[Epidemiologic evidence in the treatment of cardiovascular risk factors in Germany]. / Zur epidemiologischen Evidenz der Behandlung kardiovaskulärer Risikofaktoren in Deutschland.

Up to now, approaches neither in primary nor in secondary prevention led to a relevant decline in prevalences of hypertension and hypercholesterolemia. On the contrary, prevalence of hypercholesterolemia increased from 38 to 40% (p < 0.001) while the hypertension prevalence stagnated (at nearly 20%) in the 30 to 69 years old population in West Germany between 1984/85 and 1991/92. The potential of medical advice is not sufficiently used, the compliance of patients regarding medical recommendations to change health behavior is limited. Subsequently the scientific consensus with regard to benefits from normalization of hypertension and hypercholesterolemia does not become effective at the population level. Evidence based medicine needs more efficient evaluation of continued medical education and quality assurance.

[Cost-effectiveness of conservative therapy of knee joint osteoarthritis]. / Zur Kostenwirksamkeit einer konservativen Gonarthrose-Therapie.

UNLABELLED: Hyaluronic acid (HYA) recently in several clinical studies has been shown to reduce gonarthrotic pain and to improve mobility. As an outcome measure usually the medical judgement and/or patient satisfaction as well as the Lequesne-index or the Euroquol index were used. The objective of this study was to investigate the cost-effectiveness (CEA) of HYA in a German ambulatory setting. METHODS: In 5 orthopedic specialist's practices a total of 179 patients with gonarthrosis have been evaluated, 90 under treatment with HYA, 89 with standard treatment (SDT). After 6 months the effects of HYA as measured by the Lequesne- and Euroquol-indices have been compared to SDT and analysed for cost of treatment. RESULTS: All index values for pain and mobility show--mostly significant--differences in favour of HYA, e.g. 92.4% of all patients under HYA achieved optimum values of Euroquol for general satisfaction vs. 42.9% in the reference group. The direct medical costs of 796, 11 DM are higher for HYA by 286, 85 DM (incl. 649 for HYA alone): the cost of medical services are lower by 108 DM, for lost days of work they are lower by 98 DM as compared to SDT. The average cost-effectiveness of HYA was superior for the effects on pain and mobility (e.g. differences of 978 and 328 DM resp. in direct costs), how-ever, indifferent for the complete indices. also marginal cost-effectiveness shows mainly favourable results for the various outcome-dimensions of quality of life used, the values being partly lower than the average cost-effectiveness. DISCUSSION: HYA shows mainly superior effects on quality of life as compared so SDT. Savings occur mainly with the regard to additive therapies and loss of work days. Overall HYA therapy is not more expensive but more beneficial than SDT.

[Hip ultrasound screening within the scope of U3--initial experiences]. / Hüftsonographie-Screening im Rahmen der U3--Erste Erfahrungen.

OBJECTIVE: After introduction of hip sonographic screening in Germany in the year 1996 we are interested in its organisational features and the results on a national level. It has to be scrutinized in how far the medical consequences are oriented and in accordance with the national guideline of hip sonographic screening. METHODS: Our study includes all 191.000 documentation sheets of hip sonographic screening in the year of 1996 in Germany. RESULTS: In the year 1996 pediatricians were responsible of 70% of all hip sonographic screening which were performed on the 36. day (median). About 80% of the examined infants showed alpha-angles > 56 Grad, about 1.7% only reached < 51 Grad. 27% of all cases were recommended a second sonographic examination and 7.7% should get a therapy. For 73% of all examined infants the consequences were compatible with the national guidelines for hip sonography screening. Orthopaedists more often showed deviations than other professional groups. CONSEQUENCES: There is the case for a more binding consensus regarding the adequate consequences in the cases of sonographic alpha-ankles between 51 to 56 degrees. In the light of an unexpected high proportion of infants with therapy recommendations there is to establish an informational feedback which covers results from the monitoring of the hip sonographic screening as well as results from the national outcome study.

Economic evaluation of lenograstim (glycosylated rHuG-CSF) in the treatment of inflammatory breast cancer for Germany and Italy.

