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BACKGROUND: An evaluation of geriatric rehabilitation has been carried out in Rhineland-Palatinate for over 10 years by collecting data of patients absolving an inpatient geriatric rehabilitation program. The aim of the project was to improve the transparency of outcome quality. The procedure is equally supported by geriatric rehabilitation clinics, health insurance companies and the Medical Service of Health Insurance (MDK). MATERIAL AND METHODS: Consented information about the rehabilitation process has been collected from every geriatric rehabilitation clinic in Rhineland-Palatinate. The data were pseudonymized and sent to the MDK in Rhineland-Palatinate for statistical analysis. The dataset included age, diagnosis, life circumstances before rehabilitation, duration of the rehabilitation, therapy implemented and need for support (with or without personal assistance) in eight activities of daily living at the beginning and at the end of rehabilitation. RESULTS: The results of 45,751 participants who underwent rehabilitation between 2005 and 2014 are presented. There was a slight tendency towards an increase in the number of very old geriatric patients undergoing rehabilitation. The average duration of rehabilitation decreased slightly during the observation period, while the frequency of therapy increased. The reduction in the need for assistance during rehabilitation remained constant over the observation period. CONCLUSION: Systematic evaluation improves the transparency of the rehabilitation process.
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Actividades Cotidianas/psicología , Personas con Discapacidad/rehabilitación , Personas con Discapacidad/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Calidad de Vida/psicología , Rehabilitación/estadística & datos numéricos , Revisión de Utilización de Recursos , Anciano , Anciano de 80 o más Años , Personas con Discapacidad/psicología , Femenino , Alemania/epidemiología , Encuestas de Atención de la Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Rehabilitación/psicología , Resultado del TratamientoRESUMEN
INTRODUCTION: There are hardly any publications about the outcome of cardiac rehabilitation considering patients with an increased need for medical, nursing and therapeutic care. The aim of this study, which consecutively included n=387 statutory health insurance inpatients over a period of 2 years, was to find out differences in outcome in self-care patients (Barthel index>70) as compared to patients with a need for complex care (Barthel index≤70). METHODS: Rehabilitation outcomes concerning physical capacity, emotional status and activities of daily living as measured by Barthel index, FIM index, HADS, clinical complications, exercise test, duration of rehabilitation and form of dismission were analyzed and compared between both groups. RESULTS: The inpatients with a Barthel index ≤70 at admission were older, had a longer stay in hospital and in rehabilitation, developed more complications and more often suffered from concomitant diseases. They were readmitted to hospital more often. They showed a comparatively higher increase in indices of self-care and a significant increase in physical performance tests. CONCLUSION: Higher medical care expenses of multimorbid cardiac inpatients are no contraindication against rehabilitation, because even in this group the specific rehabilitation aims of the healthcare payers can be reached.
