Zahlreiche Studien belegen schädigende Assoziationen zwischen Atemwegserkrankungen und gasförmigen und partikulären Luftschadstoffen. Feinstaub erwies sich als besonders schädigend. Es ist jedoch noch nicht geklärt, welche Partikelfraktionen des Feinstaubes für die Zusammenhänge verantwortlich sind. In dieser Arbeit werden die Kurzzeit-Effekte von grobem Feinstaub (TSP) sowie den gasförmigen Schadstoffen Schwefeldioxid (SO2) und Stickstoffdioxid (NO2) auf Krankenhauseinweisungen aufgrund von Atemwegserkrankungen in Drobeta, Rumänien untersucht. Zudem wird der Zusammenhang von PM10 (Partikel mit einem Durchmesser < 10 µm), NO2, SO2 und größenabhängigen Partikelanzahlkonzentrationen (PNC) mit respiratorischen Notfallaufnahmen und Sterbefällen in Peking, China, analysiert. Für Peking wird zudem ein statistisches Modell entwickelt, um fehlende PNC zu modellieren. Ziel der Arbeit ist es, die relevanten Faktoren in den Beziehungen zwischen Atemwegserkrankungen und Luftverschmutzung, vor allem Feinstaub, zu untersuchen. In beiden Städten wurde ein schädigender Einfluss von Luftschadstoffen auf Atemwegserkrankungen festgestellt. In Drobeta waren TSP und SO2 mit Atemwegserkrankungen assoziiert, wobei der schädigende Einfluss von TSP durch trockene Luft verstärkt wurde. In Peking zeigten vor allem Akkumulationspartikel (Durchmesser 0.1 – 1 µm) eine schädigende Wirkung, welche für ultrafeine Partikel (UFP, < 100 nm) nicht festgestellt werden konnte. Dabei war der Einfluss von PNC unabhängig von PM10. Der Effekt von PNC war für stagnierende Luftmassen größer, was darauf hinweist, dass neben der Partikelanzahl und -oberfläche die Partikelchemie einen negativen Einfluss hat. Darüber hinaus wurde eine Assoziation von NO2 mit Notfallaufnahmen und von SO2 mit der Mortalität festgestellt. Die Ergebnisse bestätigen den schädigenden Einfluss von gasförmigen sowie partikulären Luftschadstoffen auf Atemwegserkrankungen und weisen auf größenabhängige Effekte von Feinstaub hin. / Numerous epidemiological studies have described adverse effects of particulate and gaseous air pollution on respiratory health. Especially particulate matter (PM) seems to be relevant for the observed associations. However, it is not yet clear which particle fractions are responsible for the observed health effects of PM. In the presented studies, we analyse the short-term associations of total suspended particles (TSP) as well as of sulphur dioxide (SO2) and nitrogen dioxide (NO2) with respiratory hospital admissions in Drobeta, Romania. Moreover, effects of PM10 (PM with a diameter < 10 µm), NO2, SO2, and size-segregated particle number concentrations (PNC) on respiratory mortality and emergency room visits (ERV) are investigated for Beijing, China. For Beijing, we also develop a statistical model to impute missing PNC. The aim of the studies is to investigate the factors influencing the short term associations between respiratory health and air pollution, especially PM. Air pollution was adversely associated with respiratory health in Drobeta and Beijing. In Drobeta, TSP and SO2 were adversely associated with hospital admissions for chronic bronchitis; thereby, dry air aggravated the adverse associations of TSP. In Beijing, mostly accumulation mode particles (0.1 – 1 µm) showed adverse associations with respiratory health, whereas, there was a lack thereof for ultrafine particles (UFP). The effects of PNC were found to be independent of PM10. Adverse health effects of PNC were stronger for stagnant air masses indicating that, besides particle number and surface area, also particle chemistry influences the observed associations, as stagnant air masses result in chemically diverse particles. Also, NO2 was adversely associated with respiratory ERV and SO2 with respiratory mortality. These findings underline the strong influence of gaseous and particulate air pollution on respiratory health and indicate size dependent effects of particulate matter.

