Einleitung Während inzwischen gut belegt ist, dass Frauen ihre subjektive Gesundheit gegenüber Männern negativer einschätzen, liegt bislang kaum Wissen darüber vor, wie sich diese Geschlechterunterschiede vor dem Hintergrund des sozialen Wandels verändert haben. Die vorliegende Studie knüpft hier an und untersucht die zeitliche Entwicklung des Geschlechterverhältnisses in der subjektiven Gesundheit zwischen 1994 und 2018 in der Lebensphase der aktiven Erziehungszeit. Darüber hinaus geht der Beitrag der Frage nach, welche Bedeutung hierbei sozioökonomischen, psychosozialen und familienbezogenen Veränderungen zukommt.

Against the backdrop of population aging and growing strain on pension systems, monitoring the development of Working Life Expectancy (WLE) is vital to assess whether the policies taken are effective. This is the first study investigating time trends and educational inequalities in WLE based on German health insurance data. The analyses are based on the data of the AOK Lower Saxony (N = 3,347,912) covering three time periods (2006-08, 2011-13, and 2016-18). WLE is defined as years spent in the labor force (i.e. in employment and unemployment) and was calculated for each age between 18 and 69 years for the three periods to depict changes over time using multistate life table analysis. Educational inequalities in 2011-13 are reported for two educational levels (8-11 years and 12-13 years of schooling). WLE increased in both sexes with increases being stronger among women. This holds irrespective of whether WLE at age 18 (35.8-38.3 years in men, 27.5-34.0 years in women) or the older working-age (e.g. at age 50 10.2-11.7 years in men, 7.8-10.5 years in men) is considered. Among women at all ages and men from their mid-20s onwards, WLE was higher among higher-educated individuals. Inequalities were most pronounced among women (e.g. Delta 3.1 years in women, Delta 1.3 years in men at age 50). The study supports previous research indicating that measures to extend working life are effective, but that noticeable inequalities in WLE exist. Health insurance data represent a valuable source for such research that has so far remained untapped. The data provide a suitable basis to investigate trends and inequalities in WLE. Future research should build on the strengths of the data by broadening the research towards a more comprehensive analysis of the development of WLE from a health perspective.

Einleitung Vor dem Hintergrund der angestrebten Ausweitung der Lebensarbeitszeit besitzen Studien zur Entwicklung der Lebensarbeitszeit (Working Life Expectancy, WLE) und ihrer sozialen Ungleichheiten eine besondere Bedeutung. Krankenversicherungsdaten bilden hier eine wertvolle Datenbasis, die bisher ungenutzt geblieben ist, aber große Potentiale bietet um die Fragestellung auch aus gesundheitlicher Perspektive zu analysieren. Unseres Wissens nach ist dies die erste Studie, die Zeittrends und Bildungsungleichheiten in der WLE auf der Grundlage von deutschen Krankenversicherungsdaten untersucht.

Abstract Background Different hypotheses have been proposed about the future development of morbidity associated with the temporal improvement in life expectancy. However, many studies have focused on general morbidity while testing these hypotheses. In type 2 diabetes (T2D), one of the most prevalent chronic diseases, research points towards an increasing prevalence over time with a simultaneous increase in life expectancy among this population. While morbidity compression in T2D can thus be ruled out, it remains unclear whether morbidity expansion or dynamic equilibrium applies, which could be the case with a decrease in personal disease burden despite increasing prevalence. Against this background, this study aims to examine how the prevalence of T2D-related comorbidities is developing over time. Methods Using claims data of a large statutory insurance provider in the state of Lower-Saxony, Germany, the period prevalence of nine T2D-related comorbidities was examined for the time periods 2005-2007, 2010-2012, and 2015-2017 in 240241, 295868, and 308134 individuals with T2D, respectively. The temporal development of comorbidities was examined by logistic regression analysis. The change in the number of comorbidities over time was examined by ordered logistic regression. Analyses were stratified by gender and three age groups. Results Over the three time periods, age-adjusted predicted probabilities for more severe cardiovascular diseases (CVDs) decreased in men and women with T2D while those for less severe CVDs and other vascular diseases such as retinopathy, polyneuropathy any nephropathy increased significantly in all subgroups. Among all subgroups, the predicted probability of having more comorbidities over time also increased significantly. Conclusions Despite differences in the way CVDs are developing, the results are in favour of the morbidity expansion hypothesis for this population. Further research is needed to examine the reasons behind the observed trends. Key messages The developement of comorbidities in individuals with type 2 diabetes points towards morbidity expansion among this population. Future studies should examine whether the change is socioeconomic status, medication use and lifestyle risk factors are contributing to these trends.

