Modelling the effects of normal faulting on alluvial river meandering.

The meandering of alluvial rivers may be forced by normal faulting due to tectonically altered topographic gradients of the river valley and channel at and near the fault zone. Normal faulting can affect river meandering by either instantaneous (e.g. surface-rupturing earthquakes) or gradual displacement. To enhance our understanding of river channel response to tectonic faulting at the fault zone scale we used the physics-based, two-dimensional morphodynamic model Nays2D to simulate the responses of a laboratory-scale alluvial river with vegetated floodplain to various faulting and offset scenarios. The results of a model with normal fault downstepping in the downstream direction show that channel sinuosity and bend radius increase up to a maximum as a result of the faulting-enhanced valley gradient. Hereafter, a chute cutoff reduces channel sinuosity to a new dynamic equilibrium value that is generally higher than the pre-faulting sinuosity. A scenario where a normal fault downsteps in the upstream direction leads to reduced morphological change upstream of the fault due to a backwater effect induced by the faulting. The position within a meander bend at which faulting occurs has a profound influence on the evolution of sinuosity; fault locations that enhance flow velocities over the point bar during floods result in a faster sinuosity increase and subsequent chute cutoff than locations that enhance flow velocity directed towards the floodplain. This upward causation from the bend scale to the reach and floodplain scale arises from the complex interactions between meandering and floodplain and the nonlinearities of the sediment transport and chute cutoff processes. Our model results provide a guideline to include process-based reasoning in the interpretation of geomorphological and sedimentological observations of fluvial response to faulting. The combination of these approaches leads to better predictions of possible effects of faulting on alluvial river meandering.

The relative contribution of peat compaction and oxidation to subsidence in built-up areas in the Rhine-Meuse delta, The Netherlands.

An increasing number of people lives in coastal zones with a subsurface consisting of heterogenic soft-soil sequences. Many of these sequences contain substantial amounts of peat. While population growth and urbanization continues in coastal zones, they are threatened by global sea-level rise and land subsidence. Peat compaction and oxidation, caused by loading and drainage, are important contributors to land subsidence, and hence relative sea-level rise, in peat-rich coastal zones. Especially built-up areas, having densely-spaced urban assets, are heavily impacted by land subsidence, in terms of livelihoods and damage-related costs. Yet, built-up areas have been largely avoided in peat compaction and oxidation field studies. Consequently, essential information on the relative contributions of both processes to total subsidence and underlying mechanisms, which is required for developing effective land use planning strategies, is lacking. Therefore, we quantified subsidence due to peat compaction and oxidation in built-up areas in the Rhine-Meuse delta, The Netherlands, using lithological borehole data and measurements of dry bulk density, organic matter, and CO2 respiration. We reconstructed subsidence over the last 1000 years of up to ~4 m, and recent subsidence rates of up to ~140 mm·yr-1 averaged over an 11-year time span. The amount and rate of subsidence due to peat compaction and oxidation is variable in time and space, depending on the Holocene sequence composition, overburden thickness, loading time, organic-matter content, and groundwater-table depth. In our study area, the potential for future subsidence due to peat compaction and oxidation is substantial, especially where the peat layer occurs at shallow depth and is relatively uncompacted. We expect this is the case for many peat-rich coastal zones worldwide. We propose to use subsurface-based spatial planning, using specific subsurface information mentioned above, to inform land use planners about the most optimal building sites in organo-clastic coastal zones.

[Temporary Disability Pension from the Perspective of the Individual: Self-Reported Physical and Mental Health, Medical Rehabilitation, and Return to Work Plans]. / Befristete Erwerbsminderungsrente aus Sicht der Betroffenen: subjektiver Gesundheitszustand, Rehabilitationserfahrungen und Pläne zur Rückkehr ins Erwerbsleben.

STUDY PURPOSE: To assess health and psychosocial variables as well as return-to-work (RTW) plans in people with long-term illness-related absence from work in Germany. METHODS: Structured telephone interviews with N=452 persons receiving a temporary disability pension (53.3% female, mean age 50.3 years). RESULTS: Participants reported high levels of multimorbidity and physical and mental complaints. The majority however stated to intend or even to have prepared their RTW. This intention was correlated with age and the duration of the temporary disability pension, but not with gender, number or type of diseases, or current subjective health status. CONCLUSION: Our results indicate a large intention-behavior gap which needs to be addressed in studies, but also in rehabilitation and return-to-work interventions.

