[The hygienic status in community health nursing stations]. / Zur hygienischen Situation in Gemeindeschwesternstationen.

199 bases of so-called "Gemeindeschwestern" (nurses delegated by communal authorities as medical auxiliary personnel to practising physicians) in the territory of the former district of Neubrandenburg (now part of the new Land called Mecklenburg-Vorpommern) were examined to determine the sanitary and hygienic conditions obtaining in these bases. Many of these were found to be unsatisfactory: not only the desolate state of the building materials, but also the available space and the water supply. In 14.6% of the consulting rooms hands could not be washed in running water. 39 nurses were found to be violating the rules governing the handling of drugs in respect of storage practices. Sterilisation equipment was often obsolete, and some of the nurses were not complying with their obligation to keep records of the performance of the equipment and to conduct obligatory checks on its proper functioning. Other violations concerned improper storage and unsatisfactory packing of the sterilised items. In 20.1% of the cases disinfectants were incorrectly employed. 45.2% of the ready solutions did not conform with the nurses' statements. A multitude of rules governing the safety of working were ignored due to neglect, quite apart from the low overall standard of hygiene; due to all these unpleasant circumstances, the safety upon which a patient must be able to rely, was no longer assured.

[Collaboration between the specialist in general medicine and pediatrics in the rural area with special emphasis on informational relations]. / Zur Zusammenarbeit zwischen dem Facharzt für Allgemeinmedizin und Kinderheilkunde im ländlichen Bereich unter dem besonderen Aspekt der Informationsbeziehungen.

An analysis is made of the scope of health care performances provided by family practitioners and paediatricians to children in a mountainous community (of the Erzgebirge), with special regard to the informational relations existing in the community. The survey is, in the main, a two-stage interval investigation. At the first stage, a description is given of the high share the family practitioner has in the health care performances provided to children (preventive care: 100%; curative care: 95.4%, about 60% of which require the occasional collaboration with the paediatrician). At the second stage, an informational sheet is used, which not only permits complete feed-back information from the paediatrician but also increases the referral rate, multiplies the back referral rate and improves the quality of health care in general. This model is recommended for use by analogous territories.

[Health counseling--an element of preventive care responsibility of the general practitioner]. / Gesundheitsberatung--Bestandteil prophylaktischer Tätigkeit durch den Hausarzt.

An analysis and assessment is made of international experience in health counselling by the family physician. In line with the health policy mission, recommendations are given for a list of prophylactic performances to be offered by the family physician. Health counselling harmoniously fits into the overall concept of health information, health surveillance and long-term care. Methodological variants of individual and group counselling as well as recommendations for the work of patients' clubs to encourage and qualify the individual citizen to practise a health-promoting life-style, are presented.

[Analysis of the qualitative care indices as a prerequisite to further improvement in fundamental outpatient medical care]. / Die Analyse qualitativer Betreuungsmerkmale als Voraussetzung einer weiteren Verbesserung der ambulanten medizinischen Grundbetreuung.

The paper is aimed at finding the possibilities of increasing the quality of outpatient care, especially of home care and of the specific forms of specialized dispensary care. Authors emphasize the importance of organizing a unitary and long-term medical and social care for chronic, disabled and old patients. Likewise, they consider medical home-care as a basic principle of outpatient care--and important factor for the harmonious physical and mental development of men, for maintenance of working capacity.

Medium and long latency EMG responses in leg muscles: Parkinson's disease.

Short, medium, and long latency EMG responses to muscle stretch from triceps surae and anterior tibialis muscles were recorded in normals and in 33 patients with Parkinson's disease. The latencies of all EMG responses except short latency were normal in patients with Parkinson's disease. The integrals of the medium latency responses in the stretched triceps surae muscle were significantly increased in patients. This result indicates a modulatory influence of the basal ganglia on medium latency EMG responses.

Long latency EMG responses in hand and leg muscles: cerebellar disorders.

Electromyographic responses to stretches of hand muscles (first dorsal interosseus) and leg muscles (triceps surae, tibialis anterior) were investigated in patients with cerebellar disorders of different locations. Stimuli consisted of short dorsiflexions of the index finger during background force and in tilting (toe up) of a movable platform on which the subject stood. The most important findings were increased long latency responses in upper and lower extremities. For hand muscles it was the late part of the long latency complex, which was increased. For leg muscles it was the long latency response in the anterior tibialis muscle, the antagonist of the stretched triceps surae. The medium latency response in the triceps surae was unaffected. Latencies of the early segmental reflexes and the long latency responses were normal except for cases with peripheral neuropathy (moderate increase in latency of all EMG responses) and diseases affecting both the peripheral nerves and the dorsal columns (for example Friedreich's ataxia). The latter leads to a pronounced delay of the short latency response and a massive delay of the long latency complex in the first dorsal interosseus and of the long latency response in the anterior tibialis muscle.