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Actividades Cotidianas/psicología , Rehabilitación Cardiaca/psicología , Rehabilitación Cardiaca/estadística & datos numéricos , Personas con Discapacidad/psicología , Personas con Discapacidad/rehabilitación , Autocuidado/estadística & datos numéricos , Anciano , Personas con Discapacidad/estadística & datos numéricos , Tolerancia al Ejercicio , Femenino , Alemania/epidemiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Admisión del Paciente/estadística & datos numéricos , Prevalencia , Pronóstico , Estudios Retrospectivos , Autocuidado/psicología , Resultado del TratamientoRESUMEN
BACKGROUND: Rehabilitation after hip and knee replacement surgery is effective, but cost intensive. To ensure consistent cost-effectiveness across different providers prospective cohort studies on its clinical and economic outcome are recommended. Comparisons alongside suitable outcome quality indicators enable to contrast different providers and--in case of clinically or economically relevant differences--reveal constructive approaches to quality improvement. AIM: Therefore an external benchmarking for posthospital curative treatment after hip and knee arthroplasty between nine inpatient rehabilitation departments in the German Federal Land Rhineland-Palatinate was implemented based on data acquired between 01/2007 and 12/2009. DESIGN: Multi-centre retrospective cohort benchmarking study. SETTING: Inpatient rehabilitation in nine rehabilitation departments POPULATION: A total of 8672 patients after unilateral hip arthroplasty (THA) and 8180 patients after unilateral knee replacement (TKA) surgery were investigated. The median age of the patients after hip arthroplasty varied between 71 and 75 years, after knee arthroplasty between 72 and 75 years. The department-wise proportions of female patients ranged from 62% to 77% (THA) and from 70% to 81% (TKA). METHODS: Data on clinical outcome of inpatient rehabilitation after THA and TKA were documented using the EVAReha® software. As primary indicator of clinical outcome quality the intra-individual pre-post change in the total Staffelstein Index was determined [%], as primary economic indicator the cost-normalized effect estimate (CNEE) was estimated [%/] relating the individual Staffelstein Index change to a patient's respective direct costs [] paid by the statutory health insurance. RESULTS: In the nine departments the median Staffelstein index increase after THA ranged between 18% to 31% corresponding to median CNEEs ranging from 9% to 15% Staffelstein increase per 1000 investment of the statutory health (Kruskal/Wallis P<0.001). After TKA the median Staffelstein index increase ranged between 19% to 34% corresponding to median CNEEs ranging from 9% to 16% Staffelstein increase per 1,000 investment of the statutory health (Kruskal / Wallis P<0.001). CONCLUSION: Inpatient follow-up treatment after hip and after knee replacement surgery demonstrated a statistically significant and both clinically and economically relevant heterogeneity between the departments. Additional exploratory analyses by means of adjustment with further predictors could not resolve these heterogeneities. CLINICAL REHABILITATION IMPACT: Benchmark information on cost effectiveness would enable departments to learn from the "best" and to implement corresponding peer cooperation, to then identify own shortcomings and potentials, and thereby to analyze and optimize local processes.
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Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Pacientes Internos , Anciano , Benchmarking , Análisis Costo-Beneficio , Femenino , Alemania , Humanos , Masculino , Estudios Retrospectivos , Programas Informáticos , Resultado del TratamientoRESUMEN
BACKGROUND: So far, for center comparisons in inpatient cardiac rehabilitation (CR), the objective outcome quality was neglected because of challenges in quantifying the overall success of CR. In this article, a multifactorial benchmark model measuring the individual rehabilitation success is presented. METHODS: In 21 rehabilitation centers, 5123 patients were consecutively enrolled between 01/2010 and 12/2012 in the prospective multicenter registry EVA-Reha (®) Cardiology. Changes in 13 indicators in the areas cardiovascular risk factors, physical performance and subjective health during rehabilitation were evaluated according to levels of severity. Changes were only rated for patients who needed a medical intervention. Additionally, the changes had to be clinically relevant. Therefore Minimal Important Differences (MID) were predefined. Ratings were combined to a single score, the multiple outcome criterion (MEK). RESULTS: The MEK was determined for all patients (71.7 ± 7.4 years, 76.9% men) and consisted of an average of 5.6 indicators. After risk adjustment for sociodemographic and clinical baseline parameters, MEK was used for center ranking. In addition, individual results of indicators were compared with means of all study sites. CONCLUSION: With the method presented here, the outcome quality can be quantified and outcome-based comparisons of providers can be made.
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Personas con Discapacidad/rehabilitación , Cardiopatías/diagnóstico , Cardiopatías/rehabilitación , Hospitalización/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/normas , Garantía de la Calidad de Atención de Salud/normas , Anciano , Alemania , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
INTRODUCTION: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators. METHODS: With "EVA-Reha; cardiac rehabilitation" the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed. RESULTS: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators. CONCLUSION: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population--e. g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers.
