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The aim of this methodological paper is to summarize evidence on how to implement cost-benefit assessment according to the new German legislative framework (Competition Enhancement Act). Given the complexity of existing health policy frameworks within industrialised countries in adapting health economics in their respective regulatory scheme, no clear international scientific consensus on which health economic methods should be chosen for assessment can be determined. Nevertheless, a broad consensus on the internal properties of methods itself can be found. Based on these common international standards in methodology, this work provides a minimum catalogue of methods and criteria that meet legal and local German requirements with regard to specific factors of its health care system. Aside from categorising clearly defined standards (e.g., study forms, cost and benefit categories) the suggested catalogue specifies some intensively debated areas in Germany (e.g., the QALY, modelling, the perspective used in the assessment). After the proposition of certain methods the paper leads to a first recommendation of a detailed assessment-process itself specific for the German way in implementing cost-benefit ratios within regulatory decision making in Germany.

The nature of intracellular communication and integration in the central nervous system remained a source of controversy long after it had been accepted that the brain is intrinsically involved in the reception of external and internal sensory impressions, in the control of both voluntary and involuntary physiological functions, and in the processes associated with consciousness and psychic function in humans. The role of the specific chemistry of the brain in these functions was specifically addressed only in the 20th century, although chemical examination of brain tissue can be traced at least as far back as 1719 to Hensing's Cerebri examen chemicum. Throughout the 1940s and 1950s evidence accumulated from a variety of laboratories that certain chemical substances, such as acetylcholine, noradrenaline and histamine, might be involved in central nervous system neurotransmission, but conclusive evidence for such communication was difficult to obtain. Commencing with Carlsson's 1957 paper on the anti-reserpine effects of DOPA and culminating in the successful amelioration of parkinsonian akinesia by Birkmayer and Hornykiewicz via administration of L-DOPA in 1961, followed by the identification of specific nervous tracts which utilized dopamine as a transmitter, chemical neurotransmission in the brain was ultimately demonstrated through a combination of pharmacological, physiological and clinical research. Neurochemistry had thereby graduated from a branch of general physiology to being centrally involved in models of central nervous system function.

The objective of this study was to determine the prevalence of neck pain (NP) in the world population and to identify areas of methodological variation between studies. A systematic search was conducted in five databases (MEDLINE, EMBASE, CINAHL, OSH-ROM, and PsycINFO), followed by a screening of reference lists of relevant papers. Included papers were extracted for information and each paper was given a quality score. Mean prevalence estimates were calculated for six prevalence periods (point, week, month, 6 months, year, and lifetime), and considered separately for age, gender, quality score, response rate, sample size, anatomical definition, geography, and publication year. Fifty-six papers were included. The six most commonly reported types of prevalence were point, week, month, 6 months, year, and lifetime. Except for lifetime prevalence, women reported more NP than men. For 1-year prevalence, Scandinavian countries reported more NP than the rest of Europe and Asia. Prevalence estimates were not affected by age, quality score, sample size, response rate, and different anatomical definitions of NP. NP is a common symptom in the population. As expected, the prevalence increases with longer prevalence periods and generally women have more NP than men. At least for 1-year prevalence Scandinavian countries report higher mean estimates than the rest of Europe and Asia. The quality of studies varies greatly but is not correlated with the prevalence estimates. Design varies considerably and standardisation is needed in future studies.

This paper analyses all the peer-reviewed articles published by European authors in 161 neurological journals screened by ISI in accordance with Current Contents/Life Science and Current Contents/Clinical Medicine in the period 1995-1998. Our aim was to report the amount and quality of neurological research in the different countries of the European Union (EU), the USA and the world. The number of papers, the impact factors (IF), the population of the source country and gross domestic product (GDP), were downloaded. Data show that in the EU there is a progressive increase in the number of published papers from 1995 to 1998 and that large countries such as Germany, the United Kingdom, France and Italy rank at the top four places for absolute number of papers. The gap in the number of papers between the USA and the EU significantly diminished in the examined period, from a difference of 14 % to 6 %. However, when the IF is considered, the USA performed better than EU, although excellent results have been obtained by the United Kingdom, Ireland, Netherlands and Sweden. When the number and quality of papers are plotted against the number of inhabitants or GDP, Sweden, the Netherlands and Finland are the leading countries in Europe. The present study demonstrates that neurological research in the EU is active and productive, is steadily increasing and is now a relevant part of all biomedical world research.