[Stance toward psychosomatic rehabilitation: development of a patient-questionnaire]. / Einstellung zur psychosomatischen Rehabilitation: Entwicklung eines Patienten-Fragebogens.

BACKGROUND: The transition from home to psychosomatic rehabilitation is problematic for many patients. They show little treatment motivation because of insufficient information and fear of stigmatization. Pre-treatment seeks to reduce these problems. The patient-questionnaire for stance toward psychosomatic rehabilitation was developed and tested for performance criteria. METHODS: A German statutory pension insurance scheme sample of psychosomatic rehabilitation patients (n=317) were recruited for testing psychosometric attributes and were questioned before and after pre-treatment. To determine whether the questionnaire can show clinically relevant changes, 124 patients with pre-information were compared with 88 patients without intervention. Additionally, clinically relevant changes for patients without knowledge of psychosomatic rehabilitation (n=70) were analyzed. RESULTS AND CONCLUSIONS: Factor analysis shows a three factor solution with ten items. The discriminatory power was good. High reliability was found for two factors and lower reliability for one factor. The patient-questionnaire for stance toward psychosomatic rehabilitation contains three scales: "knowledge", "confidence", and "motivation", and can be characterized as a reliable and economic instrument. After pre-treatment a general improvement was observed regarding patients' stance toward psychosomatic rehabilitation. The analyses result in significantly higher mean for patients with pre-treatment. Patients without previous information showed less "confidence" and "motivation". Pre-treatment can have a positive impact on the stance toward psychosomatic rehabilitation.

[Psychosomatic rehabilitation: effects of pre-treatment counselling under the statutory pension insurance scheme]. / Psychosomatische Rehabilitation: Effekte einer prästationären Beratung durch die Rentenversicherung.

BACKGROUND: Currently, little is known about the influence of pre-treatment in rehabilitation outcomes of patients with psychosomatic symptoms. This study examines whether there are differences in therapy motivation and impairment between patients with and those without pre-treatment measures. Additionally, the outcome for patients with prior knowledge of psychosomatic rehabilitation is analyzed. METHODS: As part of a randomized controlled pre-post design the Patients' questionnaire of therapy motivation (PAREMO) and the Brief Symptom Inventory (BSI) were distributed to 166 patients in psychosomatic rehabilitation. The selection of patients with prior knowledge of psychosomatic rehabilitation was made according to the scale "knowledge" of the patients' questionnaire. Changes were tested by analysis of variance at two treatment points. RESULTS: Although there were positive effects of rehabilitation, no interaction was found between measurement points and groups. The analyses of patients without prior knowledge of psychosomatic rehabilitation showed different outcomes for males and females. Higher rehabilitation outcomes for females than for males were found on the BSI scales "somatisation", "phobic anxiety", and "psychoticism". CONCLUSIONS: The findings show that pre-treatment facilitates the patients' approach to psychosomatic rehabilitation. Apart from receiving information patients should be motivated more strongly and their confidence in psychosomatic rehabilitation strengthened.

[Psychosocial workload, sick leave, and health-related well being: an empirical study from the perspective of gender research]. / Psychosoziale Arbeitbelastungen, Arbeitsunfähigkeit und gesundheitsbezogenes Wohlbefinden: Eine empirische Studie aus der Perspektive der Geschlechterforschung.

PURPOSE: The aim of this study was to test hypotheses on the consequences of gender role expectations with regard to the extent of work stress, selected health-related measures and their associations. METHOD: Data on psychosocial workload (questionnaire of effort-reward imbalance), sick leave (self-reports of the duration of medically certified sick leave during the past two years) and health-related well being were collected in a representative sample of German full-time employees (n = 666). Hypotheses were tested using analyses of variance (ANOVA) and covariance (ANCOVA) and moderated linear regression analyses. RESULTS: Women reported lower health-related well-being as compared to men while effort-reward imbalance and sick leave did not differ between the sexes. Parents reported slightly longer durations of sick leave during the past two years than childless participants (not significant). The results of stratified linear regression analyses show stronger associations between effort-reward imbalance and both health-related measures for women with children than for men with children, while single men and women do not differ in this regard. CONCLUSIONS: Evidence of this kind can be useful for the purposeful planning and implementation of health promotion measures at work. Women with children would be a group deserving special attention. The findings also point to continuing differences in gender role expectations in the family context.

