[Structures and concepts for nationwide outbreak management in a federal state]. / Strukturen und Konzepte für ein überregionales Ausbruchsmanagement im föderalen Staat.

With pandemic influenza in 2009/2010 and an EHEC outbreak in 2011, the Federal Republic of Germany experienced two extensive outbreaks in the course of only 3 years. Although both infectiological crises were comparatively successfully coped with, certain aspects have been critically examined. One point of criticism has been the presumption that federal structures may not be well suited for the management of a nationwide outbreak. This has been linked to the request for a central authority with responsibility. In fact, centralized as well as federal structures have advantages and disadvantages during infectiological crises. However, the "first response," i.e., immediate action against the spreading of infectious diseases, has to take place locally anyway. Regional differences, even in the context of a nationwide outbreak, might well demand regional action. After all, the federal structure of the Republic of Germany is deliberately firmly rooted in the German constitution, and there are no indications that this may change in the near future. Suitable concepts and structures should be used so as to benefit from the advantages and avoid the disadvantages of a federal state. The current structures are described, and improvements that may be necessary are discussed. The existing structures are shown to be entirely appropriate in allowing necessary decisions to be made and a fast transmission of information even in a federal state. Occasional shortcomings are seen as mainly due to the inadequate implementation of already existing regulations and partly to the ambition of a few spotlight seekers rather than to actual inadequacies of existing federal structures.

[Anonymous STD counselling versus mandatory checks for prostitutes--what is effective in STD prevention?]. / Anonyme STD-Sprechstunde versus Pflichtuntersuchung für Prostituierte--was ist effektiv in der STD-Prävention?

BACKGROUND: When in 2001 in Germany the new act for control of infectious diseases came into force, mandatory checks for prostitutes were abolished. The consequences of this paradigm shift in STD prevention are being judged controversially even today. The public health department of the city of Cologne, like others, adapted its programme, staff, equipment, and diagnostic procedures to the new requirements. The department for venereal disease control was converted into a walk-in-clinic for STD and now forms part of a comprehensive STD and Aids prevention unit. The present article illustrates the changes by comparing the clients and the STD numbers of the years 1994 and 2004. METHOD: The following data were compared: number of consultations, number of clients regarding sex, occupation in sex business, health insurance, national or ethnic background, frequency of consultation, number of STD. RESULTS: In 1994, almost all clients of the department for venereal disease control were female prostitutes. 74% of them worked in established sex business venues with a high grade of professionalism, few STD cases were diagnosed. In 2004, the STD clinic was open for anybody considered to be at risk and not having access to the regular health care system. Only 49% of the patients were prostitutes, either female or male. 25% of the clients were male. 68% of the patients were migrants, many of them without any legal status and without any access to regular health care. A high number of acute STD and subsequent disorders that required treatment was registered. Besides the STD-related services, a great need for gynaecological and urological differential diagnostics as well as a high demand for counselling and provision of other problems of sexual health were observed. DISCUSSION: The data show that an STD department providing comprehensive services anonymously and free of charge will reach a broader range of highly vulnerable persons in comparison with an obligatory VD check of prostitutes. The high numbers of STD and STD-related disorders demonstrate the improved effectiveness of the new service.

[The role of the German public health service in social medicine]. / Sozialmedizinische Aufgaben des OGD.

Although the German public health service is mainly concerned with social medical tasks there is too little awareness of the fact that social medicine forms the scientific basis of most actions. As a matter of fact social medicine in public health departments is often reduced to mere medical insurance and expert reports. This is mainly due to the historical development of social medicine in Germany. Among the numerous important social medical tasks of the public health service, this article mainly concentrates on local coordination, health promotion, health care, and social compensation, including subsidiary medical care of certain groups of the population and aspects of infectious disease control with particular attention to measures against AIDS. The further development of both the public health service and social medicine requires a closer cooperation between them.

[Histopathological findings in the proprioception of the shoulder joint]. / Histomorphologische Befunde zur Propriozeption am Schultergelenk.

Purpose of this study was the evaluation of distribution and morphology of mechanoreceptors in the glenohumeral joint capsule and rotator cuff in comparison to the coracoacromial ligament by means of specific immunfluorescence microscopy. The complemente joint capsules, rotator cuffs and coracoacromial ligaments of three fresh cadaver shoulder were harvesed. Serial cryostate sections were taken and alternately incubated with antiserum against neurofilament, lamin or myelin of peripheral nerves. The antibody-reaction was visualized with fluorescin lg-G. The nerve endings were photographed and computer-aided 3-dimensional reconstructions were performed. Three types of corpuscular and free nerve endings of different morphology were found in different distributions: whereas the Ruffini corpuscles were much more frequent in the coracoacromial ligament and rotator cuff, Pacini endings were predominantly found in the joint capsule. Generally corpuscular nerve endings were more frequent in the coracoacromial ligament and the rotator cuff than in the antero-inferior capsule and the number of corpuscles increased from medial to lateral within the anterior and inferior parts of the capsule. The dense ligamentous tissue was almost aneural whereas the periarticular fatty or loose connective tissue contained nerve fibres and nerve endings. In view of the results of other experimental and clinical studies the high frequency of Ruffini and Pacini endings in the rotator cuff and coracoacromial ligament suggest, that both are involved in the neurosensory control of glenohumeral stability and subacromial impingement. In contrast our findings in the joint capsule do not clearly prove, that those joint receptors predominantly maintain joint stability.