Im Frühjahr/Sommer 2002 wurde eine Befragung von 51 erwachsenen Patienten im Raum Berlin-Brandenburg mit seltenen Muskelerkrankungen bzw. neuromuskulären Erkrankungen zu verschiedenen Aspekten der medizinischen Versorgung durchgeführt. Angewandte Methoden waren ein standardisierter Fragebogen sowie ein Leitfadeninterview. Vom ersten Arztbesuch bis zur in 59% der Fälle im Krankenhaus erfolgten Diagnosestellung einer Muskelerkrankung vergingen durchschnittlich 4,1 Jahre (Median: 1 Jahr). Es fanden sich eine unzureichende Anamneseerhebung und körperliche Untersuchung sowie eine mangelnde Überweisungsbereitschaft an Neurologen. Eine signifikante Verzögerung erlitten Patienten, die anstelle eines Hausarztes zunächst einen anderen Facharzt als den Neurologen aufgesucht hatten. 43% der Patienten hatten Schwierigkeiten, im Anschluss einen kompetenten Arzt für die Langzeitbetreuung zu finden. Fragen der Vererbbarkeit sowie der respiratorischen und kardialen Komplikationen wurden unzu! reichend besprochen. Im Verlauf erfolgte eine mangelnde Überwachung der respiratorischen sowie kardialen Funktion. Die Verordnung von Physiotherapie und Hilfsmitteln wurde dagegen gut bewertet. Bei 51% der Patienten kam es auch nach der Diagnosestellung zu Krankenhausaufenthalten. 22% der Patienten mussten wegen Komplikationen stationär behandelt werden. Insgesamt zeigten sich Defizite in der medizinischen Versorgung, wie sie z.T. bereits in Expertenstellungnahmen bzw. wenigen anderen Studien berichtet wurden. Für den Bereich der seltenen Erkrankungen gilt eine Spezialambulanz als geeignetes Versorgungsmodell, welches die spezialisierte, multidisziplinäre Betreuung der Patienten sichern soll. Solche Einrichtungen existieren mittlerweile in Deutschland, Outcome-Studien fehlen jedoch bisher. / In spring/summer 2002 a group of 51 adult patients in Berlin-Brandenburg suffering from a muscle or a neuromuscular disease were questioned concerning various aspects of their medical care. The applied methods were a standardized questionnaire and a qualitative interview. The average time between the first consultation of a physician and the establishment of the diagnosis of a muscle disease was 4,1 years (median: 1 year). 59% of the patients received their diagnosis at a hospital. An insufficient history-taking, lacks in the physical examination and a reluctance to refer the patient to a neurologist could be identified. There was a significant delay for those patients who initially consulted a non-neurological specialist instead of a general physician. 43% of the patients had difficulties in finding a qualified physician for the long-time care. The patients were insufficiently informed about the heredity of their disease and about possible respiratory and cardiac complicati! ons. There was a lack in following up the respiratory and cardiac functions of the patients. The prescription of physiotherapy and aids was rated positively by the patients. 51% of the patients had hospital stays also after having their diagnosis. 22% were admitted to hospital due to complications of their disease. In general, deficits in the medical care for these patients were shown, similar to those described in expert opinions or few preview studies. A specialized hospital-based outpatient centre that should ensure the specialized multidisciplinary care for the patients is regarded as the model for the medical care in the area of rare diseases. Similar centres exist in Germany by now, but there are no outcome-studies yet.

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Objective: Despite the advanced therapy with statins, antithrombotics, and antihypertensive agents, the medical treatment of atherosclerotic disease is less than optimal. Therefore, additional therapeutic antiatherosclerotic options are desirable. This pilot study was performed to assess the potential antiatherogenic effect of the peroxisome proliferator-activated receptor-γ agonist pioglitazone in nondiabetic patients. Methods: A total of 54 nondiabetic patients were observed in a prospective, double-blind, placebo-controlled study. Patients were randomized to pioglitazone or placebo. The following efficacy parameters were determined by serial analyses: artery pulse wave analysis and carotid-femoral pulse wave velocity (PWV), static and dynamic retinal vessel function, and the common carotid intima-media thickness (IMT). The main secondary endpoint was the change in different biochemical markers. Results: After 9 months, no relevant differences could be determined in the two treatment groups in PWV (pioglitazone 14.3 ± 4.4 m/s vs. placebo 14.2 ± 4.2 m/s), retinal arterial diameter (pioglitazone 112.1 ± 23.3 μm vs. placebo 117.9 ± 21.5 μm) or IMT (pioglitazone 0.85 ± 0.30 mm vs. placebo 0.79 ± 0.15 mm). Additionally, there were no differences in the change in biochemical markers like cholesteryl ester transfer protein, lowdensity lipoprotein cholesterol, high-sensitivity C-reactive protein or white blood cell count. Conclusions : Treatment with a peroxisome proliferator-activated receptor-γ agonist in nondiabetic patients did not improve the function of large and small peripheral vessels (PPP Trial, clinicaltrialsregister. eu: 2006-000186-11).

