The recent cloning of the genome of a parenterally transmitted non-A, non-B hepatitis virus, designated the hepatitis C virus (HCV), has been used for the development of an enzyme immunoassay for the detection of antibodies against HCV (anti-HCV). We have employed this assay to evaluate the prevalence of HCV antibodies in hospital personnel and voluntary blood donors. Twelve of 1018 sera (1.2 percent) from health care workers were repeatedly reactive in the enzyme immunoassay for anti-HCV. Specificity testing with a modification of the enzyme immunoassay (additional wash cycle with 8 mol/l urea) and a recombinant immunoblot assay demonstrated HCV antibodies in only 6 of the 12 sera. Thus, the true prevalence of anti-HCV in hospital personnel was 0.6 percent. Nine of 1046 sera (0.9 percent) from blood donors were reactive in the enzyme immunoassay for anti-HCV. In none of the 9 sera the presence of HCV antibodies could be confirmed by additional testing with the urea wash modification or the recombinant immunoblot assay. The true prevalence of anti-HCV in blood donors thus appears to be lower than 0.1 percent. Our results indicate that the risk of HCV transmission in the hospital setting appears to be low, but is significantly higher than that of the general population.
The following points of emphasis were highlighted during a tour of the laboratory in which physicians participated who are interested in measurements in environmental hygiene (e.g. biomonitoring) and are therefore keen on installing such equipment themselves: Relevant substances in water, soil and air--Sampling procedures--Methods of analysis and price of equipment--Limit values, reference (standard) values, general principles of assessment--Legal aspects of measurement programmes conducted by Public Health Services. Possibilities were shown to gradually change over from the methods of measurement conventionally employed by the Public Health services, to more efficient methods, by discussing as examples the direct indicating air measurement tubes (standard size approx. 1 mg/m3 transverse sensitivity) as well as active sampling using Dräger activated carbon tubes.
Hypertension is one of the principal risk factors for cardiovascular diseases; its roots go back to childhood. A load study such as ergometry can help to recognise which persons are at risk. Ergometric measurements were performed by us on 105 children and adolescents, 72 of whom had borderline hypertensive or hypertensive blood pressure levels. Of these, the blood pressure rose during stress in 14%, the proportionate share being independent of the physical activity of the subjects. However, among those whose hypertension was on a borderline level, there was a disproportionately large percentage of obese subjects. These showed in addition an increase in blood pressure with increasing load and a reduced physical performance range. Obesity and lack of physical mobility had an unfavourable influence on blood pressure. Unfortunately there are no standardised rules for assessing the blood pressure during stress in children and adolescents. This would be all the more desirable since this easy examination is of prognostic value for an early discovery of manifest hypertension.
It is possible to describe all work-relevant psychological abilities of every disabled person, as well as the corresponding requirements of different jobs with a recently developed catalogue of only 30 items. A comparison of ability profiles with job-related requirement profiles allows a well-directed vocational integration of the disabled. The method can be used in every trade or branch; it includes all job-related psychological characteristics and is economic in application.
We sum up below an assessment of data collected in respect of outpatient medical care in the new Federal Land of Saxony-Anhalt as well as of the expert discussions conducted with the medical officers, the responsible physicians of the Association of Doctors registered with the compulsory German sickness insurance body, and with many practising physicians: The process of enabling the doctors to register their practice on an independent basis, is nearing completion and will be finalized in 1992. The medical associations and especially the association of doctors registered with the compulsory German sickness insurance body have a large share in this development. As early as in August 1991, outpatient medical care by general practitioners was already safeguarded. This applies also to the disciplines of ophthalmology, skin diseases and paediatrics. It will be the task of the association of doctors of the compulsory sickness insurance system to close existing gaps in some disciplines and to balance out any regional differences. This process has materialized in a very short time only. The result has been far better than expected, both quantitatively and qualitatively. Hence, the association has been successful in safeguarding medical care in a satisfactory manner.
In the course of industrial-scale manufacture of unfermented rhubarb fruit juice, the deacidifying agent CaCl2 was confused with the disinfectant NH4HF2. Hence, fluoride in a quantity of up to 0.6 g/l was present in the unfermented fruit juice. Signs of acute fluoride poisoning were therefore seen after ingestion of the rhubarb juice. The incident as well as the steps taken by the relevant control authorities are described in detail.
An incidence study, completed in 1990, revealed a significantly increased incidence of leukaemias in the near vicinity of a hazardous waste dump. Linear regression of community incidence rates with community distance to the hazardous waste site showed negative coefficients for leukaemias and malignant lymphoma.
