In 2007, the German Central Committee against Tuberculosis (DZK) published recommendations for contact tracing that introduced the new interferon gamma release assays (IGRAs). Meanwhile, substantial progress has been made in documenting the utility of IGRAs. Because IGRAs are usually superior to the tuberculin skin test (TST) in detecting latent TB infection (LTBI) with respect to sensitivity and specificity in adult contact populations that are at least partially BCG vaccinated, it is now recommended that instead of two-step testing only IGRAs be used. As the literature does not yet provide sufficient data on the accuracy of IGRAs in children younger than 5 years, the TST remains the method of choice in that age group. To date, also, no clear body of data exists to substantiate better performance for IGRAs than for the TST in older children, thus in this age group using of either test is recommended. The new recommendations also underscore the importance of a diligent preselection of close contacts in order to achieve a high probability that positive test results represent recent infection and to thus increase the benefit of chemopreventive treatment for those identified as requiring it. In a third point of update, it is noted that re-testing of contacts individuals found positive for LTBI may produce a considerable number of false-negative results and should thus be avoided in case of documented exposure.
The article provides an overview on the state of research with regard to a comparative analysis of health care systems. The focus is on the financing, provision, and regulation of health care systems. Finally, some concepts are discussed which aim at the development of a typology of health care systems. It is demonstrated that existing models (for instance, a Beveridge versus a Bismarck type of system or a National Health Service type versus a Social Insurance type) are not sufficient to capture the accelerating change of health care systems in a systematic way. The development of a health care system typology, based on concepts which are discussed in this article, is a promising objective of future research.
In 2002 nearly 36000 cases of notifiable infectious diseases were reported in Bavaria representing a 10% increase compared to 2001 (33000 cases). As in 2001, around 75% of reported cases were gastrointestinal infections. Every third infection was due to salmonella. As compared to last year, the incidence of Norwalk-like virus infections increased fivefold. These infections occurred mostly as outbreaks in nursing homes, hospitals or other institutions, affecting as many as 200 persons. Other frequently reported infections in Bavaria are tuberculosis and hepatitis. The relatively high incidence of measles is mainly due to an outbreak in Coburg. The decline in the incidence of tuberculosis observed over the last years has ceased. Around 70% of reported hepatitis cases were due to hepatitis C. It should be noted that these cases were a mixture of new infections and ongoing infections diagnosed for the first time. Of great epidemiological importance are diseases caused by meningitis pathogens. The incidence of meningococcal infections was practically unchanged as compared to last year. Around half of them were caused by serotype B, which is currently not preventable by vaccination. Meningitis caused by Haemophilus influenzae B is continually declining due to the high vaccination rate and is very rarely reported. Several cases of FSME were described. According to investigations carried out by health departments these infections were acquired in countries not yet classified as FSME risk areas. Hence, the endemics maps of FSME have to be revised. Two years of reporting according to IfSG (infectious disease control law) yielded very encouraging results, i. e. rapid accessibility of data, flexibility, complete and standardised reporting with high quality of data. We thank all the reporting physicians and laboratories and the staff of the Bavarian health departments for their continuous support.
About one third of the economical costs, which are due to death, sickness and life quality deficits in higher developed industrial countries, are caused by pollutants such as nicotine, alcohol and false eating habits. Within a period of one year 183,000 people in Germany die on tobacco associated sickness effects, 73,000 on direct or indirect aftermaths of alcohol usage and a proportional amount of mostly adipoptic people on the hereof resulting sickness effects. These risk trias, decided by every person mainly for himself by his own behaviour or misbehaviour, are even aggravated by the free enterprise sanctioned politics of the highly profitable mega markets of the tobacco-, alcohol- and fast-food-industry. Health orientated politic, which is based on independence and solidarity and an exhaustive primary prevention within the scope of early nationalization authorities can therefore only have a limited effect. Even though, standardized, therapeutic short interventions used by hazardous alcohol- and usage, the qualified detoxification on addiction illness and an way to little used meanwhile time- and cost optimized withdrawal treatment have been proven to be quite effective. Exhaustive established ambulant smoking-withdrawal treatment programs are of special importance, because with continuously sinking of first contact, nicotine is know to be the gate way drug with the strongest addiction potential among all legalized and non-legalized drugs. In canon of mean while worldwide (except for Germany) started drug-control politics one will be able to start a health orientated politic in the future, which is including especially the economic aspects for the benefit of all as well as for the national budgets.