Hintergrund Vor dem Hintergrund der steigenden Lebenserwartung wurden mehrere Hypothesen über die zukünftige Entwicklung der Morbidität aufgestellt. Bei Diabetes Typ 2 (DT2) legen bisherige Untersuchungen nahe, dass eine Morbiditätsexpansion aufgrund steigender Prävalenz und Lebenserwartung mit DT2 ausgeschlossen werden kann. Es bleibt aber offen, ob für diese Erkrankung eine Morbiditätsexpansion oder ein dynamisches Gleichgewicht (d.h. Abnahme der Krankheitsschwere bei vorliegender Morbiditätsexpansion) gilt. Diese Studie zielt darauf ab, die folgenden Fragen zu beantworten:

Zusammenfassung Hintergrund Übergewicht und Bewegungsmangel stellen bei Kindern ein Risiko für kardiovaskuläre Erkrankungen dar. Das Ziel der Studie war, den kardiovaskulären Gesundheitsstatus und die Fitness deutscher Grund- und Gesamtschülerinnen und -schüler sowie mögliche Einflussfaktoren zu erfassen. Methodik In einer prospektiven Querschnittsstudie wurden 357 Kinder (9,6 ± 1,7 Jahre) auf kardiovaskuläre Risikofaktoren untersucht. Die Pulswellengeschwindigkeit (PWV) als Maß für die arterielle Gefäßelastizität sowie die Fahrradergometrie zur Einschätzung der Fitness wurden bestimmt. Ergebnisse 24 % der Kinder waren übergewichtig (Body-Mass-Index, BMI >90. Perzentile) oder adipös (BMI >97. Perzentile). Nahezu alle diese Kinder litten an einer viszeralen Adipositas (99 %). Bei Kindern mit Übergewicht/Adipositas war häufiger eine geringere Gefäßelastizität nachweisbar (PWV „standard deviation score“, SDS 0,8 ± 1,0 vs. 0,2 ± 0,9 bei Kindern ohne Übergewicht, p < 0,001; PWV-Werte >95. Perzentile 24 % vs. 3 %). Das Vorliegen von Übergewicht/Adipositas, Grundschulalter, höherer Blutdruck und niedrigeres „High Density Lipoprotein“(HDL)-Cholesterin waren unabhängige Prädiktoren für geringere Gefäßelastizität. Zudem zeigten Kinder mit Übergewicht/Adipositas einen höheren systolischen Blutdruck, ein nachteiligeres Fettstoffwechselprofil, höhere Harnsäure- und Glutamat-Pyruvat-Transaminase(GPT)-Werte sowie schlechtere körperliche Fitness und einen höheren Medienkonsum. Es bestand eine signifikante Assoziation von BMI und glomerulärer Filtrationsrate. Diskussion Das mit erhöhtem BMI und reduzierter Fitness einhergehende kardiovaskuläre Risiko wird durch weitere Risikofaktoren für die Entwicklung eines metabolischen Syndroms verstärkt. Zusätzlich finden sich Hinweise, dass bereits strukturelle Veränderungen an den Gefäßen vorliegen. Unsere Daten legen eine umfassende Beurteilung des individuellen kardiovaskulären Risikos bei Kindern mit Übergewicht nahe und unterstreichen die Notwendigkeit, Präventionsmaßnahmen früh in den Alltag von Kindern zu implementieren, um die kardiovaskuläre Morbidität im Erwachsenenalter zu verringern.

Die bisherige Forschung zeigt, dass auch in Bezug auf Multimorbidität gesundheitliche Ungleichheiten bestehen. Bisher ist jedoch wenig darüber bekannt, ob sich die Ungleichheiten im Zeitverlauf abschwächten oder verstärkten. Daher wird anhand der erwerbstätigen Bevölkerung im mittleren und höheren Alter untersucht, ob sich die Zeittrends im Auftreten von Multimorbidität zwischen den sozioökonomischen Status (SES) Gruppen unterscheiden.

Von der chronischen Nierenerkrankung bis zur Nierentransplantation durchlaufen Patienten im Zuge der Verschlechterung der Nierenfunktion zwei Stufen: Dialyse und Aufnahme auf die Warteliste. In dieser Studie werden alle drei Übergänge betrachtet: Pfad 1: Chronische Nierenerkrankung bis Dialyse, Pfad 2: Dialyse bis Aufnahme auf die Warteliste und Pfad 3: Warteliste bis Transplantation. Dabei werden Geschlechterunterschiede und soziale Ungleichheiten im Hinblick auf die Übergangsraten zur nächsten Stufe der Nierentherapie analysiert.