Of the unnatural deaths in childhood, those following child abuse are among the most disturbing. The incidence of unknown cases is high, although a rising number becomes known with increasing awareness by physicians, but obviously also with higher frequency of autopsies. Fatal physical child abuse is mainly related to head and abdominal trauma, besides meeting worst cases of neglect again and again. Diagnostic differentiation between falling from baby's dressing-tables, washing-machines, bed or rockinghorse--as stated generally--may be difficult in individual cases, but in most cases there is rather repeated abuse, so that the different age and nature of the injuries make it possible to draw decisive conclusions. The casual discrepancy between insignificant external and serious internal injuries again and again complicates discovery and identification of such abuses in time, but also of culpable homicides and accidents. From our point of view, it is imperative to perform an autopsy in every unclear case of death in infancy or childhood for further clarification.
We have used a recently developed enzyme immunoassay to evaluate the prevalence of hepatitis C virus antibodies (anti-HCV) in patient groups and hospital personnel. The prevalence of anti-HCV in haemophiliacs, intravenous drug users, male homosexuals, and haemodialysis patients was 86, 63, 28, and 9 percent, respectively. Eight of 738 (1.1 percent) sera from health care workers were positive for anti-HCV. Only two of the 8 employees which were seropositive for anti-HCV also demonstrated serological markers of a previous infection with hepatitis B virus. The reported seroepidemiological data may not correctly reflect the risk of HCV transmission in the hospital setting, since the currently available assay shows a high sensitivity only for the detection of persistent HCV infections. There is an urgent need for the development of HCV antibody assays with increased sensitivity.
In the former GDR, a series of central regulations governed the sanitary and hygienic aspects of town planning and building construction. Special analysis of the hygienic aspects of town planning was of particular importance and was performed by a standardised method by the planning authorities. In such an analysis both the existing hygienic conditions in an area to be built up or reconstructed had be included, as well as the planned hygienic conditions after putting the building measures into practice. The complicated way of planning and the possibility of rejecting hygienic considerations in favour of political decisions proved to be an obstacle to quick and hygienically satisfactory realisation of planned investments.
To estimate the danger of infection by a mud bath, especially in group baths, 51 mud samples were analysed before and 80 after application for faecal and total coliforms (FC, GC), Pseudomonas aeruginosa. Staphylococcus aureus and Candida albicans. The latter two germs were not identified in any of the samples. Pseudomonas aeruginosa was found in about 11% of the samples of both groups. FC and GC were also found before as well as after the bath. Besides E. coli, 9 other strains could be identified. It can be concluded from the data on FC and GC before and after bath, firstly, that a slight faecal contamination is possible, secondly, that the mud can be considerably contaminated with faecal germs even before application. The risk of faecal germs in mud baths causing an epidemic can be neglected, because the bath mud is not swallowed. Therefore, the use of a large-scale mud bath for several patients can be recommended.
New legal provisions set a limiting value of 0.1 mg TCE/m3 air in flats. Follow-up examinations by the Public Health Office Bremen show again that so far this limit can not be complied with in flats adjacent to dry cleaners. Interviews with affected residents give no hint for a change in utilisation habits. The Upper House of the German Federal Parliament has taken the legislative initiative for a complete prohibition of TCE in consequence of the fundamental problem of limiting values.
The aim of the present study was to analyse the state of medical care by the family doctor in selected areas of the province Halle in the former GDR (land Sachsen-Anhalt). We questioned physicians on their activities, and patients on their expectations in medical care by the family doctor. Both groups considered the trusting physician-patient relation, long-time medical care by the same doctor, home visits and the attention given to the whole family, as the main characteristics of this medical care. The results show that permanent medical care by the same doctor increased with advanced age, and was at every age higher in women than in men. In about 60% of the patients medical care had been exercised by the same doctor for more than five years. Both physicians and patients valued the reciprocal trustful correlation as the most important feature of medical care by the family doctor. During the study period in 1988/89 about 77% of the 1,238 patients with continual care by the same doctor regarded themselves as well cared for about 67% had complete confidence in their doctor and 66% considered this physician as their family doctor.
The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war guilt of the National Socialist era. Guilt is a burden on the mind, but non-assessed guilt and lack of a possibility of redemption destroys humans. The article is a plea against an increasing tendency to criminalize the former GDR citizen and the doctors. "It will be necessary to honestly review the past history embodying my own errors, mistaken concepts and illusions." All this is only a first approximation to an important and complex subject. It is the author's aim to promote a better understanding between the former GDR citizens and those of West Germany.
In the former GDR, in-patient treatment had been performed mainly by governmental hospitals. Between 1950 and 1989 the number of hospitals was reduced from 1060 to 539 by closing uneconomic small hospitals or by combining them with bigger ones. During the same period the number of beds decreased from 197,219 to 163,305. Finally, 98.2 bed accommodations existed per 10,000 inhabitants. Information is given on personnel, financing and on the structural status of the hospitals. In-patients discharges of the hospitals were recorded by uniform documentation over about 20 years. It was therefore possible to evaluate in-patient morbidity.
