[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?]. / Patientenspektrum im Notarztdienst. Was hat sich in den letzten 20 Jahren geändert?

BACKGROUND: In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes. METHODS: In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician. RESULTS: In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01). CONCLUSIONS: The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

Predictors of Chlamydia trachomatis infection among women attending rural Midwest family planning clinics.

OBJECTIVE: To determine predictors of Chlamydia trachomatis infection among women 14-24 years of age attending family planning clinics throughout a rural Midwestern state. METHODS: The study population included 16,756 women between the ages of 14 and 24 years attending family planning clinics for annual examinations throughout the state of Iowa in 1997. All women under 25 years of age having annual exams were tested for C. trachomatis during the visit. At the time of exam, both behavioral and demographic data were collected on all women participating in the study. RESULTS: The majority of women in the study (96%) reported no symptoms of chlamydia. Only 2.5% of all women had a positive test result. In the multivariate model, the odds ratios were significantly increased among the youngest age (14-17 years; OR = 2.2), those with mucopurulent cervicitis (OR = 3.4), cervical friability (OR = 2.2), symptomatic for infection (OR = 1.8), risk history (OR = 1.6), and black race (OR = 1.2) and predictive of a C. trachomatis infection. CONCLUSIONS: Risk factors predictive of C. trachomatis infection among younger aged women attending family planning clinics in a Midwest rural population are consistent with predictors of infection among women attending family planning clinics across the United States. The overall findings suggest the importance of developing screening guidelines as a means of lowering chlamydia rates. This may be a particularly difficult task in light of the low rate of symptoms that would lead a woman to seek medical care, even in younger age women who are at higher risk. In addition, screening guidelines would be more difficult to implement in a rural setting.

Active bacterial core surveillance of the emerging infections program network.

Active Bacterial Core surveillance (ABCs) is a collaboration between the Centers for Disease Control and Prevention and several state health departments and universities participating in the Emerging Infections Program Network. ABCs conducts population-based active surveillance, collects isolates, and performs studies of invasive disease caused by Streptococcus pneumoniae, group A and group B Streptococcus, Neisseria meningitidis, and Haemophilus influenzae for a population of 17 to 30 million. These pathogens caused an estimated 97,000 invasive cases, resulting in 10,000 deaths in the United States in 1998. Incidence rates of these pathogens are described. During 1998, 25% of invasive pneumococcal infections in ABCs areas were not susceptible to penicillin, and 13.3% were not susceptible to three classes of antibiotics. In 1998, early-onset group B streptococcal disease had declined by 65% over the previous 6 years. More information on ABCs is available at www.cdc.gov/ncidod/dbmd/abcs. ABCs specimens will soon be available to researchers through an archive.

Optical imaging of cat auditory cortical organization after electrical stimulation of a multichannel cochlear implant: differential effects of acute and chronic stimulation.

OBJECTIVE: To study the effects of electrical stimulation on cortical activation patterns. MATERIALS AND METHODS: Optical imaging of auditory cortex in cats that are acutely and chronically electrically stimulated with cochlear implants. RESULTS: Chronic electrical stimulation results in expansion of cortical territory and overlap. CONCLUSION: Effects of chronic electrical stimulation are comparable to use-dependent cortical plastic reorganization.

Optical imaging of cat auditory cortex cochleotopic selectivity evoked by acute electrical stimulation of a multi-channel cochlear implant.

We measured reflectance changes by means of optical imaging of intrinsic signals to study the effects of acute electrical cochlear stimulation on the topography of the cat auditory cortex. After single-pulse electrical stimulation at selected sites of a multichannel implant device, we found topographically restricted response areas representing mainly the high-frequency range in AI. Systematic variation of the stimulation pairs and thus of the cochlear frequency sites revealed a systematic and corresponding shift of the response areas that matched the underlying frequency organization. Intensity functions were usually very steep. Increasingly higher stimulation currents evoked increasingly larger response areas, resulting in decreasing spatial, i.e. cochleotopic, selectivity; however, we observed only slight positional shifts of the focal zones of activity. Electrophysiological recordings of local field potential maps in the same individual animals revealed close correspondence of the locations of the cortical response areas. The results suggest that the method of optical imaging can be used to map response areas evoked by electrical cochlear stimulation, thereby maintaining a profound cochleotopic selectivity. Further experiments in chronically stimulated animals will shed more light on the degree of functional and reorganizational capacities of the primary cortex and could be beneficial for our understanding of the treatment of profound deafness.

Short-term functional plasticity of cortical and thalamic sensory representations and its implication for information processing.