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Cardiopatías/diagnóstico , Cardiopatías/rehabilitación , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/normas , Evaluación del Resultado de la Atención al Paciente , Indicadores de Calidad de la Atención de Salud/normas , Índice de Severidad de la Enfermedad , Anciano , Algoritmos , Femenino , Alemania , Humanos , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: In the German health system general practice has changed drastically in the past few years and patients' opportunities to get medical informations have increased significantly. In light of this, patients' needs in general practice should be re-assessed. PATIENTS AND METHODS: 279 patients from 16 practices mainly in Hessen and Rhineland-Palatinate were interviewed. Using principal factor analysis, 51 questions about doctors were analyzed regarding possible dimensions of patient care needs. RESULTS: The dimensions of patient care needs could be described with four scales: (1) social situation and emotional support, (2) the practitioner's expertise, explanations and information, (3) empathy and esteem for patients and (4) availability of the practitioner and care to chronic patients. In older age groups the importance of psychosocial care was emphasized as well as the practitioner's availability and care for patients with chronic diseases. CONCLUSION: Patient care needs are concentrated in four scales, which include psychosocial and continuous care and availability for patients with chronic diseases. These tasks should be further emphasized in medical education and also represented in the remuneration of practitioners.
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Medicina General/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Programas Nacionales de Salud/tendencias , Satisfacción del Paciente , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Consejo/tendencias , Femenino , Alemania , Accesibilidad a los Servicios de Salud/tendencias , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Derivación y Consulta/tendencias , Factores Sexuales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: The aim of this study is to evaluate if theoretically possible edge shifts induced by noise-suppression filters potentially occur on objects found in digital radiographs. Most manufacturers carry out noise-suppression filtering of their images before they are displayed to the user. It is not usually possible for the user to disrupt the function of the filters. The use of these filters can lead to deletion of small image structures. METHODS: K-files (ISO size 06, 08, 10 and 15) were placed in the root canals of 6 human teeth located in cadaver jaw segments. File tip positions were measured on original and filtered digital images by three observers. The file position was marked on each filtered image and compared with the unfiltered ones. RESULTS: The 5 × 5 pixel-sized median and mean filters caused the largest underestimation of measured lengths between -7.87 pixels and -10.8 pixels (-306.93 µm and -421.2 µm). Maximum standard deviation for length differences was found for the calculated position ( = gold standard) and the original unfiltered images with 13.31 pixels. The standard deviation found for the 5 × 5 mean and median filter was 7.62 pixels and 8.68 pixels. CONCLUSION: Different studies showed that noise-suppression filters can induce edge shifts in diagnostic radiographs. The high standard deviations found for length differences between the defined gold-standard and the original images indicate that theoretical edge shifts may not be clinically relevant for length measurements of endodontic files.
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Artefactos , Instrumentos Dentales , Cavidad Pulpar/diagnóstico por imagen , Filtración/instrumentación , Radiografía Dental Digital , Preparación del Conducto Radicular/instrumentación , Cadáver , Diseño de Equipo , Humanos , Mandíbula/diagnóstico por imagen , Técnica de SustracciónRESUMEN
BACKGROUND: Since 2009 there is a legal obligation in Germany to provide quality reports for all nursing facilities. OBJECTIVE AND METHODS: Criteria for measuring and presenting the quality of care defined for health services are applied to the area of nursing care. The German Nursing-Transparency-Order for nursing homes has been compared with those attributes. RESULTS: Prior to realisation of the concept of publishing quality reports of care facilities, the definition of high-quality care standards, an explicit objective for quality reporting and the definition of addressees are required. The quality indicators to be derived must be relevant from the user's point of view as well as from professional perspectives. Benefits and undesirable effects must be weighted out mutually. Relevant for the choice of quality indicators are the methodical attributes: strength of evidence, precision of definitions, ability of discrimination, reliability and validity. To make the results comparable between facilities, it is suggested to include an equally stratified random sampling of persons. An aggregation or summation of the results may basically only occur when the results have a common content coherence (correlation) and the same importance (weighting). Through explicit specifications for the assessment, for example, so-called knock-out criteria, it must be assured that in essential events like damages under non-expert care, there are no compensations by other results. The German Nursing-Transparency-Order for nursing homes fulfils only one part of the generally established methodical quality criteria. CONCLUSION: The procedure for the choice of quality indicators must be made clear; the methodical quality must be tested and the test results must be published. Above all it must be proven with test results that the appraisal of experts and users agrees with the results of the nursing transparency (validity). An accompanying research is absolutely necessary.