[Prevalence of urinary incontinence in the German population]. / Prävalenz der Urininkontinenz in der deutschen Bevölkerung. Komorbidität, Lebensqualität, Einflussgrössen.

The purpose of this study was to determine the frequency of incontinence in men and women in different age groups. In a representative survey, 883 men and 1,182 women with a mean age of 50 years (18-92 years) were studied based on standardized questionnaires on physical and psychological complaints, and quality of life. Participants suffering from involuntary loss of urine were considered "incontinent". The frequency of incontinence strongly increased with age, from 6.9% among the 18-40 year old population to 9.5% among the 41-60 year olds and 23% over the age of 60 years. Women complained more frequently of incontinence (15%) than men (9.5%; total of 12.6% in the population). The majority of the participants with incontinence also suffered from urinary urge, multiple disorders of digestion, pelvic pain and sexual dysfunction. There was also a strong increase in exhaustion, gastric pain, joint pain and cardiac complaints. The younger participants were more strongly affected by incontinence. When patients complain of incontinence, strong impairments in physical and psychological well-being, and quality of life are to be expected.

[Somatoform complaints in elderly of Germany]. / Somatoforme Beschwerden bei über 60-Jährigen in Deutschland.

The aim of this paper is to report on the prevalence of somatoform disorders in older age. A total of 630 representatively selected persons older than 60 years were asked to complete the questionnaire SOMS 2 (Screening for somatoform disorders, Rief et al., 1997). The results show that somatoform pain is very common in old age. Of the people, 71.8% report at least one symptom, 50.5% on at least four symptoms and 23.4% suffer from at least eight symptoms. The frequency of somatoform symptoms is much higher in people over 60 years old than in persons who are younger than 60 years old. Pain is very often localized in several body regions. In contrast to findings from younger age groups, older women do not report more somatoform pain than older men. When looking at the differences between "young olds" and "old olds" somatoform pain increases with increasing age. The high frequency of somatoform pain in older people is in clear contrast to the low prevalences of somatoform disorders defined according to DSM-IV or ICD-10 (0%-0.3%). The results show that the real prevalence of somatoform disorders is extremely underestimated because of the restrictive criteria of the diagnosis systems.

Amyloid-beta-induced chemokine production in primary human macrophages and astrocytes.

In Alzheimer's disease (AD), chemotaxis might be responsible for attracting glial cells towards the neuritic plaque. Using primary monocyte-derived macrophages and primary adult astrocytes as a model, amyloid-beta (Abeta) (1-42) was able to stimulate the production, as measured by RT-PCR, of MIP-1alpha and MIP-1beta mRNA in macrophages and MCP-1 in astrocytes. Cocultures showed in unstimulated as well as in Abeta-stimulated cells an increase in MIP-1alpha, MIP-1beta and MCP-1 mRNA. ELISAs of supernatant samples of stimulated macrophages and astrocytes also showed an increase in MIP-1alpha and MIP-1beta in macrophages and MCP-1 in astrocytes. Stimulated cocultures showed an increase in MIP-1alpha, MIP-1beta and MCP-1 protein levels in contrast to unstimulated cocultures.

Somatization symptoms and hypochondriacal features in the general population.

OBJECTIVE: The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population. METHODS: A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index. RESULTS: The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes. CONCLUSION: We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

Trichoblastic carcinoma: a report of two cases of a deeply infiltrative trichoblastic neoplasm.

