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Background: Comorbid substance use disorder in patients with schizophrenia is associated with poor clinical and social outcome and low compliance with integrated outpatient treatment programs. For the first time the present trial compares the efficacy of four sessions of motivational interviewing (MI) and four sessions of supportive therapy (ST). The primary outcome was compliance with integrated outpatient treatment post-intervention. Secondary outcomes were substance use, psychopathology, compliance with medication and stage of change in psychotherapy., Methods: Sixty inpatients with schizophrenia and substance use disorder were randomised to receive either four sessions of MI or four sessions of ST. Masked assessments took place at baseline, post-treatment and 3- and 6-month follow-ups., Results: The integrated outpatient program was attended by 70.0% of the MI (n=30) and 40.0% of the ST patients (n=30; p=0.020). There were no differences regarding secondary outcome between MI and ST groups., Conclusion: The study design allows one for the first time to attribute the findings to the specific effects of MI and thereby emphasizes the effectiveness of this particular treatment approach. In summary, these findings show that the integration of short-term MI for people with both psychosis and substance abuse could significantly improve their chances of attending appropriate outpatient settings and thereby improve their well-being.

Patients with schizophrenia and substance abuse disorders [dually diagnosed patients (DD)] show an unfavourable course of the illness and little interest in participating on specific integrated treatment programmes. Motivational interviewing (MI) has been shown to be effective among other substance abuse disorders and it aims to enhance intrinsic motivation to change problem behaviour. MI has been adapted for DD. The present paper reviews the empirical evidence for the efficacy of MI in DD. A search in the databases MEDLINE, EMBASE, PsycINFO was conducted and the methodological quality of the identified trials was assessed according to the Cochrane Collaboration and to the JADAD Scale. We identified 4 randomised studies with a total of 346 participants, in which MI interventions of 1 to 3 sessions were compared with various control conditions over a follow-up period of up to 6 months. With regard to the main outcome measures "subsequent participation at integrated treatment programme" (1 x positive, 2 x negative) and "substance use" (1 x positive, 1 x negative,) the studies gained contradictory results. In all 4 studies, there were relevant general methodological limitations (randomisation, blindness of raters, description of the reasons for drop-outs) and specific methodological shortcomings (sample size and sample homogenity, numbers of MI sessions, assessment of motivational status). Hence, at present the evidence for supporting MI in DD is not clear. This may be due to the methodological problems mentioned above or it may be that there is, in fact, no effect. Therefore, there is an urgent need for further research of MI in DD.

Objectives: The self-reported emotional and behavioural disorders among adolescents were assessed by the Youth Self-Report (YSR). The YSR was administered either in households or in classrooms. The goal of the study was to prove whether these different settings affect the prevalence rates of symptoms reported in the YSR., Methods: Mean scores and standard deviations of problem scales of two classroom samples and one household sample that was generally used as a reference were compared. The data were also compared with two classroom samples from Sweden and Greece. Statistical analyses were performed by means of t-test (unpaired), the evaluation of the magnitude of the effects by means of Cohen's criteria., Results: Classroom samples detected a significantly higher prevalence of symptoms than did household samples. This is the case for almost all of the problem scales in the YSR. The result of our study supports the finding that the setting of surveys that use self-administered questionnaires in classrooms themselves affect the prevalence of self-reported symptoms assessed by the YSR., Conclusions: The results of surveys may be influenced, to a much greater degree than previously thought, by the settings in which they are administered. Further research is needed to identify the specific influences that differ for surveys administered at home, respectively at school.

