[Disparities in hospital mortality after proximal femoral fractures in East Germany 1989]. / Disparitäten der Krankenhaus-Fatalität nach proximalen Femurfrakturen in der DDR 1989.

The revised and pseudonymized data set of the hospital discharge diagnoses of East Germany (German Democratic Republic, GDR) for 1989 was analyzed regarding the in-hospital case fatality of closed hip fractures (ICD-9 820.0, 820.2, 820.8). The case fatality of 20.2% during an average hospital stay of 60 days including between-ward and between-hospital transfers is high when compared to international data and data for West Germany. Apart from the expected influence of age, fatality was reduced for cervical (intracapsular) fractures, female sex, and for a location of the treating hospital within East Berlin. This reduction of the case fatality within East Berlin by nearly two thirds after adjustment for age, sex, and type of fracture compared to other regions is most likely explained by better medical treatment facitilities within East Berlin, the former capital of the GDR. The regional disparities that were observed during our model analysis give a hint towards the influence that medical care can have on the fatality associated with this on a population level relevant disease.

HIV type 1 V3 serotyping of Tanzanian samples: probable reasons for mismatching with genetic subtyping.

HIV-1 V3 serotyping is used to classify immunodeficiency viruses on the basis of antibody binding to V3 peptides derived from env genetic subtypes. Although it shows a reasonable overlap, it has been reported to be distinct from viral genetic subtypes. The aim of this study is to determine the feasibility of HIV-1 serotyping to predict genetic subtypes in an East African setting, where multiple HIV-1 subtypes have coexisted for many years. HIV-1 genetic subtypes of 86 AIDS patients in Mbeya Town, southwest Tanzania, were determined, using env nucleic acid sequencing as the basis for comparison. Those data were compared with V3 serotyping results obtained by four different methodologies. Four HIV-1 genetic subtypes were identified, including A (25, 29%), C (47, 55%), D (13, 15%), and G (1, 1%). The sensitivity and specificity of those serotyping assays varied considerably: sensitivity for genetic subtype A (40-48%), C (52-96%), and D (9-31%); and specificity for genetic subtype A (77-95%), C (46-63%), and D (97-100%). We further tried to identify reasons for the discrepancies between serotyping results and genetic subtypes. By means of logistic regression analysis three amino acid residues within the V3 loop (positions 12, 13, and 19; V, H, and A for serotype A, I, R, and T for serotype C) were found to be most important for antibody binding; a deviation from the subtype-specific amino acids was highly related to mismatched results. In addition, we have shown that phenetic analysis of V3 amino acid sequence data could be used to predict the majority of V3 serotypes (93-94%). Our data demonstrated that for the majority of specimens HIV-1 V3 serotyping results closely match the subtype of the analyzed sample as revealed by the V3 loop amino acid sequence. However, our data demonstrate that HIV-1 serotyping is not sufficiently accurate to predict genetic subtypes in Tanzania, where subtypes A, C, D, and G are circulating. This was due to highly similar amino acid sequences throughout the prevalent genetic subtypes, which caused the inability of HIV-1 V3 serotyping to differentiate subtype A from C as well as D from C. Instead, the serotyping results reflect the frequency distribution of V3 serotypes. To investigate HIV-1 genetic subtypes in population-based studies in this African setting additional or modified algorithms are needed.

PIP: HIV-1 V3 serotyping is used to classify immunodeficiency viruses on the basis of antibody binding to V3 peptides derived from env genetic subtypes. Findings are reported from a study conducted to determine whether HIV-1 serotyping could be effectively used to predict genetic subtypes in an East African setting, where multiple HIV-1 subtypes have coexisted for many years. The HIV-1 genetic subtypes of 86 people with AIDS in Mbeya Town, southwest Tanzania, were determined, using env nucleic acid sequencing as the basis for comparison. Those data were then compared with V3 serotyping results obtained by analysis with tests manufactured by Behring and the Pettenkofer Institute, tests conducted by St. Mary's Hospital Medical School, tests conducted by Georg-Speyer-Haus, and tests conducted by Universite Francois Rabelais. The following HIV-1 genetic subtypes were identified: 25 cases of A (29%), 47 of C (55%), 13 of D (15%), and 1 of G (1%). The sensitivity and specificity of the serotyping assays varied considerably. These data indicate that HIV-1 serotyping is not accurate enough to predict genetic subtypes in Tanzania. This conclusion was reached based upon the highly similar amino acid sequences throughout the prevalent genetic subtypes, which caused the inability of HIV-1 V3 serotyping to differentiate subtype A from C as well as D from C. The serotyping results instead reflect the frequency distribution of V3 serotypes.

Psychological factors associated with the uptake of measles immunization: findings and implications for prevention.

A cross-sectional study of 8204 children was performed to investigate the prevalence of immunization against measles, mumps and rubella and possible determinants of immunization uptake. The study was approached from a Lewinian perspective on preventive behaviour. Seventy-one questions referring to the guardian of the child, his or her partner, the household and the child, as well as to immunization-related experiences and situational topics were asked. Two psychological variables were studied: health locus of control and subjective relevance concerning measles. The immunization rate was 77.7 percent [95 percent confidence interval 76.8-78.6]. Multiple logistic regression yielded the following odds ratios for non- uptake of measles immunization: natural health orientation 8.74 [6.72-11.37]; advice of paediatrician 6.02 [4.67-7.75]; dangerousness of measles 2.00 [1.53-2.60]; marital status 1.87 [1.31-2.51]; assessed reliability of vaccination 1.57 [1.23-2.01]; smoking 1.55 [1.21-1.98]; and number of siblings 1.55 [1.21- 1.98]. Parents or guardians of immunized children were more internal and assessed measles as more relevant than those of non- immunized children.

[Measles, mumps and rubella vaccination status of school beginners in Munich]. / Masern-, Mumps- und Rötelnimpfstatus bei Münchner Schulanfängern.

A cross-sectional study was performed on all of 10029 school-beginners in Munich in 1994 to investigate the vaccination status of measles, mumps and rubella immunisation. The objective of the study was to determine socio-demographic and psychological factors affecting the MMR vaccination rate. Data were received from 81.8% of all 10029 school-beginners. The vaccination rate was 86.1% for measles, 84.5% for mumps and 72.9% for rubella (missing values not included). Low overall vaccination rate was found in not first-born children, children of parents with non-german nationality, in children of parents with a low socio-economic status, in children accompanied by a working parent, and in children accompanied by a smoking parent. Children without any denomination also showed a lower vaccination rate. Girls had a higher vaccination rate for rubella than boys. A higher overall vaccination rate for MMR was associated with parents considering these infections to have a high impact for people's health. Vice versa children of parents considering adverse effects of vaccination against MMR as an important impact on health had significant lower vaccination rate. The results of a multiple logistic regression model showed two factors significantly affecting the MMR vaccination rate: Physician's recommendation and individual attitude towards medicine seem to have the most important influence on decision making for or against vaccination. In conclusion MMR vaccination strategies have to be improved. New ways such as, no vaccination--no school's should be considered for Germany.