Objectives: An informal European coordination group organized two round-robin tests on filters collected from environmental, workplace and diluted diesel emissions. Previous inter-laboratory comparisons have shown that experimental samples give reasonably good results in terms of the dispersion around the mean, from all the participating laboratories. However, there were significant differences between the laboratories owing to a narrow distribution of the results within a single laboratory. In order to gain a better understanding of the differences obtained between the laboratories, it was decided to carry out more round-robin tests and to investigate further the possible factors which may influence the results., Methods: The first round-robin (RRT3) was performed on six different samples (eight replicates) analyzed by ten laboratories. The range of loading was 40 to 138 micrograms cm-2 of total carbon (TC). Laboratories used their own thermal procedure parameters. The second round-robin test (RRT4) was performed on three different diluted diesel emissions (two replicates) samples analyzed by 13 laboratories. The range of loading was 21 to 37 micrograms cm-2 TC. Laboratories analyzed samples using imposed temperatures (500, 650 and 800 degrees C) and imposed duration (12 min)., Results: Inter-laboratory coefficients of variation for diluted diesel emission samples were 10% for RRT3 and ranged from 6 to 19% for RRT4. The influence of the desorption temperature was clearly demonstrated and the results tended to show that a desorption temperature of 650 degrees C could be an acceptable compromise. The influence of the organic carbon/elemental carbon (OC/EC) ratio was shown to be insignificant with pure diesel soot samples., Conclusions: It was expected that a significant improvement would be seen in the inter-laboratory dispersion by the use of a common standardized thermal desorption program, but the objectives of these RRTs were only partly reached. This paper provides new information that will be useful in the elaboration of a standardized procedure for the European Normalisation Centre (CEN TC 137 WG2--General requirements for measuring procedures).

The measurement of functioning and well-being from the perspective of the patient has in recent years become central to the assessment of health and the evaluation of treatment regimes. The past decade has seen an enormous growth in the application of measures designed to assess quality of life in a vast array of medical specialties. However, the use of such measures in neurology has been relatively limited, and this has certainly been the case in amyotrophic lateral sclerosis (ALS). The European ALS Health Profile Study is a longitudinal survey of patients diagnosed with ALS or other motor neurone diseases in which patients are asked to complete questionnaires concerning their subjective health status. Data from clinical assessments are also collected. It is intended that the information collected will provide more systematic and detailed evidence of the impact of the disease from the perspective of the patient. This contribution documents results from baseline assessment obtained from data supplied by clinicians, carers and patients themselves. Three outcome measures are assessed in this paper: the SF-36, a generic measure of well being and functioning, the ALS Functional Rating Scale and the Carer Strain Index. The evidence presented here suggests that these measures provide a meaningful and valid picture of the impact of the disease. The data indicate that ALS has substantial adverse effects both upon the functioning and well being of patients and carers, as well as an association between the emotional health status of patients and carers, and between the physical health status of patients and carers.

Objectives: A previous extensive review of the literature including that from the middle of 1992 concluded that whole-body vibrations may contribute to low back pain, but that the exposure-response relationship had not been clarified. We reviewed the literature of the past 7 years to find out: (i) whether there is evidence in the recent epidemiological literature for a causal association between whole-body vibrations and low back pain, and (ii) if there is evidence in the recent literature for a dose-response relationship between whole-body vibrations and low back pain., Methods: All relevant epidemiological articles which were obtained through a search in the databases MEDLINE, OSH-ROM and TOXLINE, and through personal communication, were reviewed independently by the two authors, using a checklist., Results: Twenty-four original articles concerning the association between whole-body vibrations and the lower back were retained for use. The quality of the papers was mostly low, but improved with time. Only seven articles passed our predetermined quality criteria. Of the seven reports, one showed increased frequency of lumbar prolapse in occupational drivers, and six showed low back pain to be more frequent in whole-body vibration-exposed groups. Only two out of the four articles reporting on dose, showed a dose-response association., Conclusions: Despite the lack of definite evidence, we found sufficient reasons for the reduction of whole-body vibration-exposure to the lowest possible level. If new knowledge is to be produced, good prospective studies with repeated measurements of exposure, analyses of work postures, and clear definitions and subgroupings of low back pain are needed. Other research in this field should be given up, and the resources used for more important issues, as the size of the problem of whole body vibration is probably on the decrease because of the technical prophylactic developments that are already in progress.

The aim of this paper is to demonstrate an example of evidence-based medicine for a clinically relevant and frequent disease - gastro-oesophageal reflux disease - for which an increasing number of laparoscopic operations is performed. A consensus development conference was performed on this topic in 1996. During the following 3-year period, increase of knowledge shown by the number of publications was monitored and the consecutive changes of the consensus as well as its consequences and impact were analysed. The six published randomised clinical trials revealed important information about the technique of the laparoscopic operation focussing on the gastric fundic mobilisation and the modification of the anti-reflux wrap. Five consecutive consensus conferences were performed and published. Citations of the 1996 consensus conference could not be found in the major surgical journals - not even by participants of the conference. The responsibility of societies to run such conferences continues.

