, ritodrine infusions (0.2 gm/min) had failed to arrest preterm labor and they were then given ethanol with ritodrine (0.2 gm/min) The dose of ethanol was 0.11 gm/kg/hour on the average, which is approximately equivalent to the metabolic rate. Altogether, 64 treatments were given, 14 with ethanol alone and 50 combined with 0.2 gm/min ritodrine. In 81% of the treatments, contractions were suppressed within 15.3 hours on the average. Preterm birth (infant less than 2500 gm) was prevented in 70% of the patients. No adverse effects attributable to ethanol were observed. Treatment with low-dose intravenous infusion of ethanol is a cheap, efficacious, and low-risk method to stop preterm uterine activity and is clinically useful for prevention of preterm birth. Possible mechanism of this effect is discussed.

[Incidence of Chlamydia trachomatis infections in pregnant patients in Vienna]

Pregnant women were examined for chlamydia trachomatis-infection on a routine basis during a multicentric study in Vienna. Samples were taken from the cervix and fornix between the 30th and 34th week pregnancy. FTIC-conjugated monoclonal antibodies and immunofluorescence techniques were used to verify chlamydia trachomatis. Out of 1238 pregnant women, 101 (8.16%) were positive for chlamydia trachomatis. Since chlamydia infections can result in severe local or generalized complications and also spread to the newborn baby, screening investigations should be regularly performed during pregnancy and, if indicated, adequate treatment undertaken.

The technique of fibrin adhesion for premature rupture of the membranes during pregnancy

The description of a new technique for fibrin adhesion (in 28 patients) for premature rupture of the membranes in pregnancy is reported. Unless cerclage has been carried out earlier, it is necessary to suture the cervical canal immediately after rupture of the membranes in order to be able to insert a fibrin clot. The author's modified cerclage technique (reverse McDonald procedure) is described. The advantages are minimal trauma to the lower uterine segment and a somewhat physiologic fixation of the synthetic suture material. For application of the fibrin sealant, the Duploject syringe clip is used, as it allows exact dosage and blending of the two sealant components in the course of their application to the site of sealing. The problem of evaluation of the results of the procedure is discussed. The technique carries no risk to mother or child. No cases of amniotic infection syndrome have been observed. Through prolongation of the pregnancy, time is gained for maturation of the fetal lungs. Accordingly, the authors recommend the technique for treating premature rupture of the membranes, although there is as yet no definite answer as to the optimal timing of this adhesion treatment during pregnancy.

[Effect and adverse effects of epidural anesthesia during labor. With special reference to changes in the cardiotocogram]

In an Obstetric Department with approximately 2,000 deliveries yearly, offry third mother is delivered under epidural anesthesia. In a group of 600 maternity patients, the effectiveness, the side effects and the changes in the fetal cardiotocogram were examined during labour and delivery under epidural anesthesia. Evaluated were questionnaire to the mothers with mainly subjective impressions, the anesthetic protocol, and the protocol of labour and delivery including the internal cardiotocogram. 85% of the mothers would have a future delivery under an epidural anesthesia. The incidence of headaches and its independence of the type of obstetric analgesia and anesthesia is mentioned. The number of punctures, the technique of epidural anesthesia, the concentration of the local anesthetic used, failures and side effects are described. The incidence of cesarian sections, fetal morbidity and changes in the cardiotocogram are discussed in detail. The incidence of transilent silent decelerations and alarm dips in the cardiotocogram are mentioned. This study shows that epidural anesthesia is free of risks and a highly effective method for the conduct of obstetric analgesia.

Uterine motility after post-partum application of sulprostone and other oxytocics

With the introduction of prostaglandins to obstetrics another group of substances was known to influence uterine motility also post partum. It was interesting to study the effect of equal doses of synthetic prostaglandin E2 (sulprostone), methergin and synthetic oxytocin on the so-called puerperal model in humans. By transcervically introduced twin-catheters uterine motility was recorded after uncomplicated pregnancy and delivery in 101 volunteers. Uterine motility was recorded and evaluated according to the onset of the effect, its duration, motility pattern and uterine activity. Maternal heart-rate was additionally recorded similarly to the feto-maternal cardiotocogram. All substances were applied by intramuscular injection. The following observations could be made: 1. Onset: sulprostone is effective in the shortest time, followed by oxytocin and methergin. 2.

