[Contemporary diagnostics and therapy of osteoporosis]. / Zeitgemässe Diagnostik und Therapie der Osteoporose.

Since the World Health Organisation's announcement of the "Bone and Joint Decade 2000-2010" diseases of the musculoskeletal system attract more and more attention throughout patients and professional health care providers. In an aging society especially osteoporosis represents a major public health concern. Fragility fractures are the most limiting condition in osteoporosis with the highest impact on both, life quality and health care systems worldwide. Orthopaedic surgeons play a key role in implementing primary diagnostics and therapy in patients with fragility fractures. Objective of this effort is the reduction of the common subsequent fractures in patients with osteoporosis. According to national and international guidelines implementation of contemporary clinical pathways to diagnose and treat patients with fractures due to diminished bone mineral density is fast, simple and proven to be effective.

[Role of osteoporosis in trauma diagnostics]. / Stellenwert der Osteoporose in der traumatologischen Diagnostik.

PURPOSE: To evaluate the current bone mineral density (BMD) distribution in elderly patients hospitalized due to traumatic hip fracture and to assess the necessity of concomitant pharmacotherapy of underlying osteoporosis. MATERIALS AND METHODS: 58 female patients > or = 50 years (mean 81 years) with proven hip fracture were included. The diagnosis of fracture was established either by conventional radiography (CR) or by computed tomography (CT). BMD was assessed prospectively by means of dual energy X-ray absorption (DXA) measurement of the lumbar spine and/or femoral neck. DXA data was routinely achieved by analysis of T- and Z-values of the BMD. Distribution of BMD was assessed. Results for both measurement sites were compared using T-test and Pearson correlation analysis. RESULTS: 56/58 patients with proven hip fracture received DXA of the lumbar spine, 51 DXA of the femoral neck. The mean BMD was 0.829 +/- 0.137 g/cm (2) (lumbar spine) and 0.451 +/- 0.126 g/cm (2) (femur). T-values were - 2.8 +/- 1.14 (lumbar spine) and - 3.53 +/- 0.97 (femur). Compared to the normal distribution (lumbar spine), 53 patients (94.6 %) had diminished BMD (T < or = - 1). Of these 15 (26.8 %) had osteopenia (T > - 2.5) and 38 (67.9 %) had osteoporosis (T < or = - 2.5) according to WHO definition. With respect to femoral bone measurement, all patients (100 %) had diminished BMD (T < or = - 1), 9 patients (17.6 %) had osteopenia (T > - 2.5) and 42 patients (82.4 %) had osteoporosis (T < or = - 2.5). Results for different measurement sites differed significantly and were weakly correlated. CONCLUSION: This data indicate that diminished BMD in terms of osteopenia or osteoporosis is a frequent finding in hip fractures of elderly females. A large majority of these elderly patients therefore should be treated according to recent guidelines for treatment of osteoporosis. Our data indicate that this entity is potentially underdiagnosed and should be considered by radiologists as well as traumatologists.

[Osteoporosis in traumatology. Prevalence and management]. / Osteoporose in der Unfallchirurgie. Prävalenz und Management.

BACKGROUND: A fracture occurring in osteoporosis is a sentinel event but very rarely leads to bone mineral density (BMD) measurement or sufficient drug therapy. We designed an algorithm to evaluate BMD in older fracture patients and tested it for sustainability as well as acceptance among trauma/orthopedic surgeons. METHODS: For a 1-year period a prospective BMD test was carried out in women older than 50 and men older than 75 years of age with fractures. The commencement and conduction of therapy during the initial hospital stay and rehabilitation were also analyzed. RESULTS: From 228 members of the eligible age groups, 169 patients (74.1%) underwent BMD measurement. According to the WHO definition 71.6% showed reduced BMD in terms of osteoporosis and 24.3% in terms of osteopenia. In 84% therapy was started during initial hospital stay in 74.4% conducted during rehabilitation. CONCLUSIONS: The vast majority of older patients exhibited reduced BMD as a substantial underlying cause of their fracture. A standardized clinical plan can help to identify and treat most patients with fragility fractures.

Automated patient acuity. Linking nursing systems and quality measurement with patient outcomes.

Traditional patient classification systems no longer provide a useful function for nursing management. Value from these systems can only be realized through major revisions and integration with other systems. The resulting transformed system, linking patient outcomes, cost of care, and quality measurements together, provides a valuable measurement tool and enables nursing to demonstrate their value to the industry. The authors describe their rationale and experience in designing such a system.

[Problems of contraception in teenage girls]. / Probleme der Schwangerschaftsverhütung weiblicher Jugendlicher.

930 female teenagers of 17 years were questioned to their knowledge of contraceptive methods and its use. Nearly 63,6% of the female teenagers with experiences of cohabitation practised no contraception. There is the demand of an increasing attention of contraception under the frame of sexual education of the youth; it's the main point.

[Sex education and sexual development of female adolescents]. / Sexualerziehung und Sexualentwicklung weiblicher Jugendlicher.

PIP: A questionnaire survey on sex knowledge of 930 female vocational students (17-18 year olds) was done to assess future needs in sex education. Main points in the questionnaire were sex upbringing and education received; peer groups, couple and contraceptive behavior; and attitude to family and family planning. Socioeconomic factors, parents' occupation, and size of residence were considered. Results showed: 70.4% had some kind of sex upbringing before age 12; 24.5% after age 12. Whereas up to 80% wanted sex education from parents, only about 55% actually received this (mothers mostly); 80% of actual sex information came from books and TV. Peers proved closer to the girls in confidence than parents. Although teachers were 3rd in line to provide actual sex education they were last as persons desired by the girls to provide this. Nearly 60% of the subjects desired more information in the areas of love and marriage, sex in adolescence, effects and side effects of the pill, general contraceptive methods and sex behavior. Conclusions from the survey point to the need to start sex education at an early age and extend it into adolescence and beyond; it should be direct, continuous and goal-oriented. Teenagers desire interpersonal dialogue with concerned adults. There should be cooperation in sex education between parents, teachers, and youth organizations. Teachers are insufficiently prepared to assume the role as sex educator. Teenagers need more factual information on conscious family planning and contraceptive methods.^ieng

[A system for quality control of biotransformation enzymes in the mucosa of small intestine (author's transl)]. / Ein Qualitätskontrollsystem für Biotransformationsenzyme in der Dünndarmmucosa.

A system for quality control of the determination of arylhydrocarbonhydroxylase (benzpyrenhydroxylase), ethoxycoumarin-O-deethylase, NADPH-cytochrom-c-reductase, epoxidehydrase and uridindiphosphoglucouronyltransferase was developed. We used lyophilized and frozen samples of postmitochondrial supernatant of rat and guinea pig small intestinal mucosa, which was prepared using a 1:5 ratio of mucosa to K-phosphate buffer. For NADPH-cytochrome-c-reductase, the microsomal suspension from rat small intestine was used. The samples were stored at -30 degrees C. The coefficient of variation within run was about 5% (15 samples), the coefficient of variation between run (15 days) about 10%. The control specimens were stable for 6 months.