[Insurance medical consultation in private health insurance - which insurance medical questions are put to the medical consultant?]. / Versicherungsmedizinische Beratung in der PKV - welche Fragen stellen private Krankenversicherer ihrem Gesellschaftsarzt?

BACKGROUND: This study deals with the task areas of the medical consultant in private health insurance. Although insurance medical consultation for the insurance business originated in the 19th century, the tasks and competencies of the medical consultants are still mostly unknown. METHODS: This study is a complete inventory count of all insurance medical consultation requests for the year 2013. All of the 5493 insurance medical consultation requests have been evaluated. RESULTS AND DISCUSSION: Most of the consultation requests concern the medical necessity for medical drugs, followed by the medical consultation of alternative medicine and the classification of cure and rehabilitation measures of hospital medical treatments. The need for insurance medical consultation on lifestyle drugs, cosmetic operations and artificial insemination has increased significantly in the past 10 years. Since 2009, moreover, the need for medical consultation on the subject of "Ruhensleistungen" with regard to non-payers and "Notlagentarif" has strongly increased.

Programmatic prevention of adolescent problem behaviors: the role of autonomy, relatedness, and volunteer service in the Teen Outreach Program.

Explored the mechanisms by which a well-validated intervention to prevent school failure, suspension, and teenage pregnancy produces its effects, using site-level data from 66 sites involving over 1,000 students participating in national replication of the Teen Outreach Program. Multiple informants provided data on operating characteristics of each site. These were then used to explain differences across sites in levels of success in reducing youth problem behaviors using a pre-post design and a well-matched comparison group. In accord with predictions from developmental theory, middle school sites that promoted student autonomy and relatedness with peers and with site facilitators achieved significantly greater levels of success in reducing problem behaviors. Offering volunteer experiences perceived as teaching middle school students new skills and leaving them real choices about the type of work they did was also linked to program success. Although the program was equally successful with students from a wide range of sociodemographic backgrounds, links of program factors to site-level outcomes were found only for middle school but not high school sites. Implications of these findings for the development of programmatic interventions targeted at adolescents are discussed.

[Idiopathic hemochromatosis--diagnosis and therapy]. / Die idiopathische Hämochromatose--Diagnostik und Therapie.

The excessive storage of iron in idiopathic haemochromatosis leads to severe organic lesion up to life-threatening conditions (cardiac insufficiency, portal decompensation). The symptoms melanodermia , diabetes mellitus and other endocrine failures, liver cirrhosis, cardiac insufficiency and arthropathy appear together or in various combinations. The diagnosis is ascertained by the proof of iron storage, the multiple organic affection and by familial accumulation of the various laboratory diagnostic possibilities are particularly to be emphasized the serum iron value together with the percetal transferrin saturation (as search test), serum ferritin, the desferrioxamine test, simple ferrokinetic investigations and the quantitative determination of iron in the liver in the bioptate . For family examinations, apart from the search test, a HLA typisation is reasonable, in order to estimate the risk of the disease (particularly of brothers and sisters). The therapy of choice are blood- lettings (0.5 l once to twice a week) up to obtaining a permanent easy iron deficiency anaemia. The maintenance therapy should be performed with monthly to quarterly blood- lettings . Only in cases exception a desferal treatment is indicated. Endocrine failures and cardiac disturbances need a particular therapy.