DURATION

the most prolonged effect is noticed with methergin, followed by sulprostone and syntocinon. 3. Motility pattern: the strongest effect can be seen with sulprostone, followed by methergin and syntocinon. 4. Increase of uterine motility was highest with sulprostone, followed by methergin and oxytocin. 5. No side-effects on the maternal heart-rate could be found with any of the tested substances. As a conclusion, sulprostone is recommended in the treatment of severe bleeding post partum when an immediate and long-lasting effect is to be achieved with one single substance.

13,14-Dihydro-15-keto-PGF2 alpha (PGFM) and sulprostone serum levels after application of sulprostone to postpartum women

13 ,14 -Dihydro-15-keto-PGF2 alpha (PGFM) serum levels were determined by radioimmunoassay in 101 postpartum women who were treated with 200 micrograms methergin, 5 I.U. oxytocin and 500 micrograms sulprostone, respectively, 30 min after expulsion of placenta. All patients had normal deliveries. The present radioimmunoassay system did not show cross-reactivity with sulprostone. In addition, radioimmunoassayable sulprostone serum levels were monitored. Covariance analysis of area under PGFM serum levels between time zero and 180 min after application of oxytocics was performed. A higher but statistically not significantly PGFM serum level was maintained in subjects treated with sulprostone. Sulprostone serum levels are rapidly attained after application. Decrease of radioimmunoassayable sulprostone indicates a half-life of 75 min. These data corroborate clinical findings of an accompanying paper and combine to suggest that sulprostone may be a useful alternative therapy in high-risk patients with severe postpartum atony and hemorrhage in whom prior preventive measures have failed.

[Vertical transmission of hepatitis B. Results of a prospective study 1978 to 1981]

From June 1978 until August 1981 4400 pregnant women were consecutively investigated in Vienna for the presence of hepatitis B. 23 women (0.52%) were HBs-antigen positive; 15 of these were foreigners (from Yugoslavia, Turkey, Philippines, Rumania),22 pregnant women were healthy HBs-antigen carriers. One woman had an unspecific reactive hepatitis. Three pregnant women were HBe-antigen positive, 18 anti-HBe positive. Hepatitis B infection was detected in three children of HBs-positive mothers. The highest risk of infection existed in children of HBe-antigen positive mothers. There was no connection between the infection of the children and HBs-antigen in cord blood, delivery and breast-feeding habits. Hepatitis infection took a different course in the three children: one child was an HBs-antigen carrier with a healthy liver, whilst in two children seroconversion took place and anti-HBs was formed without clinical-biochemical signs of hepatitis. Measures for the prevention of vertical hepatitis B transmission are discussed.

[Sonographic studies of gallbladder kinetics in childhood--a comparison between healthy and mucoviscidosis patients]

In mucoviscidosis, the gallbladder can show signs of disease even in childhood. In 10 of 35 mucoviscidosis patients the authors found thickening of the walls, gallstones and micro-gallbladders on sonographic examination. Compared with healthy children (N = 70), the mucoviscidosis patients showed impairment of the kinetics of the gallbladder to an increasing extent in step with progressing age. X-ray films of the gallbladder were preferably taken while using a preparation containing bile acids for better absorption of the contrast medium. When using this preparation, the gallbladder was found to yield good contrast more frequently than with double-dose cholecystography recommended in literature. However, oral cholecystography yielded additional information in one case only where sonography had failed to produce a clear sonographic image of the gallbladder.

[The efficacy of oral betamimetics using an oxytocin-stimulated puerperal model (author's transl)]

Puerperal uteri were stimulated by oxytocin, the uterine motility was recorded by transcervical catheter techniques, maternal pulse and blood-pressure were recorded continuously or intermittently. Oral tocolytics as Gynipral (Hexoprenaline), Partusisten (Fenoterol), Spiropent (Clenbuterol) and Prepar (Ritodrine) were administered orally in single or double dose. The inhibitory effect of these drugs were recorded, evaluated from the records and calculated statistically concerning their significant differences. It could be demonstrated that only Hexoprenaline in a three time higher dose than used usually and Partusisten in a dose of 10 and 20 mg were able to reduce uterine motility for more than 50%. All other substances definitely had an inhibitory effect on the puerperal uterus, but inhibition was not stronger than 30%. Cardiovascular side-effects were discussed. The question, if oral given betamimetics are effective in the treatment of threatening premature labour could not be answered definitively, but there are doubts according this study concerning the dose and the repetition of it for this purpose.

