[Needs and quality of counseling in long-term care : User perspective on counseling services in Germany]. / Bedarf und Qualität von Beratung in der Langzeitpflege : Nutzerperspektive auf Beratungsangebote in Deutschland.

BACKGROUND: A wide range of counseling services with a variety of counseling purposes have been established in Germany to support care recipients and their relatives; however, there is a lack of quality criteria that are based on the counseling needs from the user's perspective. OBJECTIVE: To summarize empirical knowledge on counseling needs and quality of counseling services from the user perspective and identification of counseling-specific understanding of users. MATERIAL AND METHODS: A literature search was conducted in the databases CareLit®, LIVIVO and SpringerLink with additional online research via Google and MetaGer. Analysis of the literature and discussion on the state of research. RESULTS: A trustful relationship between counselor and user as well as the orientation to the user's individual situation are key elements of counseling that have been found helpful; however, a differentiated view of the diverse user groups and counseling purposes is lacking. CONCLUSION: In order to include the user's perspective in conceptual approaches for counseling and to define user-generated quality criteria, further scientific research is needed regarding the counseling needs of different user groups. Consideration must be given to particular care situations that involve various counseling purposes. Particularly vulnerable groups need special support in working out their counseling needs.

[Environmental Survey for Children-- the environmental module of KiGGS. I. Design and research program]. / Kinder-Umwelt-Survey--das Umweltmodul im KiGGS. Teil 1: Konzeption und Untersuchungsprogramm.

The German Environmental Survey for Children (GerES IV) is the environment-oriented module of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS) which is being performed nationwide in Germany. From 2003 to 2006, a random subsample of 1800 children aged 3-14 years is being studied with regard to their body burden and health impairments linked to housing conditions and the personal environment- and health-relevant behaviour. The basic study programme includes the analysis of blood, urine, tap water and house dust as well as the application of an extensive questionnaire. The data gained from this population sample, which is representative for Germany's children, are the basis for deriving reference values to characterise the background exposure of children aged 3-14 years. Trends over time can be detected and the success of environmental policies verified by comparing the data with those of the German Environmental Survey 1990/92 (GerES II), also conducted in close cooperation with the National Health Survey, which included children aged 6-14 years. By linking the data from the Environmental and the Health Surveys, health-relevant environmental exposures can be detected and different scientific hypotheses can be tested. The main subjects that are being dealt with using subcollectives of GerES IV are 'VOC and eye and nasopharynx irritation', 'indoor allergens and allergic diseases of the respiratory system', 'chromium, nickel, fragrances and contact allergens', and 'noise, hearing capacity and stress hormones'.

Inter-laboratory comparison of flow-volume curve measurements as quality control procedure in the framework of an international epidemiological study (PEACE project).

The aim of this work was to describe the results of a simple quality control procedure for the flow-volume curve adopted in a multicentre epidemiological study (PEACE). In 14 centres, 8-15 individuals (n = 157) performed forced vital capacity (FVC) manoeuvres following a standard protocol with both the local spirometer/pneumotachograph and a portable spirometer (i.e. the 'reference instrument' for this study). Deviances of measurements were assessed by computing the differences (delta) between the former and the latter, the ratios of such differences on portable spirometer values (delta %) and the coefficients of variation (CV). The portable spirometer yielded lower mean AFVC and deltaFEV1 (forced in 1 sec) than local instruments (except for two and four centres, respectively). In most instances, differences were statistically significant. Absolute mean A%FVC ranged from 4.9-18.2%, while delta%FEV1 ranged from 2.3-18.5%. The Bland and Altman analysis showed a good agreement between the portable and local instruments, except for two centres, where a systematic trend towards higher individual absolute deltaFVC and deltaFEV1 was observed. The overall variability, assessed by CV, was within 6.2% and 5.1% for FVC and FEV1, respectively: it was similar to other quality control studies ranging from 2.0-5.5% for FVC and 2.2-5.8% for FEV1. Our results point out the importance of performing interlaboratory comparisons as a quality control procedure in multicentre epidemiological studies on lung function, and of stimulating manufacturers to extend the accuracy and precision of the instruments.