BACKGROUND: Trichoblastoma is a benign neoplasm with primitive hair follicle differentiation. The tumor is characterized by nests and cords of epithelial cells in an organized relationship with stroma. Some of the epithelial cells resemble follicular germ and other cells show follicular sheath differentiation. The neoplasm is symmetrical and well circumscribed. In addition, cytologic examination shows no atypia. Concept of its malignant counterpart is poorly understood. OBJECTIVE: We report two trichoblastic neoplasms that show histologic features of malignancy. METHODS: Skin biopsies from the lip region of a 53-year-old female and a 74-year-old male who had presented with the neoplasms in that location for several years were reviewed. Excised specimens measured 2 x 1 x 1 cm and 1.6 x 0.7 x 0.8 cm respectively. RESULTS: The histologic sections revealed locally aggressive neoplasms showing prominent differentiation towards hair germ and follicular sheath with formation of papillary mesenchymal bodies, follicular bulb-like structures, small keratin cysts and rare malformed hair shaft. The neoplasm showed asymmetry of architecture and massive subcutaneous and muscular infiltration. CONCLUSION: With demonstration of these two cases and references of few other reported cases we raise the possibility of existence of trichoblastic carcinoma that is distinct from basal cell carcinoma.

Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival.

BACKGROUND: Merkel cell carcinoma is a rare malignant neoplasm of the skin that most often arises in the head and neck region. Despite the innocuous appearance of the primary lesion, Merkel cell carcinoma often has an aggressive clinical course with frequent locoregional recurrences and distant metastases. We evaluated the association of the width of surgical margins and the use of postoperative radiation therapy with locoregional control and survival rates. METHODS: The medical records of 66 patients with head and neck Merkel cell carcinoma seen between 1945 and 1995 were retrospectively reviewed. The Fisher exact test was used to compare outcomes. Kaplan-Meier survival curves were constructed. RESULTS: Eighteen patients for whom there was adequate information were divided into the following groups according to the width of their surgical margins: smaller than 1 cm, 1 to 2 cm, and larger than 2 cm. No statistical difference in locoregional control or survival was found among these groups owing to the small patient population. In contrast, a comparison of the patients who did (n = 26) and did not (n = 34) receive postoperative radiation therapy revealed a significant difference in local (3 [12%] vs 15 [44%], respectively; P<.01) and regional (7 [27%] vs 29 [85%], respectively; P<.01) recurrence rates. There was, however, no significant difference in the disease-specific survival between these groups (P = .30). Distant disease developed in 36% of all patients regardless of therapy. CONCLUSIONS: Any effect of the width of surgical margins on outcome was not detectable in the small number of patients analyzed. The use of postoperative radiation therapy was associated with a significant improvement in locoregional control. There was no detectable influence of the type of initial therapy on the rates of distant metastases or on survival. Future therapeutic innovations should be directed toward controlling the development of distant metastases in patients with Merkel cell carcinoma.

[Psychiatric problems in the elderly--standardization of the Symptom Check List SCL-90-R in patients over 60 years of age]. / Psychische Beschwerden im Alter--Standardisierung der Symptomcheckliste SCL-90-R bei über 60-Jährigen.

In the following article, data of the symptom checklist SCL-90-R (Derogatis 1986) for elderly people are introduced, including an estimation of the controlling factors on psychological complaints in old age. The representative sample is based on 394 persons aged 61 to 96; their psychological complaints have been studied with respect to SCL-90-R. Evidently elderly people did not state an increasing load on psychological complaints, but a different structure of psychological symptoms. Therefore with increasing age the scales "Somatization", "Obsessive-compulsive" and "Phobic anxiety" increase, while "Interpersonal sensitivity", "Anger--hostility" and "Paranoid ideation" are decreasing. Within that frame, elderly females report increasing symptomatic load compared to elderly males. Furthermore, aspects of social support and health-related attitudes were found to be important predictors of psychological complaints in old age.

[Utilization of medical services and medication intake of patients over 60 in Germany--health related, social structure related, socio-demographic and subjective factors]. / Inanspruchnahme medizinischer Leistungen und Medikamenteneinnahme bei über 60jährigen in Deutschland--gesundheitliche, sozialstrukturelle, sozio-demographische und subjektive Faktoren.