[Blood tests for PCB in teachers at a heavily PCB-polluted school]. / Blutuntersuchungen auf PCB bei Lehrerinnen und Lehrern einer stark PCB-belasteten Schule.

The levels of PCB 28, 52, 101, 153, 138 and 180 were determined in blood samples of subjects (mainly teachers; n = 18) who had worked in a PCB-contaminated school-building for many years (average: 14.2 years). The PCB concentrations in indoor air ranged up to 13,500 ng/m3. For comparison PCB blood levels were determined in 18 teachers working in schools not contaminated by PCB. The subjects of the reference group were matched with the exposed subjects with respect to age and gender. PCB 28, 52 and 101 were not detectable in the blood samples (detection limit: 0.1 microgram/l). In the exposed subjects blood levels of PCB 153 and 138 were, on average, slightly higher and the levels of PCB 180 slightly lower when compared with the reference subjects, but the differences were not statistically significant. The levels of PCB 153, 138 and 180 increased with age. With the exception of two subjects the levels of these congeners were below the reference values proposed by Kappos et al. The results show that inhalative exposure to PCB 153, 138 and 180 is very low in comparison to PCB background exposure via food. Due to rapid metabolisation and elimination the blood levels of PCB 28, 52 and 101 are usually very low.

Histomorphological findings on proprioception in the shoulder.

Purpose of this study was the evaluation of distribution and morphology of mechanoreceptors in the glenohumeral joint capsule and rotator cuff in comparison to the coracoacromial ligament by means of specific immunfluorescence microscopy. The complemente joint capsules, rotator cuffs and coracoacromial ligaments of three fresh cadaver shoulder were harvested. Serial cryostate sections were taken and alternately incubated with antiserum against neurofilament, lamin or myelin of peripheral nerves. The antibody-reaction was visualized with fluorescin Ig-G. The nerve endings were photographed and computer-aided 3-dimensional reconstructions were performed. Three types of corpuscular and free nerve endings of different morphology were found in different distributions: whereas the Ruffini corpuscles were much more frequent in the coracoacromial ligament and rotator cuff, Pacini endings were predominantly found in the joint capsule. Generally corpuscular nerve endings were more frequent in the coracoacromial ligament and the rotator cuff than in the antero-inferior capsule and the number of corpuscles increased from medial to lateral within the anterior and inferior parts of the capsule. The dense ligamentous tissue was almost aneural whereas the periarticular fatty or loose connective tissue contained nerve fibres and nerve endings. In view of the results of other experimental and clinical studies the high frequency of Ruffini and Pacini endings in the rotator cuff and coracoacromial ligament suggest, that both are involved in the neurosensory control of glenohumeral stability and subacromial impingement. In contrast our findings in the joint capsule do not clearly proove, that those joint receptors predominantly maintain joint stability.

huckebein specifies aspects of CNS precursor identity required for motoneuron axon pathfinding.

huckebein encodes a putative zinc finger protein expressed in a subset of Drosophila CNS precursors, including the NB 4-2/GMC 4-2a/RP2 cell lineage. In huckebein mutant embryos, GMC 4-2a does not express the cell fate marker EVEN-SKIPPED; conversely, huckebein overexpression produces a duplicate EVEN-SKIPPED-positive GMC 4-2a. We use Dil to trace the entire NB 4-2 lineage in wild-type and huckebein mutant embryos. Loss of huckebein does not affect the number, position, or type of neurons in the NB 4-2 lineage; however, all motoneurons show axon pathfinding defects and never terminate at the correct muscle. Thus, huckebein regulates aspects of GMC and neuronal identity required for proper motoneuron axon pathfinding in the NB 4-2 lineage.

[Complementary or subsidiary--why do we actually need the public health office?]. / Komplementär oder subsidiär--wofür brauchen wir eigentlich das Gesundheitsamt?

The public health service likes to describe itself as a kind of "third pillar", which together with the two other "pillars"--out-patient and in-patient care--supports the system of health service of the FRG. In fact, in the years since 1945 no health or sociopolitical programme of an extensive health care system could be developed which would have linked these three "pillars" in a sensible division of labour. On the one hand, original tasks of the public health system have been transferred to the private system of health care stressing the subsidiary of governmental action. On the other hand the public health service did not succeed in transforming the classical health care into a convincing system of local health service, which could fill the obvious gaps in the other parts of the health system. At present it is again under discussion whether public health service will play an original part in the system of health care, whether, following the principle of subsidiary it will only be assigned those tasks which nobody else will or can tackle or whether these will be complementary to those of the other sectors.(ABSTRACT TRUNCATED AT 250 WORDS)

[Basic medical care of drug dependent patients and young homeless persons--a report from general practice]. / Die medizinische Basisversorgung von Drogenabhängigen und jungen Obdachlosen--ein Bericht aus der Praxis.