[Indoor air pollution: current aspects]. / Innenraumbelastung: Aktuelle Gesichtspunkte.

Due to the high percentage of time spent indoors, indoor air contributes significantly to human exposure via inhalation. Up to now, toxicology-based guideline values for indoor air pollutants are very sparse. Examples are the WHO Air Quality Guidelines for Europe or guideline values published by an ad-hoc group formed from members of the Indoor Air Commission of the Federal German Environmental Agency and of the Environmental Hygiene Committee of the Consortium of German Health Ministries of the German "Leander" (provincial governments). By comparison with recent representative data referring to comparable indoor environments, rooms with unusually high concentrations can be identified. However, this is not an adequate basis for health risk assessment.

Inhomogeneity in response to air pollution in European children (PEACE project).

OBJECTIVES: The PEACE study is a multicentre panel study of the acute effects of particles with a 50% cut off aerodynamic diameter of 10 microns (PM10), black smoke (BS), sulphur dioxide (SO2), and nitrogen dioxide (NO2) on respiratory health of children with chronic respiratory symptoms. In the complete panels no consistent association between air pollution and respiratory health was found. The study evaluated whether potentially more sensitive subgroups in the panels did show effects of air pollution. METHODS: To evaluate heterogeneity in response to air pollution, effect estimates of air pollution on peak expiratory flow (PEF) and respiratory symptoms were calculated in subgroups based on presence of chronic respiratory symptoms, use of respiratory medication, atopy, sex, and baseline lung function. RESULTS: The association between PEF and air pollution was positive in asthmatic children who used respiratory medication whereas the associations tended to be negative in children who did not use respiratory medication selected only on cough. No consistent association was found among asthmatic children who did not use medication. The association between daily prevalence of symptoms and concentrations of air pollution was not different between these subgroups. CONCLUSION: None of the predefined potentially more sensitive subgroups showed a consistent association between air pollution, PEF, and respiratory symptoms.

Lead concentration in tap-water and in blood of selected schoolchildren in southern Saxonia.

In a study of associations between lead in blood and in tap-water, 113 blood samples and 140 tap-water samples of schoolchildren aged 9 to 12 years were analysed. Median and maximum values of blood lead were 8.3 and 34.0 micrograms/dl and of lead in tap water 24 and 2600 micrograms/l. Lead pipes were in use in some 50% of the houses. The pH values of the tap-water varied from 5.0 to 8.1. Both factors involved, i.e., lead pipes and acidic tap-water, have to be amended in order to reduce lead exposure in some regions or locations in Germany. This necessity is emphasized by increasing evidence of adverse effects to the central nervous system in children when blood lead levels exceed 10 micrograms/dl.

[Indoor air pollutants and their effects on human health]. / Luftverunreinigungen im Innenraum und ihre Auswirkungen auf die menschliche Gesundheit.

Differences between indoor and outdoor exposure to air pollutants are described. Some indoor air problems of actual relevance (tobacco smoke, formaldehyde, wood preservatives, tetrachlorethene, asbestos) and measures to limit indoor air pollution are discussed.

Chromosome analyses of children after ecological lead exposure.

In the present work chromosome analysis was performed in a group of 30 children living in a town with a lead plant. Due to the emission of the smelter the individual lead uptake through food, drinking water and inhalation was increased. They were selected out of 1600 children whose blood lead level, delta-aminolevulinic acid dehydratase activity in the erythrocytes and erythrocyte porphyrine level was measured. In the investigated group of children the values of these parameters showed to be indicative for a significant lead exposure. A total of 10,000 cells was scored after 48 h culture time. Despite a significantly increased lead load as compared with two groups of 10 children from a suburb and the isle of Helgoland there was neither evidence for a higher number of cells with structural chromosome aberrations, nor for an increased aberration yield.