Data from a French placebo-controlled double-blind trial in 120 female patients treated with high dose fluorouracil, epirubicin and cyclophosphamide (HD-FEC) chemotherapy for inflammatory breast cancer were used to assess the economic impact of adjunctive lenograstim therapy. The analysis compared direct costs of treatment, with or without lenograstim, with reference to the Social Security (Germany) or to the National Health Service (Italy). Resource utilisation differed between the 2 treatment groups. The lenograstim group reported 32% fewer antibiotic therapy days (9.8 days vs 14.6; p = 0.01) and 24% fewer inpatient days for any reason other than chemotherapy (7.4 'excess' days vs 9.8). By reducing infection-related morbidity associated with a high dose chemotherapy regimen, lenograstim decreased treatment costs by DM 1794 and ItL 1.2 million, excluding the cost of lenograstim itself. Since lenograstim patients reported fewer chemotherapy delays (16.4 vs 30.5%) and, hence, benefited from 1.2 (p = 0.04) more chemotherapy days, the related cost was DM 1519 and ItL 0.9 million higher than for the placebo group. This cost difference would be expected to be smaller if the placebo group patients had been followed until completion of their full chemotherapy regimen. Assuming that the costs of chemotherapy were the same for both groups, the direct cost saving for the lenograstim group would be 30% in Germany and 34% in Italy.

[Management of increased cholesterol values in general practice--results of a survey of established primary care physicians]. / Management erhöhter Cholesterinwerte in der Praxis--Ergebnisse einer Befragung niedergelassener Primärärzte.

In connection with a large population screening (N = 24317) in Bielefeld/Federal Republic of Germany a physicians inquiry has been carried out with a return of 55 out of 105 general practitioners or internists (52.4%), about 60% practicing already more than 10 years in Bielefeld. Only 42% of the answering physicians determine cholesterol in every new patient. Only 13% used own laboratory equipment, only 4% dry chemistry (almost indispensable for screening purposes). About 35% consider cholesterol lowering drug therapy to be necessary only beyond values of 300 mg/dl total cholesterol, the mean borderline value for the prescription of cholesterol lowering drugs was 265 mg/dl. Especially positions of shorter practice experience seemed to be sceptical taughts pharmacological means. The most utilized pharmacological preparations in Bielefeld correspond well with the "Arzneiverordnungs-Report '88". Side effects seem to be frequent as only three positions indicated that none of the patients under drug therapy had reported unwanted effects. Most physicians considered dietary therapy to be less effective than drug therapy. Almost all of them took means to increase the compliance of their patients, mainly (82%) through at least three monthly consultations. The prevalence of patients under cholesterol lowering dietary or pharmacologic therapy varied from 5 to 65% with the median of 17.5% which indicates a considerable underdetection of cases. However, physicians seem to be conscious about that as almost 80% hold more public information on cholesterol for desirable or (60%) very desirable.

Health effects during a smog episode in West Germany in 1985.

In January 1985 a smog period occurred for 5 days in parts of West Germany, including the Rhur District. Mortality (24,000 death certificates), morbidity in hospitals (13,000 hospital admissions, 5400 outpatients, 1500 ambulance transports) and consultations in doctors' offices (1,250,000 contacts) were studied for a 6-week period including the smog episode and a time interval before and thereafter. The study region was the State of North Rhine-Westfalia (16 million inhabitants), but the analysis is restricted to the comparison of the polluted area and a control area (6 million inhabitants each). During the smog period, mortality and morbidity in hospitals increased in the polluted area, but there was no substantial increase in the control area. The increases were for the total number of deaths 8 vs. 2% (polluted area vs. control area), for hospital admissions 15 vs. 3%, for outpatients 12 vs. 5% and for deliveries by ambulance to hospitals 28% in the polluted area (not investigated in the control area). The effects were more pronounced for cardiovascular diseases than for respiratory diseases. The consultations in doctors' offices show a slight decrease (-2 vs. -4%). Regression analysis shows a moderate influence of temperature, but a strong influence of ambient air pollution. The maxima of the ambient concentrations are more important on the same day, whereas the influence of the daily averages is more pronounced after a delay of 2 days. The results are discussed considering other possible confounders such as indoor pollution and psychogenic influences of the alarm situation. In total, the study suggests moderate health effects due to increased air pollution during the smog episode.

[Growth curves as a screening instrument--possibilities and limits]. / Wachstumskurven als Screeninginstrument--Möglichkeiten und Grenzen.