Background: To evaluate the publication rate of abstracts presented during the German Anaesthesia Congress (DAK) in MEDLINE-listed journals in comparison to the publication rate of abstracts presented during the meeting of the European Society of Anaesthesiologists (ESA)., Methods: All abstracts of free papers (FP, orals) and posters of the 1994 DAK and the 1994 ESA meeting were included. Over a period of approximately 7 years (1993 to May 1999) the appearance of authors and abstracts topics in the literature were searched with the help of MEDLINE. Only original papers were included in the analysis., Results: All 322 abstracts (268 FPs and 54 posters) of the DAK and all 244 abstracts (81 FP and 163 posters) of the ESA were analyzed. A total 122 of the DAK abstracts (37.9% of all abstracts) and 111 of the ESA abstracts (45.5% of all abstracts) were published in MEDLINE-listed journals. Posters presented at the DAK were as published often (37%) as were oral presentations (38%). Of the 122 abstracts of the DAK that were published 71 (58.2%) were published in English (in 38 different journals) and 51 (41.8%) were published in German (in 8 different journals), whereas 102 (92%) of the ESA abstracts were published in english (in 42 different journals)., Conclusion: The overall portion of abstracts of the DAK published in MEDLINE indexed journals within 7 years was disappointing. The reasons for this may include deliberate avoidance of a publication (e.g. due to lack of interest to publish, no time) or low quality of the abstract that hinders publication in a MEDLINE indexed journal.

The oral vaccination of wild animals was first attempted in 1962 after the repeated failure of poisoning or trapping to control movement of the disease in these species. Foxes were chosen for research purposes because they are a problem animal species and are exquisitely susceptible to rabies. The first successful laboratory studies with attenuated vaccine came in 1971, and the first successful field trial was carried out in Switzerland beginning in 1978. In the 1980's several European countries joined the trials. In the following years many improvements were made: the chicken head was replaced by machine-made baits for easy mass production, the hand placement of vaccine baits was to a greater extent being replaced by aerial distribution (small aircraft or helicopter), and several new vaccines were developed. Additionally, the European Union supported the oral vaccination financially. There was a great impact on the rabies situation. When the second country, Germany, joined the field trial in 1983 the total of reported rabies cases in Europe amounted to 23,002, in 1995 a total of 8,134 cases was reported. In spite of the great improvement made in the past years, in the beginning of the 1990's several severe set-backs were experienced. The paper elaborates on reasons for these set-backs and suggests a strategy to overcome them.

The harmonization of medical education, specialist training and continuing medical education (CME) in Europe progresses at different levels. University exchange programmes like ERASMUS and SOKRATES try to realize the European idea on the student and academic level. Specialist training is complicated by differences in responsibilities. The UEMS, based on various agreements, coordinates the harmonization process. Surgical training is represented by the European Board of Surgery (EBS). Its basic care and subspecialties have been described and European qualifications are being prepared. The content of education as well as log books, trainee qualification and training centers are regulated by position papers. Continued medical education is described in the Charter of Continued Medical Education of Specialists in which the content of training and requirements are defined.

Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of "sudden load" on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain patients. The subjects were fatigued by holding a 20% maximum voluntary contraction for 1 min. A functional restoration program was tested for its efficacy in reducing reaction time and EMG amplitude in chronic low back pain patients. Reaction time was longer and EMG amplitude lower in patients than in their matched controls. EMG reaction time and magnitude decreased in patients after a 2-week rehabilitation program, including specific training of coordination and posture control. The results of the modelling showed higher spinal compressive load and lower shear forces when the load was expected than when the load was unexpected. The effect of sudden loads can be exacerbated if a worker is not standing on a flat surface or is fatigued. Chronic low back pain patients have less ability to protect themselves from sudden loads, but they can be trained to improve their response by means of an appropriate rehabilitation program.

The historical development of the iodine-sulphuric acid reaction for amyloid is described. The reaction dates back to 1814 when Colin and Gaultier de Claubry, and independently Stromeyer, introduced the iodine reaction for starch. A variant of the acidified iodine reaction appears to have been used for printing paper by Gmelin in 1829, and in 1838 Schleiden used the iodine-sulphuric acid test on plants to demonstrate what he considered to be a transformation of the plant material into starch. Shortly afterwards Payen (1839) defined "cellulose", and the iodine-sulphuric acid reaction became a standard procedure used by botanists to demonstrate this plant component. In 1853 Virchow used Harting's (1847) procedure to demonstrate the reaction of Purkynĕ's corpora amylacea to this test, on the assumption that they might be cellulose derivatives, and applied it to what appeared to be similar corpuscles in a "waxy" spleen. The first histochemical reaction for amyloidosis had thus been introduced into pathology, and continued to exert from that time on an important influence on amyloid research, whose impact is felt to the present day.