The article demonstrates the importance of prevention and early detection of skin cancer as a consequence of the increasing morbidity and mortality of these tumours. Epidemiology, clinical appearance, diagnosis and therapy of the three most important and also most frequent malignant tumours of the skin, i.e. malignant melanoma, squamous cell carcinoma and basal cell carcinoma, are summarised. Subsequently the resulting means for primary and secondary prevention of these tumours are discussed. Finally the possibilities of the public health service for the prevention and early detection of skin cancer in Germany are shown with emphasis on the Bavarian prevention campaign "Sonne(n) mit Verstand" ("Sun with Sense").
Polychlorinated biphenyls (PCB) were manufactured between 1929 and 1989. Due to their great chemical persistence, these substances have been used for many different purposes. These chemical properties, however, caused PCB to accumulate in the food chain and resulted in background exposure of the general population. PCB has also been used as plasticizer for sealants in prefabricated buildings, thus causing problems to the present date. At the end of the 90-ties in a school in Nuremberg, Germany, elevated PCB concentrations were measured in indoor air. Some of these results were higher than 3,000 ng/m(3) which means decontamination according to the German "PCB directive". Press coverage made these results a matter of public debate, so that teachers, school children and parents were highly worried because of possible health effects. The Bavarian Minister for Health, Nutrition and Consumer Protection asked us to examine school children and teachers with regard to their internal PCB exposure and health complaints. A group of school children from a non-contaminated school served as controls. For the determination of PCB levels the plasma samples were blinded before analysis. Lower chlorinated PCB (PCB 28, 52, 101) were detected more often and in higher concentrations in plasma samples of school children of the contaminated school compared to the controls. The plasma levels of the higher chlorinated PCBs (PCB 138, 153, 180) did not show similar differences between exposed and non-exposed school children. The relative PCB doses additionally taken up in the contaminated school were less then 5 % of the background exposure of the children. That is why it could finally be concluded that no appreciable additional health risk may result from inhalation of PCB contaminated indoor air in this school. Due to the design, performance and interpretation of this study, including representatives of parents and teachers, these results were widely accepted by most of the parents who initially had been very concerned about possible health effects.
Steuerungsinstrumente, mit denen sich gesundheitspolitische Entscheidungen bedarfsgerecht, integrativ und akteursübergreifend gestalten lassen, sind von großer Bedeutung für das Gesundheitswesen. Im aktuellen Gesetz über den öffentlichen Gesundheits- und Veterinärdienst, die Ernährung und den Verbraucherschutz sowie die Lebensmittelüberwachung in Bayern (GDVG) wird die Bedeutung der Gesundheitsberichterstattung als Mittel der regelmäßigen Lagebeurteilung und als Ausgangspunkt gesundheitspolitischer Entscheidungen noch einmal unterstrichen. Anforderungen an eine bayerische Gesundheitsberichterstattung ergeben sich aus der Positionierung innerhalb Europas und Deutschlands einerseits und durch die regionale Gliederung innerhalb Bayerns andererseits. Angestrebt ist eine Berichterstattung, welche die Ebene der unteren Gesundheitsbehörden erreicht. Einzelne Berichte können nicht alle relevanten Themen in gleicher Tiefe behandeln. Die bayerische Gesundheitsberichterstattung ist daher modular aufgebaut. Es besteht Bedarf an aufeinander abgestimmter, flexibel auswertbarer Information. Dem Leitbild einer mit wissenschaftlicher Evidenz begründeten gesundheitlichen Vorsorge und Versorgung entsprechend werden die Entscheidungsgrundlagen im gegebenen Fall einer kritischen Würdigung unterzogen. Dies ermöglicht der Entscheidungsträgerebene eine Abschätzung des Grades an Sicherheit der Empfehlungen. Gesundheitsberichterstattung in Bayern will den Menschen im Wandel der Zeiten folgen. Dem intelligenten Einsatz neuer Medien kommt dabei im Sinne der Zeit- und Bürgernähe große Bedeutung zu.
