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Comparative investigations centre on attitudes of demand and consumption in ethnic groups living in affluence, beginning with the first pre-Christian century in the Roman Empire on the one hand and in Western countries in the post-industrial age of hight-tech in times of far advanced globalization on the other. In this context medical, psycho-social and socio-economical aspects will be treated considering ideal and cultural breaks. Renowned Roman and Greek historians, physicians and philosophers are vouching as witnesses of the times for developments in the antique world with their literary works, in excerpts and verbatim. Obviously general moral decay is a side effect of any affluence. Even in the antiquitiy the "ideology of renewal" proclaimed by the Emperor Augustus died away mostly in emptiness just as do the appeals for improving one's state of health for surviving directed to all citizens in our time. With the rise of Rome as a world power general relative affluence was widespread to such an extent that diseases caused by affluence have occured as mass phenomena. The old Roman virtues of temperance and frugality turned into greed and addiction to pleasure. In this way the Roman people under the banner of affluence degenerated into a society of leisure time, consumption, fun and throwaway mentality. The decline of the Empire was predetermined. The promise of affluence which modern Europe is addicted to is demanding its price following the principle of causality. "How the pictures resemble each other!"

With regard to environmental changes, outstanding importance is meanwhile to be attached to the cultural side of human evolution. The evolution both of mankind and of its environment are mutually dependent as processes of change and together they form a complete biotic system. First disorders of balance concerning the close relationship network between mankind and environment eventually developed following man's change from the biosphere to the "noosphere" created by him. In the course of the "neolithic revolution" mankind, while becoming more and more settled, began to become increasingly estranged from its ecological surroundings. Environmental problems caused by man led to climatic changes already about 8,000 years ago. So far they have caused an extraordinary climatic stability following the Ice Age. "Environmental art" i. e. an improved evolution - is required to escape an imminent "collapse" caused by pollution. Nowadays mankind is on the way to being the almost exclusive carrier of future evolution of this planet.

In the course of the "Neolithic Revolution", while the warming after the glacial period about 13,000 years ago was starting, the crucial evolution of mankind took place, which has consequences to this day. With the beginning of agriculture and metallurgy a transition from an accidental outlook on life to a deliberate shaping of life set in. A chance from almost egalitarian tribal societies oriented solely towards consumption into production societies organized in a hierarchically complex way was not solely the result of an adaptation to climatic conditions, but also of a positively selecting evolution of the intellect. Following the socially relevant upheavals connected with this, the prerequisites for starting modest prosperity only for a privileged few across millenniums were created. Problems and future prospects of today's global distribution of affluence are discussed.

For the first time after onset of the economic miracle since 1948/49 the continuous considerable upward trend of the prevalence of hyperuricemia among the adult population in northern Germany seems to be stopped. In a comparative study of a total of 7169 unselected patients of both sexes, that has been admitted as inpatients for rehabilitation reasons predominantly concerning rheumatic diseases, has been examined which differences result between 1988 and 1990 with respect to the prevalence of hyperuricemia in relation to overweight. Age structure, professions and social levels were comparable in both populations. In comparison with the large upward trend of the risk factor profile between 1976 and 1988 the prevalence of hyperuricemia in males decreased significantly from an average of 17.9 per cent to 15.2 per cent. For females only an insignificant trend to a decrease of the prevalence of hyperuricemia (4.5 per cent vs. 4.2 per cent) was noted. In hyperuricemic males the prevalence of overweight of more than 20 per cent in relation to the individual ideal weight was significantly more frequent than in the whole male population (70.1 per cent vs. 57.7 per cent). Just as for obesity and diabetes mellitus the prevalence of hyperuricemia among the adult population in northern Germany appears to have culminated or crossed its summit. There is further evidence for a small success of public and medical efforts to improve public health. Of a total of 3584 patients who were investigated in 1990 1977 males showed a mean serum uric acid level of 5.71 +/- 1.62 mg/dl whereas in females the corresponding mean value was highly significantly less (4.22 +/- 1.06 mg/dl).

In a comparative study of a total of 7169 unselected patients of both sexes, that has been admitted as inpatients for rehabilitation reasons concerning rheumatic diseases, has been examined which differences result between 1988 und 1990 with respect to the prevalence of overweight of more than 20% in relation to the individual ideal weight and to impairment of the carbohydrate metabolism. Age structure, professions and social levels were comparable in both populations. In comparison with the large upward trend of the risk factor profile between 1976 and 1988 there was a slight but significant increase of the prevalence of overweight between 1988 und 1990 only for males (53.9% vs. 57.7%), whereas among females the prevalence showed an insignificant downward trend (67.9% vs. 66.6%). At the same time the prevalence of an impaired carbohydrate metabolism did not differ significantly (10.5% vs. 9.5%). There is evidence for a small success of public and medical efforts to improve public health.