Im Zuge der Bevölkerungsalterung nehmen chronische Erkrankungen und Multimorbidität zu. Gleichzeitig berichten internationale Studien konstante oder gar sinkende Prävalenzen von Alltagsbeeinträchtigungen und Behinderungen. Dies lässt vermuten, dass Multimorbidität zunimmt, sich im Zeitverlauf aber immer weniger einschränkend auf das tägliche Leben auswirkt (These des dynamischen Gleichgewichts). Vor diesem Hintergrund wird untersucht, welche Zeittrends sich hinsichtlich Multimorbidität und Alltagseinschränkungen zeigen und ob sich der Zusammenhang zwischen diesen beiden Gesundheitsindikatoren über die Zeit verringert.

Journal of School HealthVolume 75, Issue 2 p. 47-49 Participation in High School Physical Education - United States, 1991–2003 R. Lowry MD, R. Lowry MD Division of Adolescent and School HealthSearch for more papers by this authorN. Brener PhD, N. Brener PhD Division of Adolescent and School HealthSearch for more papers by this authorS. Lee PhD, S. Lee PhD Division of Adolescent and School HealthSearch for more papers by this authorJ. Epping MEd, J. Epping MEd Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health PromotionSearch for more papers by this authorJ. Fulton PhD, J. Fulton PhD Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health PromotionSearch for more papers by this authorD. Eaton PhD, D. Eaton PhD EIS Officer, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3724.Search for more papers by this author R. Lowry MD, R. Lowry MD Division of Adolescent and School HealthSearch for more papers by this authorN. Brener PhD, N. Brener PhD Division of Adolescent and School HealthSearch for more papers by this authorS. Lee PhD, S. Lee PhD Division of Adolescent and School HealthSearch for more papers by this authorJ. Epping MEd, J. Epping MEd Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health PromotionSearch for more papers by this authorJ. Fulton PhD, J. Fulton PhD Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health PromotionSearch for more papers by this authorD. Eaton PhD, D. Eaton PhD EIS Officer, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3724.Search for more papers by this author First published: 20 March 2006 https://doi.org/10.1111/j.1746-1561.2005.tb00009.xCitations: 2 This article is reprinted from: Participation in High School Physical Education- United States, 1991-2003. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Centers for Disease Control and Prevention. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR. 2001; 50(No. RR-18). 2 Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR. 1997; 46(No. RR-6). 3 US Dept of Health and Human Services. Healthy People 2010. conference ed. 2 vols. Washington , DC : US Dept of Health and Human Services; 2000. 4 Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA. 2002; 288: 1728–1732. 5 US Dept of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville , Md : US Dept of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. 6 Grunbaum JA, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance - United States, 2003. In: Surveillance Summaries, May 21, 2004. MMWR. 2004; 53(No. SS-2). 7 Kaufman P, Alt M, Chapman C. Dropout Rates in the United States: 2000. Washington , DC : US Dept of Education, National Center for Education Statistics, 2001; report no. NCES 2002–114. 8 Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 Youth Risk Behavior Survey questionnaire. J Adolesc Health. 2002; 31: 336–342. 9 Burgeson CR, Wechsler H, Brener ND, Young JC, Spain CG. Physical education and activity: results from the School Health Policies and Programs Study 2000. J Sch Health. 2001; 71: 279–293. 10 Centers for Disease Control and Prevention. School Health Index: A Self-Assessment and Planning Guide. Middle school/high school version. Atlanta , Ga : US Dept of Health and Human Services; 2004. Citing Literature Volume75, Issue2February 2005Pages 47-49 ReferencesRelatedInformation

One hundred twenty-six patients with clinically suspected acute deep venous thrombosis of the lower extremity (DVT) were examined comparatively with ultrasound and venography. In total, 174 lower extremity venograms were obtained. Ultrasonic examinations were performed on patients in the supine position. The venous segments were evaluated almost exclusively with transversal scanning. In the thigh, the only criterion for DVT was the reduced or absent compressibility of the venous lumen when gently compressed with the transducer. In the calf, normal unobstructed veins can usually not be viewed in the supine patient, whereas thrombotic veins appear as sonolucent, incompressible channels. Eight-three of the 174 lower extremity venograms were positive for DVT. In the majority of cases (53 of 83) the thrombotic process had involved two or more segments in combination. The sites of involvement of the different venous segments were distributed as follows: 24 occlusions of the common femoral vein, 52 of the superficial femoral vein, 56 of the popliteal vein, and 71 of the calf veins. Ultrasound had a sensitivity of 100% for thrombosis of the common femoral vein, 96% for the superficial femoral veins, 98% for the popliteal vein, and 93% for the calf veins. For the entire lower extremity, in regard to the diagnosis of thrombosis, the overall sensitivity was 95%. In 90% the extension of the occlusion was foreseen correctly. In no cases were false-positive results reported. Thus the overall specificity was 100%. The authors conclude that real-time ultrasound is a highly accurate method for the diagnosis of DVT of the lower extremity. It is the only indirect method capable of evaluating the venous system of the thigh, as well as that of the calf, with high accuracy. It should be the first choice of diagnostic imaging method in the diagnosis of deep venous thrombosis of the lower extremity.

