Erfassung muskuloskeletaler Beschwerden mittels Fragebogen

Zusammenfassung Der standardisierte Fragebogen zur Erfassung muskuloskeletaler Beschwerden des japanischen Komitees zum Studium arbeitsbedingter Gesundheitsstörungen im Hals-Arm-Gebiet wurde auf Deutsch übertragen und seine Reliabilität und Validität überprüft. Im Fragebogen wird anhand eines Körperschemas nach der Häufigkeit (nie/selten, gelegentlich, fast täglich) von Beschwerden (Schmerzen, Steifigkeit, Müdigkeit) in 12 Körperregionen gefragt. Der Fragebogen wurde gleichzeitig mit ärztlichen Palpationsuntersuchungen bei 644 Personen aus zwölf Berufsgruppen im Dienstleistungssektor eingesetzt. Auf Grund einer Faktoranalyse der Fragebogenresultate kann festgestellt werden, dass Beschwerden regional getrennt (nämlich im Nacken-Schultergebiet, dem Rücken und je der rechten und linken oberen Extremität) auftreten und für diese Regionen die Symptome zu Indizes zusammengefasst werden können. Diese Indizes sind reliabel (Cronbach 0.8). Mit zunehmenden Indexwerten nehmen schmerzhafte Palpationsbefunde stetig zu. Beschwerden korrelieren mit vermehrtem Medikamentenkonsum und Arztkonsultationen. Der Fragebogen stellt folglich ein valides Untersuchungsinstrument für muskuloskeletale Beschwerden am Arbeitsplatz dar.

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Summary The standardized illustrated questionnaire on musculoskeletal disorders of the Japanese Committee on Occupational Cervico-brachial Disorders was translated into German. This questionnaire, composed of 37 items about the occurrence (never/seldom, occasionally, almost daily) of symptoms (pain, stiffness, fatique) in twelve body regions, was used together with medical examinations (pressure points), and further information was gathered on the consumption of analgetics and medical visits prompted by musculoskeletal symptoms. The questionnaire's reliability and validity were tested in 644 persons from twelve occupational groups within the service sector. Factoranalyses showed that symptoms can be grouped into four distinct regions of occurrence: neck/shoulder/area, back/low back, and both left and right upper extremities. Indices based on these regions are consistent (Cronbach 0.8). Palpation findings steadily increase with increasing index values. The consumption of medicaments and medical visits positively correlate with the indices. Consequently the questionnaire is judged to be a valid instrument for studying musculoskeletal disorders at the workplace.

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Résumé Le questionnaire illustré et standardisé sur les symptômes musculaires et osseux du comité japonais sur la cervico-brachialgie professionelle a été traduit en allemand et sa reliabilité et validité ont été testées. Le questionnaire est composé de 37 variables sur la fréquence (jamais/rarement, par occasion, presque toujours) des symptômes (douleur, raideur, fatigue) dans douze régions du corps. Il était distribué simultanément aux examens médicaux parmi 644 personnes de douze groupes d'employés dans le secteur de service. D'autres informations concernent la fréquence de la consommation des analgésiques et des visites médicales pour des douleurs musculaires. Une analyse factorielle a montré que les symptômes peuvent être groupés en quatre régions du corps: nuque/épaules, dos et les extrémités supérieurs. Les indices sur ces régions sont consistant (Cronbach 0.8). Les douleurs provoquées par la palpation augmentent avec la valeur de l'index. La consommation des analgésiques et les consultations sont correlées avec les indices. Par conséquent, le questionnaire illustré est un instrument valable pour étudier les problèmes musculaires sur les lieux de travail.

     

Costing depression and its management: an Australian study

OBJECTIVE: To examine the cost impact of referral to a Mood Disorders Unit (MDU), by comparing pre-service and post-service costs, and MDU and control samples. METHOD: We studied tertiary referral MDU patients and a control group of consultants' depressed patients, with the principal comparison intervals being: (i) 12 months prior to and (ii) 6 months following baseline assessment, with costs annualised to allow the impact of assessment and treatment recommendation to be determined. In addition, we assessed any 'personal cost' of depression. RESULTS: Following baseline assessment, MDU referrals showed a reduction in costs, while controls' costs increased, largely driven by contrasting directions in hospitalisation and social welfare costs. We identify variables associated with high and increased costs, including features of the earlier stages of the disorder, whether social welfare was received, diagnostic subtype and personality dysfunction, with multivariate analyses refining the variable sets. Self-report data indicated that patients judged the 'personal cost' of depression to exceed more formal cost parameters, so that to experience depression is itself depressogenic. CONCLUSIONS: This first Australian attempt to cost depression and its management in the clinical setting more provides a methodology for wider application in service evaluation studies rather than delivers an unequivocal answer to whether a specialist Mood Disorders Unit is cost efficient or not.     

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-?nial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%± 23.1%) and molar lesions (35.3%± 22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.     

Access to genetic material: reproductive technologies and bioethical issues

New assisted reproduction technologies provide access to, and require the handling of, genetic material. Such material includes gametes or early-stage embryos. After a selective appraisal of some of the most relevant developments facilitated by the access to germ cells and embryos, this paper identifies some major ethical challenges created by the assisted reproduction technologies, with a special focus on Germany. The rapid progress in medical technology makes it difficult to prohibit or allow assisted reproduction technologies on the basis of such traditional criteria as the protection of human life, medical indications or a preference to adhere to natural processes. Instead, a more open discussion and a flexible application of ethical principles may be more helpful, such as: (i) considering DNA as a biological data file which allows potential access to a person's biography or identity; (ii) reconciling the protection of the early embryo with patients' needs; and (iii) placing both the mother and her embryo at the centre of bioethical and legal considerations, instead of exclusively relying on ethical principles and expert opinions with regard to the embryo alone. To continue the success of assisted reproduction, more attention should be given to the 'lifeworld' philosophy, as some authors have put it.     

Zur Frage der Agranulocytose Nach Pyramidon

Ohne Zusammenfassung