Voller Freude dürfen wir Ihnen das Sonderheft über unseren Kongress im Jahr 2003 vorlegen. Er fand vom 7. bis 9. April 2003 unter dem Titel "Risikoanalyse, Risikomanagement, Risikokommunikation" in Würzburg statt. Das Thema beschreibt Kernaufgaben des öffentlichen Gesundheitsdienstes.
AIM of the newborn screening model programme implemented in Bavaria, Germany, in 1999 was earliest possible and complete detection of all children with treatable severe inborn errors of metabolism. This was to be achieved by the introduction of new laboratory methods (expanded disease coverage, earlier blood take) and of a tracking system to ensure complete access for all newborns and complete requested repeat testing. Long-term prognosis of the newly screened disorders is to be investigated. The model programme "newborn hearing screening in Bavaria" started in 2003 in the administrative district Oberpfalz aims at testing, whether tracking is also suitable to achieve early detection of all children with inborn severe hearing defects.To attain these goals a central state screening centre was established. Demographic tracking coordinated by this centre is achieved by matching screening notifications with all birth notifications on name on a regional basis and individual contacts with parents of children with missing screening notification. In addition, all pending recalls are consequently tracked by case-specific contacts. This system was initially introduced for metabolism screening and is currently being implemented also for hearing screening of newborns. Both screening programmes are being scientifically evaluated. Children with disorders detected by screening are followed up in a long-term study by the screening centre. Written consent by the parents is requested yearly at the childs birthday regarding medical care, knowledge of the disease und health development of the child.470,247 newborns were tested for treatable inborn errors of metabolism from 1999 to 2002. With the introduction of tracking, the documented participation rate increased from previously < 80 to 98.5 %. Due to tracking 99.2 % of requested recalls could be achieved. In 14 cases diagnosis was made, respectively therapy was initiated first after intervention by the screening centre. Altogether 368 children affected by the target disorders of the programme were detected. 332 children could be included in the long-term follow up study. Besides encouraging results, this study reveals deficits in parental information, provision with emergency cards, expert medical consultation, and sometimes treatment not according to the guidelines. Corresponding data from the hearing screening programme are not yet available.The establishment of an independent state screening centre has proved very valuable. It enables comprehensive state-wide demographic tracking despite several laboratories engaged in screening for inborn errors of metabolism. A long-term follow-up study has proved to be effective in this setting.
The present epidemiology of selected bacterial zoonoses brucellosis, anthrax, tularemia, Q fever, Chlamydia infections, tuberculosis, respectively mycobacteriosis and EHEC infections, is discussed.
Children and adolescents in Germany show a high rate of substance use, esp. concerning tobacco and alcohol. Taking these and other drugs can be seen as a juvenile risk behaviour associated with adverse effects, e. g. violence, unsafe sexuality, early pregnancy, underachievement in school. Prevention and intervention measures should begin early and be designed comprehensively in order to gain decisive and long-lasting effects. Children and adolescents of addicted parents and those with substance abusing peers have to be viewed as especially in danger for increased substance abuse and associated risk behaviours. One of the main preventive tasks is the acquisition of affective self-control and self-management competences.
Wie wird aus einem Kind ein "richtiger Junge" gemacht und welche Botschaften der Eltern und anderer Erwachsener begleiten ihn auf dem Weg zum Mann? Im Mittelpunkt stehen Informationen über die körperliche und seelische Gesundheit von Jungen, ihre Wünsche, Ängste und sexuellen Erfahrungen. Nicht zuletzt geht es um den Umgang der Erwachsenen mit den Nöten der "kleinen Helden". Ausgehend von den geschlechtsspezifischen Ausprägungen der Angst, kein "richtiger Junge" zu sein, vor Niederlagen und Versagen, Gewalt, Kummer, Zärtlichkeit und Sexualität wird der Umstand problematisiert, dass Jungen mehr als Mädchen in eine der Unerschrockenheit und Angstlosigkeit verpflichteten Männlichkeit gedrängt werden - mit unübersehbaren Folgen für ihre psychosozialen Potenziale und ihre körperliche und seelische Gesundheit.
