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Zusammenfassung In Deutschland wird gegenwärtig kontrovers diskutiert, welche gemeindepsychiatrischen Strukturen gefördert und ausgebaut werden sollen, um den besonderen Bedürfnissen der schwer psychisch Erkrankten gerecht zu werden. Anhand eines Literatur-Reviews systematischer Metaanalysen und kontrollierter Studien wird gezeigt, dass eine Reihe von gut evaluierten psychiatrischen Versorgungsbestandteilen existiert, von denen jedoch nur Teile in Deutschland verfügbar sind. Am Beispiel der Schizophrenie wird deutlich, dass strukturelle Voraussetzungen für eine Implementation evidenzbasierter nichtstationärer Behandlungs- und Versorgungsmodule in Deutschland nicht ausreichend vorhanden sind. Teambasierte aufsuchende Behandlung, Kriseninterventionsteams und andere gemeindepsychiatrische Teams sowie moderne berufliche Rehabilitationsprogramme, die zumeist im angelsächsischen Raum entwickelt wurden, konnten für die deutsche psychiatrische Versorgung bisher nur unzureichend adaptiert werden. Gleichzeitig sind viele in Deutschland praktizierte Versorgungsmodelle kaum wissenschaftlich evaluiert. Vor diesem Hintergrund wird zu künftigen Anforderungen und sinnvollen Weiterentwicklungen in der Psychiatrie und zur Deckung des zunehmenden Versorgungsbedarfs bei schweren psychischen Erkrankungen Stellung genommen.

We estimated age-specific herpes zoster (HZ) incidence rates in the Kaiser Permanente Northwest Health Plan (KPNW) during 1997–2002 and tested for secular trends and differences between residents of two states with different varicella vaccine coverage rates. The cumulative proportions of 2-year-olds vaccinated increased from 35% in 1997 to 85% in 2002 in Oregon, and from 25% in 1997 to 82% in 2002 in Washington. Age-specific HZ incidence rates in KPNW during 1997–2002 were compared with published rates in the Harvard Community Health Plan (HCHP) during 1990–1992. The overall HZ incidence rate in KPNW during 1997–2002 (369/100000 person-years) was slightly higher than HCHP's 1990–1992 rate when adjusted for age differences. For children 0–14 years old, KPNW's rates (182 for females, 123 for males) were more than three times HCHP's rates (54 for females, 39 for males). This increase appears to be associated with increased exposure of children to oral corticosteroids. The percentage of KPNW children exposed to oral corticosteroids increased from 2·2% in 1991 to 3·6% in 2002. Oregon residents had slightly higher steroid exposure rates during 1997–2002 than Washington residents. There were significant increases in HZ incidence rates in Oregon and Washington during 1997–2002 among children aged 10–17 years, associated with increased exposure to oral steroids.

Zusammenfassung Behandlungsergebnisse und Leitlinienkonformität in ausgewählten Indikationsbereichen bei der stationären Schizophreniebehandlung wurden anhand von 597 Patienten aus 7 psychiatrischen Kliniken systematisch dargestellt und verglichen. Es zeigten sich deutliche Unterschiede in der Patientenstruktur und den angewandten Behandlungsverfahren zwischen den Kliniken. Patientenmerkmale, insbesondere die Psychopathologie bei Aufnahme und die Chronizität der Erkrankung stellten sich als die stärksten patientenbezogenen Prädiktoren für den klinischen Status bei Entlassung heraus. Eine Beurteilung der Behandlungsqualität in den Kliniken mittels definierter Indikatoren ist nur eingeschränkt und nach einer Case-Mix-Adjustierung unter Berücksichtigung prognostisch relevanter Parameter möglich. In diesem Modell war ein ungünstigeres durchschnittliches Behandlungsergebnis im Klinikvergleich mit geringerer Leitlinienkonformität bei einer Reihe von Indikationsbereichen verbunden. Diese Ergebnisse unterstützen die Verwendung der Leitlinienkonformität in der Schizophreniebhandlung als zu vergleichendes Klinikmerkmal zur datengestützten internen Qualitätsoptimierung und lassen die Entwicklung von Strategien zur Steigerung der Leitlinienorientierung sinnvoll erscheinen.