During the last few years there has been an increasing number of reports from the staff in low level acceptance institutions as well as from streetworkers, about poor physical condition among drug addicts and young drifters. In May 1993 this caused the Public Health department of Cologne to set up a mobile medical service. This service offers consultation hours in so called "contact cafes" as well as in an out-of-service ambulance for drug addicts of the open drug scene and young drifters around the central station. Past experience has shown that the affections are by no means trivial ones. Phlegmoneous inflammations, abscesses, parasitosis and pyodermias of any kind as well as lesions of peripheral nerves and different kinds of acute or chronic virus infections are among the diseases. Without medical treatment there will be grave consequences. Difficulties in the treatment of drug addicts and other marginal social groups formed the term of the patient "who resists any medical treatment". As a result of bad experiences with existing medical institutions drug addicts consult the doctor either too late or they break off the treatment too early. In the treatment of drug addicts and young homeless it is absolutely necessary to face them without any prejudice and to create an atmosphere of confidence in order to guarantee an efficient medical care. There traditional medical services are not able to provide medical aid, the public health department is obliged to establish possibilities of complementary treatment. Drug addiction and homelessness cannot mean exclusion from medical care. That would also mean that the health insurances should participate in the costs.

[Between isolation and acceptance--hepatitis B and AIDS in community facilities]. / Zwischen Ausgrenzung und Akzeptanz--Hepatitis B und AIDS in Gemeinschaftseinrichtungen.

Both Hepatitis B and the HIV-infection are spread either through blood or sexual contact. The danger of these infections spreading in day nurseries and schools is very remote but nonetheless there are confused fears. These fears lead to isolation and enormous problems for the carriers, who, for the most part, are children but can also be adults. As far as Hepatitis B, HIV and AIDS are concerned there are clear scientific recommendations for those attending these social institutions. Such recommendations have been published in decrees by the responsible ministries of the Länder of the Federal Republic of Germany. These decrees enable infected children and adolescents to lead an accepted life within the community. They reduce the remaining extremely small risk of transmitting the diseases to a level that is in fact lower than the general risk of every-day life and can be tolerated in an empathic society.

[Indoor air pollution by polychlorinated biphenyl compounds in permanently elastic sealants]. / Innenraumbelastung durch polychlorierte Biphenyle (PCB) in dauerelastischen Dichtungsmassen.

A common cause for indoor pollution by polycholorinated biphenyls (PCB) are defective capacitors of luminous discharge lamps. This paper describes elastic sealing compounds as another source of PCB pollution in buildings. In several rooms of a large school building indoor concentrations of 1000 ng PCB/m3 and more were registered. The total PCB concentration in sealing compounds ranged between 124,000 and 327,000 ppm. Blood specimens drawn from the school's personnel did not show elevated PCB concentrations, but additional incorporation of PCB via the respiratory tract cannot be excluded. We do not presume that any impairment of the health has been caused by this pollutant, but we think that reduction of the PCB indoor concentrations would be advisable for prophylactic purposes. Attention should be given to so-called open PCB systems such as elastic sealing compounds. Although they have been prohibited 1978, there might be a widespread use in older buildings.

[Infectious gastroenteritis in childhood (author's transl)]. / Infektiöse Gastroenteritis bei Säuglingen und Kleinkindern.

Stool specimens from 126 children with acute gastroenteritis and from 42 controls were screened bacteriologically and virologically including electron-microscopy. Rota viruses were found in 36.5% of the children with diarrhoea, enteropathogenic E. coli in 13.5% and candida in 7.1%. These pathogens were not found in the controls. Enteroviruses were found in almost the same frequency in both groups (13.5% in children with gastroenteritis, 16.6% in the controls). The etiologic role of adenoviruses, which could be seen in 5.6% of the diarrhoea group, remains unexplained.

[Selective and controlled mass rubella vaccination - experiences with an economical method (author's transl)]. / Gezielte und kontrollierte Rötelnreihenimpfungen - Erfahrungen mit einer ökonomisch vertretbaren Methode.

Immunity to rubella virus was examined in blood samples of 5870 school girls. Only in 22.7% of the girls a vaccination proved necessary. HDC vaccine (strain RA 27/3) was used. By postvaccinal control successful vaccination could be demonstrated in 99.6% of the vaccinated girls. The hemolysis in gel test (HIG) (3557 samples) and an enzyme-linked immunosorbent assay (ELISA) (1134 samples) were compared with the hemagglutination inhibition test (HI) as to their reliability and sensitivity in demonstrating rubella virus antibodies. HIG and HI exhibited identical results, whereas with the ELISA diverging results were obtained in 14% of the samples. 30 girls being antibody-positive only in the ELISA were vaccinated. Only 28 of these girls developed rubella specific IgM-antibodies after vaccination. This results strongly suggests that at least in these 28 prevaccinal samples the ELISA yielded false positive results.