In a community sample of 394 elderly aged 61 years and older from East and West Germany, diseases, contacts with general practitioners and specialists, the use of medicine, attitudes regarding health and illness, the subjective health, psychic problems, social support, social integration, social burden, and socio-demographic variables were assessed. Based on these data the determinants for the contact of physicians and the use of medicine were analyzed. The results confirmed the frequency of multimorbidity in the elderly; on average we found three different diseases at the same time for each person. In nearly 10% of the sample we found seven diagnoses existing at the same time. 88% had contact with a general practitioner at least once a year, 97% had contact either with a general practitioner or with a specialist once a year. 55.8% took at least one medicine each day. The number of diseases existing at the same time was the most determining variable for the contact of physicians and the use of medicine. Furthermore, the elderly had more contact with physicians and took more medicine if they thought they were susceptible to diseases in a high degree, and if they rated their own health as poor. Fewer contacts with physicians and a lower use of medicine were found in those elderly that rated health behavior as little useful, that had low control beliefs regarding their own health, and that experienced only a low degree of health-related limitations in their everyday life. Furthermore, we found a higher use of medicine if there was little social support. There were no significant age-related or sex-related differences regarding the contact of practitioners or the use of medicine.

[Illness-coping in a population-based representative sample. Situational, sociodemographic and social influences]. / Krankheitsbewältigung in einer repräsentativen Bevölkerungsstichprobe. Situative, soziodemographische und soziale Einflussfaktoren.

In spite of the considerable volume of current coping research there is a noticeable lack of studies based on large representative samples. In this study a sample of 2179 subjects of 16 to 96 years of age that was representative of the entire population of Germany, was asked as to how they now cope, how they have coped in the past or how they would cope with: 1. an existing illness, 2. a past illness and 3. an imagined (non-existent) illness. The instrument used was the questionnaire version of the "Berner Bewältigungsformen" (BEFO), a coping questionnaire with 28 systematically derived coping dimensions that are defined independently of the usual empirical-topographical dimensions (behavioural, cognitive and emotional) of the type of illness. The enquiry was concerned with the influence of varying situational (proximity of illness, subjective evaluation of personal health, psychological symptoms), socio-demographic (age, gender) and social (social support) variables on the choice of coping mechanisms. The results showed that each of these factors influences the repertoire of coping mechanisms to varying degrees. This systematic variability in a representative sample should be taken into account in any evaluation of coping with illness in clinical sub-groups.

Assessment of the functional role of accessory pudendal arteries in erection by transrectal color Doppler ultrasound.

PURPOSE: Anatomical studies have demonstrated accessory pudendal arteries originating from supralevator vessels in about two-thirds of men. Injury to accessory pudendal arteries derived from inferior vesical and obturator arteries has been reported to be responsible for vasculogenic impotence after nerve sparing radical prostatectomy. We performed transrectal and perineal color Doppler ultrasound in patients before radical pelvic surgery to identify accessory pudendal arteries and assess their functional role during erection. MATERIALS AND METHODS: A total of 12 patients with a mean age of 60 years were examined before radical prostatectomy (10) or cystoprostatectomy (2). Transrectal and perineal color Doppler flow imaging and spectral waveform analysis were performed. Peak systolic velocity, end diastolic velocity, resistive index and arterial diameter were measured before and during pharmacologically induced erection. Transrectal color Doppler ultrasound data were compared with intraoperative findings. RESULTS: Transrectal color Doppler ultrasound visualized accessory pudendal arteries derived from supralevator arteries in 9, and prostatic and seminal vesicle arteries in all patients. Perineal color Doppler ultrasound visualized internal pudendal arteries in all patients. After intracavernosal injection of papaverine accessory and internal pudendal arteries displayed similar significant hemodynamic changes. Diameter as well as peak systolic and end diastolic velocities increased, and resistive index decreased. Prostatic and seminal vesicle arteries showed no significant change. Presence and location of accessory pudendal arteries demonstrated by transrectal color Doppler ultrasound were confirmed by intraoperative findings. CONCLUSIONS: During pharmacologically induced erection hemodynamic changes in accessory and internal pudendal arteries are similar to those described in cavernous arteries, thus demonstrating the functional role of accessory pudendal arteries in penile erection. Color Doppler ultrasound appears to be reliable to examine internal and accessory pudendal arteries based on morphological and functional criteria.