The application of growth charts as screening tools for children is a commonplace. Growth charts published during the past 15 years in Germany are now under debate with respect to their validity. An analysis of the problems related to growth curves gave the following results: A clear, sharp boundary between normal and non-normal permitting reliable grouping of children does not exist. Due to the heterogeneity of the population of children coming for screening, the call for an allround optimal and representative growth-curve remains wishful thinking. The growth charts so far published, show marked differences in the course of the percentile lines. The discrepancies can be explained by different sample sizes and algorithms of calculation. In the example of the longitudinal Zurich growth study on normal children it can be demonstrated, that the change between percentile ranges during the initial 4 years of life often considered to be pathological occurs in almost 50% of the probands. By conservative interpretation all growth charts can be used, because only with rare exceptions the diagnosis of growth disorders will be solely based on the measurement of tallness and its comparison to percentile values. As a rule: The grouping of a child as having non-normal growth is the result of multiparametric medical considerations.

Haemorheology in adolescent hypertensives.

Fifty-three untreated borderline hypertensives and 73 normotensives were randomly selected from 1342 adolescents (age range 23-27 years) who were examined in 1975, 1976 and 1980 in an epidemiological study. Blood pressure was 127.2 +/- 1.0/79.0 +/- 0.8 mmHg in normotensives and 147.2 +/- 1.6/93.7 +/- 1.1 mmHg in hypertensives (P < 0.001). Erythrocyte deformability was measured with a positive pressure filter system (pore diameter 5 microns) at 37 degrees C. Erythrocyte deformability was significantly increased in hypertensives with a value of 1.77 +/- 0.05, compared with 1.64 +/- 0.04 in normotensives (P < 0.05). No difference in apparent whole blood viscosity, haematocrit and plasma fibrinogen was measurable between the groups. Although plasma noradrenaline and adrenaline concentration at rest and after 3 min standing were not different, excretion of urinary catecholamines was significantly elevated in hypertensives with 155.0 +/- 3.3 micrograms/24 h (normotensives: 100.7 +/- 5.3 micrograms/24 h; P < 0.001).

[First examination of neonates. Results of early diagnostic documentation]. / Die Neugeborenen-Erstuntersuchung. Ergebnisse aus der Früherkennungsdokumentation.

There is an annual statistical evaluation of documentation, done since 1971, of an early disease diagnosis programme for children. At first examination of neonates in the years 1977-1981, sex-specific difference was low as regards data on pregnancies at risk, but definite and constant differences were recorded as regards psychic and social stress during pregnancy. Pregnancies at risk without any special features at birth were registered in 12.5%. In 58.4% of newborns no special features with regard to pregnancy or birth were recorded. In contrast to all other markers, final pelvic position was more frequent for girls than boys. The proportion of operative obstetric procedures has slowly fallen from 1977 to 1981. Cesarean section has recently been practised in 12.4%. With regard to birth weight of children, the documentation revealed a difference from the Federal Statistical Office, which showed a higher number of low-birth weight new-borns. Comparing the results with those of other German or foreign statistics, there is a strikingly high frequency of cesarean section in the Federal Republic of Germany.

[Problems with developmental diagnostic procedures]. / Probleme entwicklungsdiagnostischer Verfahren.

After mentioning historical origins of developmental diagnostics, the present article focuses on some of the problems attached to procedures used in developmental diagnostics, as for example the Denver Scales well known and widely distributed in the Federal Republic of Germany, the Münchener Funktionelle Entwicklungsdiagnostik (Munich Functional Developmental Diagnostics), and the Federal Early Diagnostic Program for early discovery of developmental disorders. From this, criteria for the construction and evaluation of developmental tests are derived.

[Prevention during adolescence: cardiovascular risk profile in juveniles of Cologne]. / Prävention im Wachstumsalter: Das kardiovaskuläre Risikoprofil bei Jugendlichen in Köln.

6302 adolescents were examined in 1975 for a cardiovascular risk profile ("Cologne Study"). Defined subpopulations could be followed-up prospectively in 1976 and 1980 (participation rates: 76.2%, 81.4%, 66.5%). Both sexes showed a correlation of cigarette smoking and intake of alcoholic beverages. Girls taking contraceptive smoked, drank more and their total cholesterol was significantly higher, and HDL-cholesterol significantly lower as compared to girls without hormonal contraception. A quarter to a third of the total variance for blood pressure, heart rate, total cholesterol, cigarette smoking and body-mass-index can be explained by measurements one resp. four or five years ago. Elevated values in the highest quintile show a clear tendency towards stability of risk status. Considering multifactorial constellations by cluster analysis, three groups with low, medium, and high risk status can be distinguished: 48% of all adolescents maintain their category over 5 years. For children with long-term and manifest elevation of blood pressure a more detailed determination of the risk status is recommended.