Long-loop reflexes in small hand muscles studied in normal subjects and in patients with Huntington's disease.

Long-latency electromyographic (EMG) responses of the first dorsal interosseus muscle were evoked by short displacements of the index finger in healthy subjects and in patients with Huntington's disease (HD). In all 20 healthy subjects the early spinal response (mean latency 31.5 ms) was followed by a reproducible later reflex response with a mean latency of 56.5 ms. The activity pattern of single motor units of the stretched muscle was similar to that of the surface EMG. Thus all single motor units tested could be active during either the first or second response phase, but never in both in a given trial. Of the 50 patients with HD, the late EMG response was missing completely in all but 7, but the early spinal component was almost identical to that of the control group. Double stretches at an interval of 25 ms evoked two similar EMG responses in these patients, proving that the motoneuron pool is still excitable during the time at which the second response would have appeared in healthy subjects. The reflex responses of the thenar muscles evoked by electrical stimulation of the median nerve were examined during a voluntary opposing contraction of the thumb in both groups of subjects. In normal subjects, two EMG responses could be distinguished with latencies similar to those of the mechanically elicited responses. Patients with HD again lacked the second response, although the first spinal response was always present. The results are discussed with respect to different proposals concerning the origin of long-latency responses in human muscles. At least for distal hand muscles, the results suggest that the long-latency responses are long-loop reflexes.

Evoked potentials in patients with Huntington's disease and their offspring. I. Somatosensory evoked potentials.

Spinal and cortical somatosensory evoked potentials (SEPs) were recorded in a large sample of patients with Huntington's disease (n = 37) and subjects at risk (first order offspring, n = 43). The SEPs were elicited by stimulation of the median and tibial nerves and recorded at Erb's point, the cervical level (C2) and at the corresponding scalp areas. The most striking finding in patients with Huntington's disease was a drastic diminution of the amplitude of the early cortical components, especially N20/P25 for the median nerve and N33/P40 for the tibial nerve. The latencies (Erb's point, C2, cortical) were only slightly prolonged in comparison to the normal values. Forty-three per cent of the persons at risk exhibited pathological results with a clear reduction in amplitude of the early cortical responses or with a pathological side difference between the amplitudes. Fifty-three per cent of the persons at risk exhibited a normal result. Two persons at risk (= 6%) could not be classified unambiguously. Some patients with benign and symptomatic chorea were investigated. These showed normal results with one exception. The diagnostic and predictive value of the investigation of SEPs in Huntington's disease is discussed.

Long latency reflex force of human finger muscles in response to imposed sinusoidal movements.

Reflex stiffness of the flexing human index finger was studied using sinusoidal movements at 3-16 Hz. The Nyquist stiffness diagram indicates the presence of a 'presonance' at around 4 Hz, its 'C' shape after correction for the mechanical properties of the relaxed finger is consistent with the involvement of a stretch reflex in its generation. This contention was supported by the presence of negative friction around 4 Hz and the disappearance of the modulation of the stiffness curve after afferent ischaemic block. Correction for the mechanical properties of active muscle, measured after afferent block, permitted the isolation of the reflex component of stiffness. The circular form of the Nyquist diagram indicates a relatively flat frequency response for the reflex over the range tested, and its radius gives a measure of reflex gain. The low value of the frequency at which the frictional force is minimal, suggests the involvement of a reflex of longer than spinal latency. This is discussed in relation to mechanisms of tremor genesis and the interaction of spinal and long latency reflexes in distal hand muscles.

Absence of long latency reflexes to imposed finger displacements in patients with Huntington's disease.

Long latency reflexes in the electromyogram (EMG) of the first dorsal interosseus muscle were elicited by short finger displacements under isometric conditions. In all healthy subjects tested the spinal response was followed by a second involuntary component. Patients with Huntington's disease lacked the late EMG response almost completely, but exhibited a spinal component indistinguishable from that of the control group. A spinal mechanism responsible for this result is unlikely, since double stretches evoked two distinct EMG responses in these patients. Moreover, drastically reduced cortical somatosensory evoked potentials in all patients support the notion that the second EMG response seen in our motor paradigm is of supraspinal origin.