[Significance of atopic dermatitis in outpatient medical care. Analysis of health care data from Saxony]. / Bedeutung des atopischen Ekzems in der ambulanten medizinischen Versorgung. Eine Sekundärdatenanalyse.

BACKGROUND: Data on health services utilization by children and adults due to atopic eczema (AE) are scarce, as well as data concerning the epidemiology of AE in adults. METHODS: Utilizing a population-based administrative health care database from Saxony, Germany, that covers comprehensive information on outpatient health care of 2.1 million individuals in 2003 and 2004, this study describes the relevance of AE as the proportion of children and adults with outpatient visits due to AE (ICD10 L20). Age- and sex-stratified prevalences of AE were estimated as the proportion of individuals insured by the Saxony Compulsory Health Insurance (AOK Sachsen), who were diagnosed as having AE at least twice within the study period. RESULTS: Being diagnosed in 15.6% of all children (age<18), AE was the most prevalent chronic-inflammatory condition at all in this age group. The prevalence of AE was 22.8% in one year old children, 8% in adolescents, and 2 to 4% in adults. CONCLUSION: AE is of utmost public health importance in children and adolescents, and also relevant for outpatient healthcare beyond the discipline of dermatology in adults. Despite the higher prevalence in children, approximately 60% of all patients with AE were adults.

The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention.

OBJECTIVE: The magnitude of the contribution of childbearing to the development of obesity is not entirely understood. Published studies on postpartum weight retention focus on risk factors and clinical interventions. Pooled estimates of postpartum weight retention have not been reported. We summarized the existing evidence of the natural history of postpartum weight retention and estimated the extent of time after delivery that weight retention is attributable to pregnancy. DESIGN: Systematic review and meta-analysis of qualitatively homogeneous studies. DATA SOURCES: Medline search of published studies between January 1995 and August 2005; bibliography of candidate studies. REVIEW METHODS: Eligibility: Observational studies and control groups of randomized controlled trials. Independent review and data abstraction including study design, subject characteristics, women's weight and study quality by two reviewers. Meta-analysis of average postpartum weight retention at different points in time after delivery. Sensitivity analysis for study specific covariates using meta-regression. RESULTS: Twenty-five studies describing 21 cohorts met eligibility criteria. Sixteen studies appeared homogeneous enough to be included in the meta-analysis. Average postpartum weight retention decreased continuously until 12 months postpartum (6 weeks: 2.42 (95% confidence interval (95% CI): 2.32-2.52) Body mass index (BMI), 6 months: 1.14 (95% CI: 1.04-1.25) BMI, 12 months: 0.46 (95% CI: 0.38-0.54) BMI). Postpartum weight retention was 0.46 BMI lower in studies with follow-up rate > or =80% at 6 weeks postpartum compared to studies with lower follow-up rate (P<0.01). CONCLUSION: Published studies consistently showed a decline in mean body weight within the first year postpartum. Data on body weight later than 12 months postpartum are scarce. The published evidence suggests a re-increase in body weight. As there are rather lifestyle-related than biological reasons for an increase in body weight after one year postpartum, we suggest using the term 'postpartum weight retention' exclusively within a limited period (for example, up to 12-18 months) postpartum.

ECG data compression for the emergency setting.

A low-cost system for digital transmission of the electrocardiogram (ECG) from a remote location to a medical facility under emergency conditions is developed. Delta threshold, Aztec and a hybrid combination of these two data compression techniques are evaluated to determine their ability to accomplish real time transmission of the ECG over a telephone system. The evaluations are performed using ten electrocardiograms representing arrhythmias commonly encountered in the emergency setting. It is shown that the delta threshold technique may cause data expansion under certain conditions. The hybrid technique is the optimum choice and real-time transmission can be accomplished over a 2400 BAUD system.

Improved sinus node sensing after atropine.

Although atropine is known to increase sinus rate through its vagolytic effect, the effects of atropine on sinus node sensing are unknown. The purpose of this study was to investigate alterations in sinus node sensing produced by atropine. Measurement of the zone of sinus node reset and sinoatrial conduction time was performed in 10 patients by programmed premature atrial stimulation. The zone of sinus node reset was determined as the transition point where premature atrial stimuli were followed by a less than compensatory pause. Sinoatrial conduction time was calculated from sinus node return cycles in the area where sinus node reset occurred. Atropine administration produced a significant increase in the percentage of the sinus cycle length at which premature atrial contractions penetrated and reset the sinus node. Sinus node reset occurred at a mean percentage of the sinus cycle of 71 +/- 8 per cent before atropine and 83 +/- 5 per cent after atropine (P less 0.01). The sinoatrial conduction time was significantly reduced from 109 +/- 29 to 62 +/- 23 msec. (P less than 0.01) from atropine as sinus cycle length was reduced from 909 +/- 118 to 642 +/- 75 msec. after atropine. Sinus node echoes were observed in two patients. In one patient atropine abolished the appearance of sinus node echoes. In the second patient atropine reduced the coupling interval necessary to produce sinus node echoes but appeared to facilitate sinus node re-entry by the appearance of an additional sinus node echo and a reduction in the echo cycle length. This study demonstrates that atropine produces significant improvement of sinus node sensing in man.

Electrophysiologic and electrocardiographic consequences of congestive heart failure.

In order to determine the effect of altered autonomic tone in patients with reduced left ventricular function and congestive failure on atrioventricular conduction, the refractory periods of the A-V conducting system were compared in forty-five patients with normal left ventricular function and fifteen patients with a left ventricular end-diastolic pressure greater than 12 mmHg and a left ventricular ejection fraction less than 50% with symptoms of congestive failure. All patients in the study had resting heart rates of 90 beats per minute or less. Patients with congestive failure were found to have a significant reduction in the functional refractory period of the A-V node (390 +/- 29 msec versus 430 +/- 38 msec; P less than 0.01) and the effective refractory period of the total A-V conducting system (275 +/- 34 msec versus 311 +/- 45 msec; P less than 0.01). In addition, patients with congestive failure had a higher incidence of aberrant conduction of premature atrial contractions (14 of 15 versus 22 of 45; P less than 0.01) and a significantly higher incidence of left bundle branch aberration (50% versus 20%; P less than 0.01). The results indicate significant facilitation of A-V nodal conduction in patients with congestive failure probably due to enhanced sympathetic activity and decreased parasympathetic inhibition. These findings may increase the ability of the clinician to understand electrophysiologic changes in congestive heart failure.