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Hogares para Ancianos/normas , Programas Nacionales de Salud/normas , Casas de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Informe de Investigación/normas , Alemania , HumanosRESUMEN
Health-related quality of life (QoL) is a major topic within the care for cancer patients (CP). Compared with the general population (GP), QoL of CP is worse in most dimensions; however, only few data comparing QoL of CP with that of other patients have been provided so far. We determined QoL with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire in hospitalized patients aged 60 years and older: 195 CP and 130 patients treated for other medical disorders (MP). In addition, data were compared with an age- and gender-stratified German GP. Explorative statistical analyses were performed. The CP aged >or=70 years compared with those aged 60-69 years had decreased QoL in two scales, physical and cognitive functioning, MP in four scales, physical and role functioning, fatigue and dyspnoea respectively. Compared with the GP, both CP and MP had worse QoL in almost all scales. The CP and MP differed in two of 15 scales only, with CP having lower scores in emotional functioning and more loss of appetite. In conclusion, reduced QoL in elderly CP compared with GP cannot solely be attributed to the diagnosis of cancer, but also to a medical disorder requiring inpatient hospital care.
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Estado de Salud , Neoplasias/psicología , Calidad de Vida , Encuestas y Cuestionarios , Factores de Edad , Anciano , Anciano de 80 o más Años , Comparación Transcultural , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Psicometría , Factores SexualesRESUMEN
The aim of the present roentgenographic in vitro study was to determine the initial straight length from the cemento-enamel junction (CEJ) to the appearance of a root canal curvature in human mandibular premolars. A total number of 282 mandibular premolars were examined. Exclusion criteria comprised root caries, extensive restorations and endodontically treated teeth. The teeth were fixed and digitally radiographed by means of a specially developed fixation device with standardized and reproducible distances with the parallel technique (Heliodent MD; Merlin 2.1). The distances from the CEJ to the first curvature (> 5 degrees ) (distance I), from the first curvature to a second curvature (distance II), and from the first or second curvature to the radiological apex (distance III) were recorded. The lengths of the initial straight distance and the appearance of a curvature were statistically analyzed and related to each other. In first mandibular premolars, the mean value for distance I was 10.9 mm, for distance II 3.7 mm and for distance III 3.04 mm. The mean values for the second mandibular premolars were 1.1mm in distance I, 4.3mm in distance II and 3.1mm in distance III. No statistically significant differences between left and right mandibular premolars could be observed regarding the canal curvature location and the angle values. The results of this investigation show that curvatures are increasingly observed 9 to 12 mm from the original path in mandibular premolars.
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Diente Premolar/diagnóstico por imagen , Cavidad Pulpar/diagnóstico por imagen , Humanos , Mandíbula , Radiografía , Cuello del Diente/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. METHODS: One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the device. Teeth were then extracted and examined under a stereomicroscope by two trained dentists (DENT 1, DENT 2) and a dental student. Results were compared with the measurements of the OP and direct visual control. RESULTS: In group A, post-extraction results revealed 89% and 90% agreement with the positive and negative OPs detection. In group B, 17% of the surfaces demonstrated even after subgingival debridement and control with the detecting device still calcified deposits in the microscopic evaluation. The highest inter-examiner agreements were observed between DENT 1 and DENT 2. CONCLUSION: It was shown that the optical detection system identifies subgingival calculus with a high efficacy and therefore, may be a support for the operator to determine the endpoint of root surface instrumentation.