We studied phenomena, constraints, rules, and implications of cortical plastic reorganization produced by input coactivation patterns in primary somatosensory cortex of adult rats. Intracortical microstimulation (ICMS) and an associative pairing of tactile stimulation (PPTS) induced plastic changes within minutes to hours that were fully reversible. Reorganization of receptive fields and topographic maps was studied with electrophysiologic recordings, mapping techniques, and optical imaging of intrinsic signals. Utilizing the specific advantages of local application of ICMS, we investigated lamina-specific properties of cortical representational plasticity, revealing a prominent role of the input layer IV during plastic reorganization. To study subcortical plasticity, we compared ICMS and intrathalamic microstimulation (ITMS), revealing robust thalamic reorganizations that were, however, much smaller than cortical changes. Using PPTS, we found significant reorganizational processes at the cortical level, including receptive fields, overlap, and cortical representational maps. The protocol was similarly effective at the perceptual level by enhancing the spatial discrimination performance in humans, suggesting that these particular fast plastic processes have perceptual consequences. The implications were discussed with respect to parallel changes of information processing strategies. We addressed the question of the possible role of RF size and size of cortical area, inhibitory mechanisms, and Hebbian and non-Hebbian learning rules. The short time scale of the effects and the aspect of reversibility support the hypothesis of fast modulations of synaptic efficiency without necessarily involving anatomic changes. Such systems of predominantly dynamically maintained cortical and adaptive processing networks may represent the neural basis for life-long adaptational sensory and perceptual capacities and for compensational reorganizations following injuries.

Optical imaging of rat somatosensory cortex reveals representational overlap as topographic principle.

We measured reflectance changes by means of optical imaging of intrinsic signals to study the topography of the paw representations in rat somatosensory cortex. Following circumscribed tactile stimulation of single digits or pads, we found large and partially overlapping areas of reflectance changes (delta R). The diameters of their focal zones defined at 75% maximal delta R were in the range of 150 microns and preserved all details of the underlying maps. Zones of overlap were in the range 15-25% measured at half-maximal delta R. In contrast, we found sharp boundaries with no overlap between the fore- and hindpaw representations. The data suggest that large and overlapping cortical maps constitute a normal type of neural representation supporting the idea of a distributed neural processing scheme.

Is there an increase of reproductive rates in schizophrenics? III. An investigation in Nordbaden (SW Germany): results and discussion.

Two cohorts of schizophrenic patients admitted to a psychiatric hospital for the first time either during 1949-50 or 1965-67 were compared with matched controls for reproductive rates before and 13 years after onset of psychosis. Patients of both admission periods had reduced marriage rates. After onset of the disease the rate of reproduction was decreased in males of both periods, but not in females. Patients of both periods did not differ from control values with respect to marital fertility. It has repeatedly been reported that fertility of schizophrenics has been increasing in recent times. Comparison of total reproduction, rate of marriage and marital fertility in patients of the two admission periods and matched controls did not yield any evidence for increasing rates. Instead, the results favour the idea that the patients parallel at a lower level the general decline of birth rates observed in Western Germany.

Is there an increase of reproductive rates in schizophrenics? II. An investigation in Nordbaden (SW Germany): methods and description of the patient sample.

For an investigation on the question of whether fertility rates of schizophrenics have been increasing in recent times, two cohorts of patients were defined on an epidemiological basis. The patients were first admissions during either 1949-50 (n = 183) or 1965-67 (n = 228). The conditions of case definition as well as their demographic and psychiatric characteristics are described. These data are necessary for the evaluation of reproductive rates observed in the patient sample. Furthermore, the two cohorts of patients may be of general interest, because they comprise patients first admitted to a hospital who were completely ascertained in a certain region and time period. They reflect certain changes in hospitalization practice in Germany.

Is there an increase of reproductive rates in schizophrenics? I. Critical review of the literature.

It is well-known that the fertility of schizophrenic patients, particularly males, is below the population average. The main measures of fertility (reproductivity) are marriage rate, marital fertility, and rate of reproduction. A review of the literature reveals the rate of reproduction of schizophrenic patients to be 30% to 80% of the general population, the reduction being mainly due to reduced probability of marriage. At least one investigation presented evidence for an increase in marriage rate and rate of reproduction in schizophrenic patients relative to the general population in recent time. If this increase were to be confirmed it would undoubtedly have practical as well as theoretical implications. The hypothesis of a compensatory higher fertility of healthy relatives of schizophrenics based on a physiological advantage is empirically unproven. Additionally, the concept of a balanced polymorphism in schizophrenia rests on a superficial analogy with Mendelian traits.