Abstract Background: The world population is aging and the number of older adults with bipolar disorder is increasing. Digital technologies are viewed as a framework to improve care of older adults with bipolar disorder. This analysis quantifes Internet use by older adults with bipolar disorder as part of a larger survey project about information seeking. Methods: A paper-based survey about information seeking by patients with bipolar disorder was developed and translated into 12 languages. The survey was anonymous and completed between March 2014 and January 2016 by 1222 patients in 17 countries. All patients were diagnosed by a psychiatrist. General estimating equations were used to account for correlated data. Results: Overall, 47% of older adults (age 60 years or older) used the Internet versus 87% of younger adults (less than 60 years). More education and having symptoms that interfered with regular activities increased the odds of using the Internet, while being age 60 years or older decreased the odds. Data from 187 older adults and 1021 younger adults were included in the analysis excluding missing values. Conclusions: Older adults with bipolar disorder use the Internet much less frequently than younger adults. Many older adults do not use the Internet, and technology tools are suitable for some but not all older adults. As more health services are only available online, and more digital tools are developed, there is concern about growing health disparities based on age. Mental health experts should participate in determining the appropriate role for digital tools for older adults with bipolar disorder.

Objective: Cardiovascular diseases are the leading cause of death. The gold standard for their diagnosis and treatment are angiographic procedures. Clinicians rely on dedicated and specialized equipment for these interventions, e.g. angiography systems. The speed of the associated development is important as better technology enables progress in treatment methods and clinical outcomes. The goal of this article is to show how to optimize the innovation and development process such that it takes minimal time. Methods: 672 data sets on 302 topics were collected over 47 months during a long-term observation of the innovation and development process of angiographic systems. The total data collected is equivalent to efforts worth 30 man-years. This input was used to calculate key process parameters, analyse key process roles, evaluate the use of problem-solving methods and identify key technologies. We also developed a process model comprising the primary innovation sources, important input providers and key processes. This model is characterized by a continuous loop for the innovation and development process. Results: The conducted literature research identifies this closed loop process model as being unique in comparison to the well-established models proposed by Brockhoff, Cooper, Crawford, Durfee, Ebert, Eppinger, Hughes, Pleschak, Thom, Ulrich, Vahs and Witt. According to the best knowledge of the authors no comparable data collection has been performed and presented anywhere else yet. When analysing our 672 data sets, we found that the median process time ( in this data pool (n=672) was to be 10 weeks (p<0,05). The median number of task owners (xPA) per task across all topics was 2. Our data revealed that the number of task owners had a direct impact on the process time. For data sets with up to eight task owners the relationship between process time and task owners can be described as tPd=3.6*xPA^1.4. The median time of owning a topic was determined for Sales (7 weeks), Service (11 weeks), Customer Relationship Management (6 weeks), Product Lifecycle Management (10 weeks) and Research & Development (11 weeks). Main input providers were Sales (53%) and customers (28%). Sales (42%) and PLM (37%) are significant connectors. Problem solvers are PLM (35%), CRM (27%) and R&D (27%). The problem-solving methods were analysed and it was found that clarification (77%) as well as dialog and variation method (both 50%) were used most often. We found that changes to the application software (33%), mechanics, device interfaces and user interface (all 21%) are the four out of six components that were involved in most often. In the analysed datasets a potential of an up to 20% shorter process time was identified. Conclusion: This article proposes a new model for the innovation and development process. Based on our data, we recommend to apply a continuous loop process in the context of innovation and development of medical devices. Our results can, for example, be used for Activity Based Costing Approach or be applied to bring new or upgraded angiography systems faster to market benefitting patient outcome due to improved diagnosis and treatment of cardiovascular diseases.