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Cálculos Dentales/diagnóstico , Diagnóstico por Computador , Luz , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Semiconductores , Procesamiento de Señales Asistido por ComputadorRESUMEN
BACKGROUND: Depressive symptoms are a major complaint reported by cancer patients. Somatic and affective symptoms can contribute to depression. PATIENTS AND METHODS: We investigated the prevalence of somatic and affective depressive symptoms with the Beck Depression Inventory (BDI) in 213 hospitalized cancer patients prior to the start of chemotherapy. RESULTS: Seventeen of 213 patients (8%) were screened positive for major depression; 40 (19%) had mild to moderate depressive symptoms. The corresponding figures for somatic and affective symptoms were 33.3% and 2.8% in the patients with major depression and 23.0% and 8.0% in those with mild to moderate depressive symptoms. Female patients, patients with solid tumour and those with functional limitations had significantly higher mean scores. All differences were related to higher scores in somatic and not in affective items. CONCLUSIONS: Most alterations in the BDI in cancer patients are related to somatic and not to affective symptoms and may be attributed not to depression but to severity of the underlying disease.
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Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Neoplasias/epidemiología , Calidad de Vida , Adaptación Psicológica , Adolescente , Adulto , Distribución por Edad , Anciano , Estudios de Casos y Controles , Causalidad , Comorbilidad , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Hospitales Universitarios , Humanos , Entrevista Psicológica/métodos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/psicología , Prevalencia , Probabilidad , Escalas de Valoración Psiquiátrica , Medición de Riesgo , Distribución por Sexo , Perfil de Impacto de Enfermedad , Estadísticas no Paramétricas , Estrés Psicológico , Encuestas y CuestionariosRESUMEN
Associations of functional status (as measured with the Karnofsky Index), depressive symptoms (as assessed with the Beck Depression Inventory), and sociodemographic characteristics with health-related quality of life (HrQoL; measured with the EORTC Quality of Life Questionnaire QLQ-C30) were assessed in 170 recently diagnosed cancer patients. A better functional status (p<0.001) and a lower level of depressive symptoms (p<0.001) were associated with better HrQoL. In addition, an interaction effect of functional status with HrQoL was found (p<0.001), indicating that stronger functional impairments were related to lower HrQoL in patients with low and average levels of depressive symptoms, but not in those with high levels of depressive symptoms. Associations of HrQoL with sociodemographic variables were not significant. It is concluded that functional decline does not additionally impair HrQoL when patients already have elevated levels of depressive symptoms.
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Depresión/diagnóstico , Estado de Ejecución de Karnofsky , Neoplasias/psicología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Anemia/complicaciones , Carcinoma/tratamiento farmacológico , Cognición/fisiología , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Carcinoma/epidemiología , Humanos , Neoplasias Pulmonares/epidemiología , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: The aim was to assess the impact of comorbidity on survival of postmenopausal women with breast cancer diagnosis in the period 1995-1997. METHODS: The level of comorbidity was described by the methods suggested by Satariano and Charlson. Cox's proportional hazard models were used to explore the impact of comorbidity on all-cause mortality. RESULTS: After a median follow-up time of 52 months, an increasing level of comorbidity was associated with a higher all-cause mortality. Compared to patients with-out comorbid conditions, the hazard ration of death (HR) was 1.2 (95% CI: 0.8-1.7) for Satariano index 1 and HR 2.3 (95% CI: 1.5-3.5) for Satariano index >or=2, and HR 1.6 and 2.1 for the Charlson comorbidity index, respectively. Independent of comorbidity, the treatment pattern had a strong impact on survival. The level of comorbidity has an influence on the 3-year survival of postmenopausal women with breast cancer. CONCLUSIONS: Long-term follow-up is required to appraise these findings in relation to treatment strategies.