Hardly any other disorder in this century has been subject to such strong changes--referring to epidemiology and symptomatology--as was gout. These changes were all linked to fundamental social upheavals. In the past 4 decades effective medicamentous possibilities of treating hyperuricaemia and gout have been added. The clinical picture of gout is being obscured by many and partly indiscriminate beginnings of treatment of innocuous or symptomless hyperuricaemias that were found by accident on the occasion of a medical checkup; attacks of gout and classical gout-specific morphological degenerations have become rare in spite of a still increasing number of hyperuricaemias among the general population. For these reasons epidemiological inquiries about gout lack any solid foundation. It is rather appropriate to speak only of "potential" gout, of a constellation which--if untreated--would probably mean manifest gout sometime. Because of the numerous accompanying diseases which usually attack patients with gout and which mostly occur combined with other disorders (such as obesity, lesions of the liver and kidneys, high blood pressure, disorders of the lipoprotein and carbohydrate metabolism), those patients' life expectancy--if they are not treated--is limited anyway. Most of these accompanying diseases can contribute to the development of an early severe atherosclerosis the consequences of which do lead to the death of most of the untreated "cases". Today gout as an arthropathy can be considered to be overcome--punctual and correct medical treatment provided; also the numerous accompanying diseases are well treatable today.(ABSTRACT TRUNCATED AT 250 WORDS)

In a comparative study of a total of 5740 unselected patients of both sexes, that had been admitted as inpatients for rehabilitation reasons concerning rheumatic diseases, it has been examined which differences result between 1976 and 1988 with respect to the prevalence of one or more of the following 5 diseases: diseases of the liver, arterial hypertension, disturbances of the lipid, uric acid or carbohydrate metabolism. Underlying were the same conditions and valuation standards. 2155 consecutively hospitalized patients in 1976 of a medium age of 53.75 +/- 10.89 years (standard deviation) were compared to 3585 patients with a medium age of 55.25 +/- 10.74 years in 1988. Age structure, professions and social levels were comparable in both populations. Whereas 1976 41.1% of the males and 27.9% of the females had one or more of the 5 diseases, this applied for 71.0% of the males and 59.5% of the females in 1988. Between 1976 and 1988 diseases of the liver, arterial hypertension, hyperlipoproteinemia and impairment of carbohydrate metabolism increased highly significant by 66%, 73%, 128% and 41%, respectively. Also hyperuricemia was found more frequently in 1988 among males than 1976 (17.9% vs. 14.2%), whereas among females the prevalence lowered significantly from 8.5% to 4.5% during this period. At the same time the prevalence of overweight of more than 20% of the ideal weight increased from 56.6% of the patients suffering from one or more of the 5 diseases in 1976 to 63.9% in 1988 significantly. Of a total of 3585 patients that was investigated in 1988 2395 patients (66.8%) had one or more of the additional diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

There is no doubt that the various rheumatoid diseases constitute a socio-medical and socio-economic problem of first order. Surely the importance of this problem will even grow till around the turn of the millenium because the share of older people in the total population of the German Federal Republic is continuing to increase. Concerning frequency and duration the rheumatoid diseases figure at the top of all the insurance benefits. The following measures are essentials to a successful combat of this popular disease: Purposive information, prevention, early diagnosis, adequate treatment and a fitting the patient back into the productive process. Among the rheumatoid diseases the degenerative changes are ranking foremost in the range of frequency, unchallenged and at a considerable distance from the primarily inflammatory diseases. Arthroses and spondyloses are by no means a simple "articular detrition" but a disease in which the time factor is not always of decisive importance. There are ascertainable degenerative articular changes to be found in every person virtually by the age of fifty-five although not everybody has physical complaints. As to the increase in frequency observed in the past few years regarding fillings of applications for therapies because of so-called rheumatic complaints, changes of the conditions at someone's workplace alone cannot be blamed for it at all, rather bad posture and unsound stresses in one's leisure time as well as a new kind of consciousness of being sick supervene. A prophylactic healthful conduct depends strongly upon a person's social status and upon socio-cultural conditions.(ABSTRACT TRUNCATED AT 250 WORDS)