[The situation of young people in Germany--results of a representative population survey]. / Zur Situation der Jugendlichen in Deutschland--Ergebnisse bevölkerungsrepräsentativer Befragungen.

Youth and adolescence is one of great periods of upheaval during a human lifetime. Separation from parents and forming a stable individual identity are major themes. The present study outlines results relevant to this issue taken from three representative surveys of German population. The average results for various psycho-social parameters applying to young people in the country as a whole reflect a well-integrated, relatively contented and stable generation. Differentiating these results according to place of residence (East vs. West Germany) demonstrates, firstly, that psycho-social gap between East and West is closing faster among the younger generation than among the older sections of the population and, secondly, that East German youth is particularly burdened by special problems. The diminishing role of family as a stabilizing "counterpole" in the face of increasing objective difficulties and the possible consequences of this trend for young people is discussed in connection with the findings.

Identification of a cross-reactive self ligand in virus-mediated autoimmunity.

Molecular mimicry has been considered to be one of the potential mechanisms underlying the induction of autoimmune diseases. Using a TCR-transgenic model specific for lymphocytic choriomeningitis virus (LCMV) we have examined the potential for cross-reactive recognition of tissue-restricted self peptides. Several peptides were identified that were able to cross-react with the TCR-transgenic virus-specific T cells in vitro. One peptide was derived from dopamine beta-mono-oxygenase, an enzyme expressed in the adrenal medulla. Interestingly, after activation of the transgenic T cells with LCMV glycoprotein peptides or viruses, infiltration of the adrenal medulla was detected in conjunction with alterations in dopamine metabolism. However, complete destruction of the adrenal medulla was not observed. This suggests that molecular mimicry may be sufficient for self recognition and infiltration, but other factors clearly contribute to chronic autoimmune disease.

[Coping with disease in the elderly - the effect of perceived control, subjective morbidity, social support and socio-demographic variables]. / Formen der Krankheitsbewältigung bei älteren Menschen - differentielle Effekte von Kontrollerleben, subjektiver Morbidität, sozialer Unterstützung und sozio-demographischen Variablen.

In a community sample of 165 elderly aged 61 to 96 years (mean 69.65 years) from East and West Germany, present diseases, subjective health, impairments, health-related control-beliefs, social support (F-SOZU; Sommer & Fydrich, 1989), and health related coping-styles ("Bern Coping Styles Questionnaire" BEFO; Heim et al., 1991) were assessed. By means of a stepwise multiple regression analysis, the differential impact of control beliefs, subjective morbidity, subjective health, social support, social integration, social burden, and socio-demographic variables (age, sex, educational level) was analyzed. Elderly with little health related impairments, emotional support, and a relatively high educational level tried to cope with diseases by lowering the affective burden by cognitive and behavioral strategies. A growing number of diseases, a high level of practical help by others, but also a high degree of social burden were the best predictors for a health related coping strategy that is characterized by avoiding the preoccupation with the disease and by searching for emotional support. A health related coping style that is characterized by lamentation, brooding, and resignation was predicted best by poor subjective health, a high degree of social burden, and a low educational level.

[Subjective assessment of self health and subjective morbidity in Germany. Results of a representative demographic survey]. / Subjektive Einschätzung der eigenen Gesundheit und subjektive Morbidität in Deutschland. Ergebnisse einer bevölkerungsrepräsentativen Befragung.

This study presents selected results from the poll of a representative cross-section of the German population during the Spring of 1996 was subjective data on health and illness investigated, inter alia. The majority of the questioned subjects stated good health with low impairment of their general condition by their general conditions by their health. Compared with data from 1975, people have the impression that their health is in a better state, but, on the other hand, more significantly inparied by their health. East Germans claim a somewhat lower state of health and more impairment than West Germans; the same results were found for women in comparison with men and elderly persons compared with younger subjects. There is no difference between East and West Germans with respect the frequency of disease, but there were more illnesses with a clear morphological correlation reported by East-Germans. West Germans report more functional infirmities or troubles. One of the most striking results was the high frequency of cardiovascular disorders in East Germany. The influence of social support and social status on the subjective assessment of one's own health and subjective morbidity is of only low importance.