Five kinds of polylactides (PLAs), with different D-lactide contents and tacticities, were subjected to high-speed melt-spinning experiments. In addition to stereochemical purity, the PLA types differed in molecular mass and molecular mass distribution. The properties of the different PLA materials were characterized by thermogravimetry, differential scanning calorimetry, dynamic mechanical analysis, size exclusion chromatography, and ¹H-NMR and ¹³C-NMR spectroscopy. The material was spun with a high-speed spinning process within the range 2000–5000 m/min. The physical and tensile properties of the fibers were determined. The maximum tensile properties of the fibers were a 300 MPa tenacity at an elongation at break of 30% and a tensile modulus of 6.8 GPa. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 91: 800–806, 2004

Thirteen women, six of whom were using oral contraceptive agents, between the ages of 23 and 3 4 years, free from illness, and without a previous clinical history of menstrual abnormality, were studied with chronobiological methods for circadian (about 24 hour) patterns of metal and creatinine excretion. Circadian rhythms were detected for the excretion of lithium, potassium, iron, sodium, copper, and creatinine. Statistically significant by lower 24 hour excretion (mesors) of lithium, potassium, and iron was detected for the subjects using oral contraceptive agents. Although all women adhered to nearly identical activity-rest (synchronization) schedules, the peak times (acrophases) of the metal excretory rhythms for oral contraceptive users were phase delayed by about two hours.

In a population-based case-control study of the association between use of diuretics and renal cell cancer, 120 white men whose cancer was diagnosed during the years 1980-1991 and 86 white women diagnosed in 1960-1991 were identified among members of the Kaiser Permanente Northwest health plan. Controls were plan members who had been individually matched to cases on sex, race, age, and time period in the plan. Data on diuretic use and other selected variables were abstracted from outpatient and inpatient medical records. In an analysis confined to exposures present at least 2 years before case diagnosis, the odds ratios associated with any use of a diuretic drug were 2.2 (95% confidence interval 1.2-3.9) for men and 1.8 (95% confidence interval 1.01-3.2) for women. Increased duration of diuretic use was associated with an increased risk of renal cell cancer. This association was not restricted to one class of diuretic and was not confounded by cigarette smoking or body mass. Both hypertension and use of nondiuretic antihypertensive drugs were closely associated with diuretic use, and it was impossible to disentangle fully the effects of these three separate exposures. These results, together with those of prior studies, are generally compatible with the view that there is an association between diuretic use and the incidence of renal cell cancer, but the interpretation of that association remains in question.

Il est actuellement classique de considérer que l'hyperplasie virilisante congénitale de la corticosurrénale est due à un défaut génétique de la C21-hydroxylase (Eberlein & Bongiovanni, 1954; Jailer et al., 1955; Wilkins et al., 1955); il en résulte un défaut ou une absence de la biogénèse du cortisol et un excès de sécrétion de 4-pregnène-17α-ol 3,20-dione (17-hydroxyprogestérone) et une augmentation de la formation de 4-pregnène-11β 17α-diol 3,20-dione (21-désoxy-cortisol). Les deux metabolites principaux de ces stéroïdes sont le 5β-pregnane 3α, 17α, 20α-triol (pregnanetriol) et la 5b-pregnane 3α, 17α, 20α-triol 11-one (pregnanetriolone). Cela a pour effet une augmentation des stéroides acétaldéhydogénes dans les urines (Cox & Marrian, 1952). Le taux faible ou nul du cortisol circulant entraine une hyperproduction d'ACTH (Sydnor et al., 1953) qui détermine, au niveau de la corticosurrénale, une sécrétion fortement augmentée des androgénes surrénaliens et en particulier de l'androsténedione et de ses dérivés (Jaoudé et al., 1957,

Study objective: To estimate the potential risk of HIV exposure for those providing emergency care for out-of-hospital cardiac arrest in Seattle, Washington, by surveying the seroprevalence of HIV in the patient population. Methods: We surveyed the seroprevalence of HIV among 1,474 persons treated for out-of-hospital cardiac arrest by paramedics during the years 1989 through 1993. Blood specimens were obtained at the site of cardiac arrest, stripped of personal identifiers, and tested for HIV-1 and HIV-2 by enzyme immunoassay and Western blot. Results: Among the 1,011 men, 8 (.8%, 95 percent confidence interval .3% to 1.4%) were seropositive for HIV-1 during this 5-year period; all 8 were younger than age 55. No serologic evidence of HIV infection was detected among the 463 women. Conclusion: The seroprevalence of HIV in this population was relatively low. Risk of possible HIV transmission during paramedic treatment was remote. [Weinmann S, Siscovick DS, Raghunathan TE, Handsfield H, Copass M, Cobb LA: Human immunodeficiency virus seroprevalence among adults treated for out-of-patient cardiac arrest in Seattle, Washington, 1989-1993. Ann Emerg Med August 1998; 32:148-150.]