Purpose: To what extent are recommendations of guidelines relevant in everyday practice?, Methods: 142 general practitioners (GPs) participating in ten different quality circles administered by the statutory medical association of Hesse were interviewed by questionnaire, which of 135 recommendations selected from eight guidelines they had used during the last 6 weeks. The guidelines proposed recommendations for eight frequent indications in primary care. The findings were presented to 15 authors of the guidelines. The authors were asked to assess each recommendation as essential, important or nonessential to therapy., Results: By setting a benchmark of 75% for adherence to each recommendation, 50% of all recommendations had been used by the GPs. With very few exceptions the authors of the guidelines assessed these recommendations as essential or important to therapy. On the other hand, many recommendations that missed the benchmark were assessed as nonessential by the authors., Conclusion: Recommendations of guidelines should be systematically assessed by users and authors together to find out which of them are really of clinical relevance.

Preventing habitual smoking by young people forms an important goal of health promotion in schools. In achieving this target, information is needed about the age at which smoking becomes a temptation for young people as well as knowledge about the attitudes that are associated with smoking. At two elementary schools and at one grammar school in a community of a former coalmining area, 985 German pupils aged 11-18 years were interviewed with the Youth Self Report (YSR) together with a questionnaire concerning their smoking habits. The rate of smoking among the pupils rose from the age group 11-15 years to the age group 16-18 years (in this age access to cigarettes is no longer restricted by law) from 12% to 63%; between the sexes there is no difference in smoking habits. According to the scales of the YSR in both types of school, smokers scored significantly higher on scales of "antisocial" and ,,aggressive behaviour". On the other hand non-smokers scored significantly higher on the scale "social problems". The significantly higher rate of smokers in both elementary schools compared with the corresponding rate in the grammar school will be interpreted by two interrelated explanations: the influence of lower social class as well as the lack of the deferred gratification pattern as an ingredient of the culture in elementary schools. The difference between smoking and non-smoking juveniles according to the scales of the YSR can be explained by the association of smoking behaviour with the juvenile culture of deviant groups on the one hand and by the attitudes of the non-smokers, who are more reluctant in joining peer groups. The results support a strategy for effectively preventing habitual smoking habits of juveniles in schools by combining youth activities inside and outside the schools.

The fundamental prerequisite of reorganising public health agencies is to create a new perspective of health policy. At present this realisation is the essence of the renewal of public health in the Anglo-American countries. The reorganisation of public health services in the old and in the new laender of the Federal Republic of Germany would gain by taking stock of the essential points that have been formulated by experts in the Anglo-American countries: the assessment of health problems by epidemiologists and health economists, the development of interorganizational cooperation, and the regional planning of health services. For translating these concepts into reality, public health has an unrivalled lead as far as chances and prerequisites are concerned, but the main obstacle is that continuing education and training are being blocked by the superior administrative bodies, so that there is a lack of experience in epidemiology, health policy and management.

Rehabilitation, along with curative treatment and prevention, is a function within a social system of comprehensive measures and services aimed at the maintenance and restoration of good health. Rehabilitation at the same time, however, is a task assigned to specific social service administrations within the structured system of social security. This entails deficits in the effectiveness and efficiency of rehabilitation measures. A working group on "reorientation in health care" has developed proposals for reducing these deficits, bearing reference, in its proposals, to the course of chronic diseases and pointing out the measures that would, in the various disease stages, be capable of securing care continuity as well as of improving the quality of care. Key factors involved are the rehabilitation competence of the primary-care physicians, as well as the competencies of patients themselves.

It is reported on 8 transureter-ureterostomies with onesided definitive nephrostomy. In one case the observation period of the definitive urination was about 5 years. We found shorter times of observation, when the patients died of their basic disease. In one case postoperatively a suture insufficiency developed. There were no difficulties with the definitive nephrostomy. The problems of the various methods of supravesical urination are discussed.

To interest people in health behavior there are two different ways. First of all the way using the methods of mass communication or as some call it: "social marketing". But this raises the problems of defining the population that should be referred to and to overcome the resistance of social structure. So generally there are only few chances in succeeding. The other way would be that those people engaged in realizing preventive medicine would try to cooperate with existing groups, organizations or institutions. This seems to be far more successful. To reduce the number of "arbeitsbedingte Krankheiten" (sickness that mainly but not only depends on working conditions) special opportunities are offered by industrial firms.