[Quality indicators for ambulatory health education programme for overweight and obese children and adolescents]. / Qualitätskriterien für ambulante Schulungsprogramme für übergewichtige und adipöse Kinder und Jugendliche.

BACKGROUND: In Germany, 9 to 12 % of all children between five and seven years of age have been shown to be overweight at school entry; 2.5 to 3.5 % of them are obese. Therapeutic intervention for obese children and adolescents is considered to be indicated especially in cases where an increased body mass index (BMI) is accompanied by a disease the effective treatment of which requires weight loss. Furthermore, the child and its family must be willing to actively change their habits. OBJECTIVE: A multitude of health care providers have begun to offer multidisciplinary group programme for prevention and treatment of obesity to affected individuals and their families. The Medical Service of the Statutory Health Insurance (MDK) has therefore developed a list of quality and assessment criteria for such programme. METHODS: A systematic search for information in international and national publications was performed using standard methodology of evidence-based medicine. Data were extracted and assessed according to pre-defined criteria taking into consideration previously published clinical guidelines and opinions of expert panels. RESULTS: Nearly all available studies were of low internal validity and mostly of poor methodological quality. Therefore, no binding recommendations for the design of health education programme for overweight and obese children and adolescents can be given. Potentially successful intervention should combine the following 4 modules: nutrition, physical activity, change of eating habits, physical activity habits and life style using methods of behavioural therapy, and involvement of parents. Such combinations may have the potential to reduce or stabilise the BMI at least during a defined period of time. In younger children, the beneficial effect will be more pronounced if the parents are actively involved. CONCLUSION: Up to now informative studies have not reliably shown that the effect of ambulatory health education programmes for overweight and obese children and adolescents and their parents may last for more than one or two years. Therefore, a controlled clinical trial determining the long-term effectiveness of such programme is imperative. The decision whether a defined programmes should be included in such a study could be taken on the basis of the quality indicators and assessment criteria described here.

[Prevention before care. Prevention by care]. / Prävention vor Pflege. Prävention durch Pflege - Präventive Aufgaben der Pflege.

BACKGROUND: Maintaining the independence of old people is an issue in the third and fourth decade of life determining the quality of life of the elderly. Its stabilisation helps to save money in the health care system. However, in the debate about efficiency of the German health care system and of the long-term care system respectively, aspects of prevention in old age are of subordinate importance. In other countries, strategies for avoiding, retarding or moderating care are successfully integrated into nursing care prevention. The proposals for the further development of the long-term care insurance eliminate these issues to a large extent. OBJECTIVE: What are the conditions to establish these preventative programmes in the German long-term care system? What should be the contents of these programmes? Which have tasks to be done by the nursing profession in the future German health and longterm care system? METHOD: Systematic search of the Internet and data-bases. Evaluation of the present proposals of various commissions concerning the subject. Analysis and evaluation of the available approaches in nursing care prevention with regard to their conversion to the German care structures. RESULTS: Before the long-term care insurance was implemented in Germany in the year 1995 rudiments of long-term care prevention existed. These approaches have meanwhile been sacrificed because of economic restrictions in the municipalities. In states like Australia, the UK, and some Scandinavian countries programmes of nursing care prevention have been established as a regular element in the service. CONCLUSIONS: Concepts for prevention in the long-term care for old and very old people have been implemented quite successfully in several states. In order to employ similar programmes in Germany one should refer to available international experience. This should be combined with the former experiences in Germany itself.

[Ambulatory physician performances in health counseling--possibilities,organization and payment]. / Ambulante ärztliche Leistungen zur Gesundheitsberatung--Möglichkeiten, Organisation und Honorierung.

Within the scope of the increasing importance of health promotion and prevention, health consultation plays an important role in out patient medical care provided by panel doctors. Nevertheless, there are some uncertainties regarding possibilities, management and payment of health promotion and health consultation, performed by physicians in outpatient care. The statutory basis laid down in the German Social Code is analysed with regard to its significance to health consultation and the possibilities of health consultation are demonstrated. This includes in particular the so-called "Check-up", maternity care, family planning and consultation of the diabetes patients. The importance of preventive medicine for the prophylaxis and therapy of particular diseases is discussed using the example of nutrition and diet consultation. In this regard, health economic issues are as important as the organization in the doctor's office. Likewise, the function of the physician as a co-ordinator is commented upon. On this occasion, the advantages and the necessity of co-operation with members of other health professions are pointed out, and corresponding types of co-operation are discussed.

In vitro sensitivity testing of human bladder cancers and cell lines to TP-40, a hybrid protein with selective targeting and cytotoxicity.

TP-40 is a hybrid fusion protein produced by recombinant technology and consists of a molecule of transforming growth factor-alpha (TGF-alpha) fused to the Pseudomonas exotoxin PE-40. A panel of human and murine bladder cancer cell lines was found to be universally sensitive in vitro to TP-40 in a clonogenic assay. All lines expressed receptor for epidermal growth factor (EGF), though none demonstrated gene amplification for the EGF receptor. The sensitivity to TP-40 may be blocked by preexposure to EGF. Six human bladder tumors taken directly from patients were all sensitive in vitro to TP-40; these included well-differentiated tumors. TP-40 may prove to be effective as an intravesical agent in bladder cancer via selective targeting to cells that express EGF receptors, as do the majority of human bladder cancers.

Hemin-induced erythroid differentiation changes the sensitivity of K562 cells to tumor necrosis factor-alpha.

