[Rehabilitation outcomes of a psychosomatic clinic integrating fully inpatient and partial hospitalization rehabilitation approaches: a comparison]

As publications from the domain of psychosomatic rehabilitation pertaining to the conceptual approaches and effects of partial-hospitalization rehabilitation have so far relied on very small case numbers, the effectiveness of partial-hospitalization rehabilitation was analysed in 318 patients in comparison to a large sample of rehabilitants who had participated in fully inpatient rehabilitation. No relevant differences were found among the groups studied in sociodemographic respects or range of diagnoses. The same was true concerning the level of complaints present at the onset of rehabilitation. Good rehabilitation outcomes were achieved in both groups, however, the effect sizes found for changes in depressiveness and indulgence to complaining ("Klagsamkeit") (GSI from the SCL-90) were lower in the partial-hospitalization group than in the patients in fully inpatient rehabilitation. Also, the relatively high share of partial-hospitalization patients discharged unable to return to work might be clinically significant. While our findings confirm the good results reported from other disciplines, they nevertheless are a reminder of the need for very careful selection of patients for partial-hospitalization rehabilitation, in order not to withhold "better" rehabilitation than could be provided on a partial-hospitalization basis from patients with special sociomedical problems. The best rehabilitation outcomes seem to be achieved by those patients who, towards the end of fully inpatient rehabilitation, were granted transition to the partial-hospitalization programme.

[Physical and psychological status of 60-70-year-old citizens of Bern with neurotic symptoms in childhood--a study over more than 50 years (Emmental cohort)]

The present study was undertaken to assess the influence of childhood variables (physical and emotional) to later well-being in a group of rural Swiss (Emmental Cohort). Our study is the first prospective cohort over a time period of more than 50 years. It includes 1537 children who were listed and assessed in 1942 (T1) because they had difficulties in school or were otherwise behaviorally disturbed. In 1995 (T2) more than 60% of the initial population could be reassessed by our study group. We found more subjects at T2 who had been rated as intelligent at T1. More subjects responding to T2 belonged to a higher social class, were more anxious, and had more psychosocial problems at T1. Social income at T2 is correlated to the social class at T1. More subjects have died since who were rated at T1 as being less intelligent, less neurotical, and having higher psychosocial problems. Twice as many men died than women. The emotional situation at T2 is significantly correlated to psychological well-being at T1. The somatic complaints at T2 correlate significantly to neurotic symptoms in childhood (T1). The more intelligent the children were rated at T1, the less emotional and somatic complaints were voiced at T2 and the better the psychic well-being was rated (T2). In addition, the former social milieu (T1) significantly determined somatic and psychological complaints at T2. Our data discern a significant correlation between actual status and former childhood variables more than 50 years later in a rural Swiss cohort (Emmental Cohort).

[1-Year follow-up of inpatient treatment in a psychosomatic rehabilitation clinic with either a psychoanalytic or behavior therapy oriented treatment]

In a naturalistic setting, we studied the long-term effects of an inpatient treatment program at a psychosomatic rehabilitation clinic, where patients were assigned to a department with either a psychoanalytic or behavior therapeutic orientated treatment after one week of comprehensive diagnosis. The study is based on a self-developed questionnaire which gathers retrospective information in a broad spectrum of problem areas at the point of admittance and release (t0 and t1) as well as current assessments one year following treatment (t2). Additionally, a symptom checklist (Giessener Beschwerdebogen) and a questionnaire assessing depression (Allgemeine Depressionsskala) were prospectively employed at t0 and t2. We asked a consecutive sample of 376 patients to participate, of which 56% answered at t2. Despite limitations of the internal and external validity of the study, we were able to show that substantial improvements are maintained following treatment for both therapies at one-year follow-up, whereas only small difference are found between the outcomes of the two different schools implemented in the clinic.

Somatostatin analogue octreotide and inhibition of tumour growth in metastatic endocrine gastroenteropancreatic tumours

Antiproliferative treatment of patients with metastatic endocrine gastroenteropancreatic tumours (GEP) is based mainly on chemotherapeutic protocols whereby drug toxicity is a major handicap. Octreotide is the first choice in the control of hormone mediated symptoms. From retrospective and a few prospective studies it has been suggested that octreotide exhibits antiproliferative properties. The prospective German Sandostatin multicentre phase II trial investigated the effects of 200 micrograms octreotide thrice daily for one year on tumour growth and endocrine abnormalities in 103 patients. Octreotide treatment was continued in those patients responding to the drug until tumour progression occurred. In 28 of those with tumour progression during 200 micrograms thrice daily octreotide dose was increased to 500 micrograms thrice daily. The study sample consisted of 52 patients with computed tomography confirmed tumour progression and 13 patients with stable disease before octreotide treatment, whereas no preobservation period was available in 38 patients. Nineteen patients (36.5%) with computed tomography confirmed tumour progression experienced stabilisation of tumour growth lasting for at least three months. Median duration of stable disease was 18 months. At month 12, stable disease continued in 12 patients, declined after 24 months to nine patients, and after 36 months to five patients. Tumour regression has not been seen in this or other subgroups. In the subgroup with stable disease before octreotide, stable disease continued in 53.8% of patients over 12 months. Increase of octreotide dose to 500 micrograms thrice daily did not influence progression seen during the lower dose with the exception of one patient in whom tumour progression changed to stable disease. No association of tumour size response and patients' characteristics could be detected. The results suggest that octreotide inhibits tumour growth in patients with metastasised endocrine GEP tumours. The antiproliferative effect is, at least in some patients, longlasting. Currently, octreotide can only be recommended as an antiproliferative drug if patients with clearly progressive disease show stabilisation after treatment for three to six months.