[Intravaginal treatment of colpitis maculosa with an oestriol-containing vaginal cream (author's transl)]

43 patients with colpitis maculosa (average age 60.2 years) were selected for an open control therapeutic study with Ortho-Gynest vaginal cream (Ortho-Cilag). The cream contains 0.5 mg of oestriol per single applicator filling. The treatment lasted from 3 to 4 weeks, success being evaluated by clinical documentation and cytological evaluation of vaginal smears before and after treatment. 10 patients (23.3%) were treated successfully, 29 (67.4%) showed a distinct improvement both clinically and cytologically, whilst the remaining 4 (9.3%) showed only moderate improvement. Hence, 39 patients (90.7%) were classified as having been successfully or partly successfully treated. Severe symptoms disappeared completely or were greatly alleviated in 91.4% cases. Moderate symptoms vanished in 59.7%. 58.1% showed a complete normalisation of the former atrophic vaginal skin. Blood spotting and reddening of the vaginal wall vanished completely. A change from dry to moist vagina occurred in 77.3% patients. Discharge vanished completely in 80.6% cases. No untoward side effects were recorded.

[Medical basis for therapy with blood components]

In contrast to the increasing demand of blood in the hospitals there is a hardly rising number of blood donations. This situation obliges transfusion services to utilize every single donation, that means to split blood in its components. These components with their advantages and disadvantages for transfusion therapy are described.

Intravenous prostaglandin E2 and 16-phenoxy prostaglandin E2 methyl sulfonylamide for induction of fetal death in utero

The efficacy of intravenously administered prostaglandin E2 (PGE2) compared to that of intravenously administered 16-phenoxy-17,18,19,20 tetranor prostaglandin E2 methyl sulfonylamide (SHB 286) for termination of fetal death in utero was evaluated in 20 pregnant women from 14 to 38 weeks' gestation. Ten subjects received 1 microgram of PGE2 per minute intravenously. This rate of infusion was doubled at hourly intervals up to 8 microgram per minute. Ten subjects received 0.25 microgram of SHB 286 per minute. This rate of infusion was doubled at hourly intervals up to 2 microgram per minute. It appears that the dosage schedules of PGE2 and SHB 286 were equally effective in inducing labor. Cumulative expulsion rates and mean induction times were similar in both groups. Rates of emesis were low in both groups. Either fever greater than 38.0 degrees C, or shivering, or phlebitis at the site of infusion was observed in three patients treated with PGE2 but in no patient receiving SHB 286.

[Spontaneous rupture of uterus during delivery. Interpretation of cardiotocogram (author's transl)]

The authors report a case of silent rupture of uterus during delivery. The whole delivery was monitored by intrauterine pressure recording and fetal scalp electrode. Severe fetal bradycardia induced cesarian section. The retrospectively study of the papercover of fetal monitoring indicates the rupture of uterus.

[Indications for the transfusion of erythrocyte concentrates]

Whole blood transfusions as usual are often not effective. The high fluid level overloads the circulatory system and the share of red blood corpuscles improves the hematocrit inconsiderably. On the contrary after application of erythrocyte suspension which has reducted volume the hematocrit increases and risks of the circulatory system will be prevented. Risks by means of whole-blood transfusions; advantages, indications, and production of erythrocyte concentrations are outlined.

Indikation zur Transfusion von Erythrozytenkonzentraten

Herkömmliche Vollbluttransfusionen bringen nicht in jedem Fall den erwarteten Effekt. Wenn ein Patient genügend Plasma besitzt, belastet die groβe Flüssigkeitsmenge unnötig den Kreislauf und der anteilige Prozentsatz der roten Blutkörperchen verbessert den Hämatokrit in nur geringem Maβe. Dagegen steigt bei Applikation einer volumenarmen Erythrozytensuspension der Hämatokrit deutlicher an und Kreislaufrisiken werden von vornherein ausgeschaltet. Gefahren durch die Transfusion von Vollblut und Vorteile der Erythrozytenkonzentrate werden gegenübergestellt sowie Indikationen und Herstellung dieser Konzentrate besprochen.

[Prostaglandins compared with oxytocin for induction of labour at term (author's transl)]

12 cases of induction of labour with prostaglandin F2 alpha and 8 with prostaglandin E2 were compared with 14 cases in which induction was undertaken with oxytocin. All inductions were successful, the induction--delivery intervals being slightly shorter in the prostaglandin groups than in the oxytocin group. Both with prostaglandin F2 alpha and with prostaglandin E2 the cardiotocogram showed uterine hyperactivity in most of the cases with an unexpected, episodically-occurring increase in basal uterine tone and remarkable tachysystoly. Uterine hyper-activity led to fetal heart rate alterations of the "dip 2" type in about 50% of the cases. According to these results prostaglandins cannot be considered superior to oxytocin for the induction of labour at term.