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Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/mortalidad , Posmenopausia , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de SupervivenciaRESUMEN
PURPOSE: To assess adherence to treatment recommendations regarding adjuvant systemic therapy of postmenopausal patients with early stage breast cancer. METHODS: A population-based cohort of women from Eastern Thuringia/Germany with first diagnosis of breast cancer in 1995-2000 was studied. The use of adjuvant therapy was assessed separately for patients with positive and negative nodal status fitting polytomous logistic regression models. RESULTS: Among 396 women with positive lymph nodes and 832 with negative lymph nodes, 92.9% and 87.3% received an adjuvant systemic treatment, respectively. Age, comorbidity, hormone receptor status, histological grading, and additionally, in nodal positives, the number of involved lymph nodes, were associated with treatment patterns. Age had the strongest impact on treatment decision. Older women more often received hormone- or no adjuvant therapy. However, 26.3% of the women with lymph node involvement and positive hormone receptor status received no hormone therapy, whereas 35.7% of women with negative hormone receptor status received hormone therapy. CONCLUSION: The number of patients with adjuvant systemic therapy is high in women with positive and those with negative lymph nodes, reflecting adherence to the recommendations. Better outcome could be expected if hormone therapy was used adequately in receptor positives. Further follow-up is required to monitor the outcome and changes in adherence to treatment recommendations.
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Neoplasias de la Mama/tratamiento farmacológico , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Diferenciación Celular/efectos de los fármacos , Quimioterapia Adyuvante , Estudios de Cohortes , Femenino , Humanos , Ganglios Linfáticos , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Vigilancia de la Población , Posmenopausia , Receptores de Estrógenos , Receptores de ProgesteronaRESUMEN
The aim of this study was to find a suitable biomarker for pyrethroid adverse effects. It was shown that there is a correlation between the half-life time (t(1/2)) of pyrethroids in plasma and the clinical findings. We hypothized that this finding indicates an interindividual different amount of total esterase activity or even a polymorphism. By in vitro experiments it was demonstrated that pyrethroids are cleaved by carboxylesterases. After it turned out that carboxylesterase activity in human plasma is too low for detection, a method for specific determination of carboxylesterase activity in human isolated lymphocytes was developed. As a substrate for carboxylesterase activity, cyfluthrin was added to the lymphocyte suspension. As a proof for cyfluthrin degradation by carboxylesterases the produced hydrocyanic acid was determined by GC/MS. First hints for interindividual differences in carboxylesterase activity in lymphocytes were found.
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Insecticidas/efectos adversos , Piretrinas/efectos adversos , Hidrolasas de Éster Carboxílico/sangre , Semivida , Humanos , Linfocitos/enzimología , Masculino , Nitrilos , Exposición Profesional , Control de Plagas , Piretrinas/metabolismoRESUMEN
Molybdenum is an essential micronutrient. It plays a complex role in the ecosystem, because the metal is a part of a cofactor for several important enzymes in human, animal and plant metabolism. The physiological requirement for this element is relatively low. Our investigations were aimed at determining the Mo intake of adults in Germany and Mexico by means of duplicate portion technique. Molybdenum was estimated in the food duplicate samples by inductively coupled plasma atomic emission spectrometry. In 1988, 1992 and 1996 the Mo consumption of humans was investigated in 14 test groups of persons with mixed diets. Each test population consisted of seven men and seven women. Furthermore, in 1996 the Mo intake of 10 female and 10 male vegetarians and of two Mexican test groups was also determined. Different factors, such as sex, time of investigation, location and eating habits have an effect on the individual Mo intake, Molybdenum intake of adults with mixed diets has increased significantly from 1988 to 1996. Furthermore, results of our study showed that Mo intake of German adults differs depending on location and the kind of diet. German women with a mixed diet consumed 89 micrograms d-1 in 1996 and men 100 micrograms d-1. In comparison, female and male vegetarians consumed 179 micrograms d-1 and 170 micrograms d-1, respectively. There was a significant difference in Mo consumption between German and Mexican test persons. Mexican women consumed on average 162 micrograms d-1 and Mexican men 208 micrograms d-1. The Mo requirement of adults amounts to about 25 micrograms d-1. Our investigations showed that the Mo requirement is met by normal intake. An intake of 150 micrograms kg-1 body weight may be toxic for humans. Therefore, people in Germany and Mexico are not endangered by Mo exposure.