[Implant fixation strength and osseointegration following systemic administration of recombinant factor XIII and factor XIII concentrate. Animal experiment with implant fixation strength and osseointegration of porous surface implants]

30 cylindrical commercially pure titanium fiber porous coated Ti6A14V implants were inserted press-fit into the proximal humeral portion of 30 sheep humeri to determine the systemic effect of recombinant factor XIII and placenta-derived factor XIII concentrate on bone ingrowth and on strength of fixation. For both the recombinant factor XIII and the factor XIII concentrate group the volume fraction of bone ingrowth and the strength of fixation was higher when compared with the control specimens. However the difference was only significant for the factor XIII concentrate group.

Comparison of death rates from acute myocardial infarction in a single hospital in two different periods (1977-1978 versus 1988-1989)

The in-hospital prognosis of patients with definite acute myocardial infarction (AMI) treated at the University Medical Center in Marburg, Germany, was retrospectively evaluated for the years 1977 to 1978 and 1988 to 1989. Diagnosis of AMI was established in 357 patients (251 men, 106 women) in 1977 to 1978 and in 338 patients (240 men, 98 women) in 1988 to 1989. Overall in-hospital death rate increased from 19.6% (1977 to 1978) to 28.7% (1988 to 1989) (p < 0.01). Median ages of both groups were comparable. Patients treated in 1988 to 1989 had a higher prevalence of arterial hypertension (p < 0.001), hypercholesterolemia (p < 0.0001), reinfarction (p < 0.01), and successful resuscitation before hospital arrival (p < 0.0002). Univariate risk factor evaluation suggested the following unfavorable prognostic variables: age, successful resuscitation before hospital arrival, diabetes mellitus, reinfarction, and female sex. A favorable prognosis was associated with a history of smoking, higher serum cholesterol concentration and thrombolysis. Logistic regression analysis identified age, smoking, serum cholesterol concentration, and the combination of treatment period with either successful resuscitation before hospital arrival, or diabetes mellitus, as independent variables of in-hospital prognosis. In conclusion, the apparent increase of in-hospital death rate between 1977 to 1978 and 1988 to 1989 could mainly be attributed to differences in the 2 study groups.

[The dimensional stability of hydrophilic impression materials after application of a disinfectant]

The influence of a disinfectant solution containing glutaraldehyde on the dimensional stability of 2 alginate and 4 elastomeric impression materials has been investigated. Die models were measured using a computer-controlled method and compared to the master die to assess the three-dimensional change in the impression material. After an immersion time of 10 min, a dimensional change did not occur. When using immersion times longer than 10 min, the accuracy of the alginate materials was generally more affected by the disinfecting solution than that of the elastomeric impression materials.

Low-dose oral contraceptives lower plasma levels of apolipoprotein E

Three different oral contraceptive preparations were studied before and after a 3 month treatment period with respect to their effects on plasma lipoprotein parameters. A total of 58 healthy women requesting oral contraception were randomly assigned to three groups. Each woman received either monophasic preparations containing ethinylestradiol and desogestrel (M-DG); ethinylestradiol and gestodene (M-GD); or a triphasic preparation of ethinylestradiol and levonorgestrel (T-LN). As has been reported in other studies, the concentrations of total plasma cholesterol and apolipoproteins B and A-IV did not change significantly in any group. HDL cholesterol, triglycerides, apolipoproteins A-I and A-II increased or tended to increase. Despite the effects of the three hormone preparations on these lipoprotein parameters, however, each led to a highly significant decrease in apolipoprotein E plasma levels. Considering the recently reported observations that oral contraceptives increase the hepatic uptake of cholesterol-rich remnants, this decrease in apo-E plasma levels may in women that take oral contraceptives be directly correlated with increased hepatic lipoprotein metabolism.

[Identification of children with high risk of caries related to caries occurrence in the past]

In several studies high correlations were found when the prevalence of caries in the past was correlated with future caries risk in children and adolescents. The practical value of this method for the identification of children with high risk for caries can be assessed by measurement of the ability of the method to recognize subjects who will develop caries (sensitivity) and to exclude those who will not (specificity). Taking into consideration worldwide studies from recent years the problems of this method were pointed out and discussed.

[Significance of the social anamnesis in the rehabilitation of coronary patients]

We studied some indicators of the course of the disease in male patients (N = 45; x age = 46 +/- 5.6 years) who after first myocardial infarction (MI) spent 4-6 weeks in a rehabilitation clinic. The investigation is done to test the following hypotheses: 1. Social distress during the preinfarction phase is related to coping with the disease (namely anxiety) and to some risk factors (overweight, low-density-Lipoprotein). 2. Participation in a stress-management training that aims at enhancement of coping with social distress has positive effects on the course of the disease. This is particularly true in those who are under strong social pressure. Two panel waves, at the beginning and at the end of stationary rehabilitation, where we gathered data on social and standard risk factors, confirmed our hypotheses in part. Anxiety after MI was related to social distress before MI. For both, anxiety and low-density-lipoprotein, we found a significant interaction effect of social distress and stress-management training as a result of a multivariate analysis of variance (MANOVA; SPSS). Given the small sample size the results should be taken as preliminary and should not be overinterpreted.