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Despite annual updates of vaccination recommendations by the German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, diseases preventable by vaccination still cause a relevant burden of disease in the elderly.A comparison of the vaccination status of the elderly in Bavaria and Thuringia was carried out.Medical settlement data from the first quarter of 2007 to the second quarter of 2008 from the association of panel doctors in Bavaria and Thuringia for insured persons aged 60 years and above were analyzed concerning vaccinations, age, gender and multimorbidity. The vaccination rates for influenza were calculated.The use of all recommended vaccinations in this age group was greater in Thuringia (eastern federal state) than in Bavaria (western federal state). In both states the administration rates of tetanus and diphtheria vaccines were lower in individuals with higher comorbidity and age. Protection rates against diphtheria were incomplete as a result of inadequate use of combination vaccines. In both states the administration of pneumococcal vaccine was higher in subjects with more comorbidities. In Bavaria administration rates increased with age. Influenza vaccination rates increased in association with age and comorbidity in both states. In elderly individuals influenza vaccination was used more often in the third quarter of 2007.Old age and multimorbidity are often insufficiently taken into consideration in studies on vaccination rates. The data from this study confirmed the relevant findings from other studies and emphasize the deficient implementation of standard vaccinations in primary prevention. In this study very old patients were differentiated and considered according to age groups for the first time.

Hintergrund: Die Ständige Impfkommission STIKO empfiehlt die jährliche Influenza-Impfung (II) als primär präventive Maßnahme altersabhängig für Senioren ab 60 Jahre wegen der Zunahme der Krankheitslast und Übersterblichkeit mit steigendem Alter. Fragestellung:[for full text, please go to the a.m. URL], 48. Kongress für Allgemeinmedizin und Familienmedizin

Physicians in Germany who are not specialized in geriatric medicine often have to make decisions regarding referral of patients for early geriatric rehabilitation. The risk of inadequate patient allocation is due to lack of knowledge or underestimation of the potential benefit of early rehabilitation in reducing a patient's need of care. Particularly the oldest old are affected by those inadequate decisions.Based on the nationwide database Gemidas Pro, the data sets of ≥ 90-year-old patients were analysed regarding diagnoses, multimorbidity, gender, length of stay, procedures, outcome parameters as nursing personnel regulation (PPR), Barthel index and the Timed Up and Go (TUG) test compared to younger age groups. Data from 85 acute inpatient geriatric institutions during the period from January 2006 to December 2009 were included.Neither the analysis of the diagnosis nor multimorbidity showed relevant differences compared to younger patients. Despite poorer functional status at admission, the ≥ 90 year olds experienced a 25 % increase in the activities of daily living (ADL) measured by PPR, 30 % increase in mobility classification based on the TUG and 59 % increase in ADL measured with the Barthel index. These changes were significantly different. In addition, the length of stay was 18.96 days on average in the group of ≥ 90-year-old patients, which was but not significantly shorter than the length of stay in the group of 70- to 79-year-old (19.7 days) and 80- to 89-year-old patients (19.65 days).The analyses show that the oldest old suffer from more severe deficits in functional status on admission in acute geriatric wards compared to younger patient groups. However, on discharge the oldest old show a significant and relevant increase in mobility and ADL without increase in length of stay.

Infections due to pneumococci especially in the elderly are vastly underestimated, e.g., because non-invasive infections such as pneumonia may appear with only few symptoms. Sequential vaccination with the pneumococcal conjugate vaccine PCV13, followed by the 23-valent polysaccharide vaccine, is considered as the best preventive measure for individual protection, even though clinical study data demonstrating the efficacy of this sequence are not yet available. Increase of "awareness" by use of computer-based reminder functions may result in a significant improvement of vaccination compliance.