Tumor necrosis factor-alpha (TNF) can inhibit the growth of erythroid progenitors (erythroid colony-forming units [CFU-E] and erythroid burst-forming units [BFU-E]) at picomolar concentrations, but only if added within the first 48 h of culture. These data suggested that cells undergoing erythroid differentiation become resistant to TNF. To test this hypothesis, K562 cells were treated with hemin to induce erythroid differentiation and then tested for their sensitivity to TNF in terms of growth and TNF receptor expression. TNF inhibited the growth of untreated K562 cells, but not hemin-treated K562 cells. Untreated K562 cells expressed TNF receptors, whereas few hemin-treated K562 cells expressed TNF receptors within 24 h of exposure to hemin. These data show that K562 cells induced to differentiate along the erythroid pathway are resistant to TNF because they lack TNF receptors and suggest that the resistance of erythropoietin-treated human bone marrow cells to TNF added after 48 h of culture may also reflect loss of TNF receptors associated with erythroid differentiation.

[Allergies to 8-hydroxyquinoline derivatives]. / Allergien gegen 8-Hydroxychinolin-Derivate.

Evaluation of our standardized test results from 1972 to 1983 indicated Vioform allergies in 1.2% of all cases and Sterosan allergies in 1.1%. Our results are within the spectrum found in the literature for Vioform between 0.3 and 5.1% and for Sterosan between 0.3 and 3.7%. In the course of those 12 years we observed a growing tendency towards Vioform and Sterosan allergies on the basis of annual percentage figures. In the last year of our observation the frequency of Vioform and Sterosan allergies amounted to 1.7% each. We conclude, therefore, that inclusion of these two substances in the standard battery is justified. According to the pertinent literature, Sterosan and Vioform allergies are, on an average, 3 to 4 times more frequent in patients suffering from leg ulcers and/or chronic venous insufficiency than amongst eczema patients.

[Group allergies and multiple reactions in patients with allergy to hydroxyquinoline derivatives]. / Gruppenallergien bzw. Mehrfachreaktionen bei Patienten mit Allergie gegen Hydroxychinolin-Derivate.

We carried out patch testing with a chinoline block comprising 25 substances in 316 patients with a suspected allergy to chinoline derivatives in the period from February 1969 to December 1983. 110 patients reacted to 2 or more substances. The reactions were totaled and tabulated in a list indicating frequency of sensitisation as decreasing in the order of Cl-F-Br-I halogens. The most frequent reactions observed were with Chlorisept, Sterosan, Vio-form, Chinosol, Ondron, and Broxychinolin, for all of which primary sensitisations are also possible. Concomitant reactions to chinaldol, chinaldine, aminochinaldine and chinoline are considered to be group allergies since contact is hardly possible with these substances in everyday life. Due to the lack of appropriate history, reactions to Resochin and the isoquinoline compounds Papaverine and Eupaverine may also be regarded as group allergies. Accordingly, non-hydroxylized chinoline derivatives are also viewed as group allergies in cases of sensitisation to hydroxy-chinoline derivatives. The group spectrum of hydroxy-chinoline allergy seems to be more far-reaching than was assumed. Five cases of a quinine allergy identified by appropriate history and confirmed epicutaneously are presented with a group allergy to various chinoline derivatives, including two cases with quinidine.

Tumor necrosis factor-alpha and hematopoietic progenitors: effects of tumor necrosis factor on the growth of erythroid progenitors CFU-E and BFU-E and the hematopoietic cell lines K562, HL60, and HEL cells.

Macrophages can modulate the growth of hematopoietic progenitors. We have examined the effects of tumor necrosis factor-alpha, a product of activated macrophages, on human erythroid progenitors (CFU-E, BFU-E) and the hematopoietic cell lines K562, HL60, and HEL cells. Tumor necrosis factor (TNF) significantly inhibited CFU-E and BFU-E growth at concentrations as low as 10(-11)-10(-12) M (0.2 U/ml), although erythroid colony and burst formation were not totally ablated. Preincubation of marrow samples with TNF for 15 min was sufficient to suppress erythroid colony and burst formation. Addition of TNF after the start of culture inhibited CFU-E- and BFU-E-derived colony formation if TNF was added within the first 48 h of culture. Additionally, TNF inhibited the growth of highly purified erythroid progenitors harvested from day 5 BFU-E. The colonies which formed in cultures treated with TNF were significantly smaller than those formed in control cultures. TNF (10(-8)-10(-10) M) also suppressed the growth of the hematopoietic cell lines K562, HL60, and HEL cells, with 40%-60% of the cells being sensitive to TNF. Preincubation of HL60 cells with TNF for 15 min significantly inhibited their growth. K562, HL60, and HEL cells expressed high-affinity receptors for TNF in low numbers (6000-10,000 receptors per cell). Fluorescence-activated cell sorter analysis of TNF binding to HEL cells demonstrated that the majority of these cells expressed TNF receptors. These data suggest that: (1) TNF is a rapid irreversible and extremely potent inhibitor of CFU-E, BFU-E, and hematopoietic cell lines K562, HL60, and HEL cells; (2) TNF appears to be acting on a subpopulation of erythroid cells, predominantly CFU-E, BFU-E, and possibly proerythroblasts; (3) TNF appears not to require accessory cells such as lymphocytes or macrophages to inhibit erythroid progenitors; and (4) the presence of TNF receptors on hematopoietic cells is not sufficient to confer sensitivity to TNF since the majority (80%-95%) of HEL cells express TNF receptors while only 40%-60% are inhibited by TNF.