A case of acute fatty liver as a rare cause of pregnancy-induced jaundice is reported. Near term the 25-year-old patient became rapidly jaundiced. On admission laboratory tests showed signs of incipient coagulopathy and impaired renal function. When fetal vital signs deteriorated cesarean section was performed. After surgery the fullblown picture of disseminated intravascular coagulation developed, with profuse bleeding only controllable by rigorous substitution of plasma factors. Acute hepatic insufficiency with ascites followed. Despite the marked bilirubin elevation the hepatic enzymes were only slightly raised. In addition, acute renal insufficiency, pancreatitis and hyperuricemia developed. Under intensive care the patient recovered slowly and was discharged after 4 weeks with a healthy baby.

Caffeine clearance has been determined in 117 volunteers and patients (including 27 patients with liver cirrhosis) after oral application of 366.1 mg caffeine according to conventional pharmacokinetic methods (Cl = D/AUC). The resulting clearance values can be estimated with adequate accuracy from the plasma concentration at 12h for a concentration range of 2.0 to 6.5 mg/l according to Cl max = Doses/C 12h x t 12h x e and for concentrations higher than 6.5 mg/l according to Cl = Vd x (1n (D/Vd) - 1n C 12h/t 12h Vd is estimated from body weight as Vd = 0.42 x BW. "One - point" - estimation does not provide reliable data for plasma concentrations below 2.0 mg/l.

The effect of smoking on caffeine elimination was measured in 7 healthy volunteers and in 18 smoking and in 30 nonsmoking patients with alcoholic liver cirrhosis following oral application of 366 mg caffeine. In an intraindividual experiment in smoking health probands, caffeine clearance decreased from 118 +/- 33 to 77 +/- 22 ml per min (p less than 0.05) after abstaining cigarette smoking for 3 weeks. In a control group without liver disease (8 smokers, 15 nonsmokers), we found a caffeine clearance of 114 +/- 40 ml per min in smokers and 64 +/- 20 in nonsmokers (p less than 0.05). Smoking and nonsmoking patients with alcoholic liver cirrhosis did not differ with respect to clinical and laboratory data and hexobarbitone elimination. However, caffeine clearance was 63 +/- 63 ml per min in smoking patients compared to 34 +/- 49 ml per min in nonsmokers (p less than 0.05). Fasting plasma concentrations of caffeine were higher in nonsmokers (5.1 +/- 6.2 micrograms per ml) than in smokers (2.1 +/- 4.5 micrograms per ml, p less than 0.05). We conclude that smoking habits have to be taken into account if caffeine is used as a model compound for measuring quantitative liver function.

Thirty-three studies in 29 patients with suspected inflammatory heart diseases (natural endocarditis, N = 10; prosthetic valve endocarditis, N = 6; perimyocarditis, N = 17) were performed prospectively using 111In-oxin-labelled granulocytes with low red cell and platelet contamination after a Percoll/plasma or Metrizamide/plasma gradient centrifugation. In four out of 10 patients with suspected natural endocarditis, circumscribed activity could be seen over the heart. Once, an additional splenic infarction could be diagnosed. Three patients with surgically proven sterile valves had a true negative scan. In three out of six patients with prosthetic valve endocarditis a pathologic 111In activity could be seen in relation to the prosthesis. Three patients showed a negative scan after 3 weeks' antibiotic pretreatment. Six out of 17 patients with suspected perimyocarditis showed a significant positive leukocyte scan. In two of the six this was proven by biopsy; in four cases, only clinical diagnosis was made. 111In leukocyte imaging is able to diagnose highly acute inflammatory heart diseases non invasively. Because of the inadequacy of other diagnostic procedures, the scan may be of great clinical importance in prosthetic valve endocarditis. Natural endocarditis can be successfully diagnosed by other procedures, but in fever of unknown origin the scan also allows the diagnosis of acute inflammatory endocarditis.