The mixed micellization between the anionic dimeric surfactant Dim1 (disodium 1,11-didecyl-3,6,9-trioxaundecane 1,11-disulfate) and the two nonionic surfactants C12E5 and C12E8 (penta- and octaoxyethylene monododecyl ethers, respectively) has been investigated. The cmc of the mixtures has been measured by fluorescence probing, using the fluorescent probe pyrene. Its variation with composition revealed synergism in micelle formation. The micelle aggregation (N) numbers have been measured using time-resolved fluorescence quenching at a total surfactant concentration of about 70 mM and at 25, 40, and 55deg;C. The differences in total aggregation number of the mixed micelles in the two systems reflect (i) the higher aggregation number of C12E5 micelles with respect to C12E8 and Dim1 micelles; (ii) the higher cloud temperature of C12E8 with respect to C12E5; and (iii) the opposite temperature dependences of N for Dim1 and nonionic surfactants micelles. The results show nonideal mixing behavior with a shallow minimum in the variation of the mixed micelle aggregation number with the mixture composition at a Dim1 mole fraction around 0.5. Copyright 1998 Academic Press. Copyright 1998Academic Press

The mixed micellization between cetyltrimethylammonium bromide (CTAB) and the anionic dimeric surfactant disodium 1,11-didecyl-3,6,9-trioxaundecane)-1,11-disulfate (2) has been investigated by elec...

The aging immune system, so-called immunosenescence, is well documented as the cause of increased infection rates and severe, often complicated course of infections in the elderly with increased morbidity and mortality rates. Furthermore, it can lead to decreased efficacy of vaccination. The administration of more immunogenic vaccines can be beneficial in the elderly. Implementing vaccination recommendations for the elderly by STIKO can reduce burden of infectious diseases by prevention of infection or reduction of severity of infection. The following vaccinations are recommended by STIKO for all persons aged 60 and above: annual influenza vaccination (additionally all nursing home residents independently of age), once only pneumococcal polysaccharide vaccination, completion of tetanus and diphtheria (Td) vaccination as well as regular revaccination. All adults should be vaccinated against pertussis with Tdap vaccine once. Meanwhile, pneumococcal conjugate vaccine is allowed for administration in adults but is not recommended by STIKO yet. A lifelong course of vaccination may help to attenuate the effect of immunosenescence.

Diallyl ethers containing two trimethylstannyl moieties or one triorganostannyl and one trimetyylsilyl moiety attached to the olefinic carbon atoms of one allyl group can undergo either an allyl-vinyl ether rearrangement or a [2,3] Wittig sigmatropic rearrangement when treated with a strong non-nucleophilic base. While the use of lithium diisopropylamide favours the Wittig rearrangement, lithium diethylamide can shift the course of reaction towards the allyl-vinyl ether rearrangment.

Ageing shows a high interindividual and intraindividual variability. Subclinical and clinical cardiovascular diseases accelerate the ageing process in part and in total. This leads to the idea that ageing is a result of a chronic inflammation process and to the term "inflammageing". A variety of biomarkers (e.g. C-reactive protein, interleukin-6, tumor necrosis factor alpha, fibrinogen, albumin and serum amyloid A) are described in this context. Furthermore there is a relationship to changes in the immune system across the lifespan (immunosenescence), viral infections, the occurrence of markers of oxidative stress and genetic changes. At this point in time the role for determining ageing and its use as a prognostic tool seems to be impossible. Whether inflammageing is a valid model for describing the ageing process or is the consequence of other mechanisms needs further discussion.

Trialkyltin fluorides are converted into the chlorides or bromides on treatment with an excess of the corresponding sodium halide in tetrahydrofuran

The scope and limitations of the palladium-catalysed preparation of acyltins from ditins and acyl chlorides are discussed in detail. Preliminary studies on the chemistry of acyltrimethylstannanes are described.

Cyclo-1,2-dienes(C9–C13) are converted into the synthetically promissing 2,3-bis(trimethylsilyl)- and 2,3-bis(trimethylstannyl)cycloalk-1-enes by disilylation with lithium chlorotrimethylsilane in tetrahydrofuran, and Pd0-catalysed addition of hexaalkyldistannes, respectively.

Depression is one of the most common affective illnesses. The investigation of changeable factors that are associated with depression is an important condition for the establishment of preventive measures. In a cross-sectional study, data on social factors were recorded from 580 geriatric patients of the municipal hospital in Munich. Ordinal logistic regression was used to analyse their association with depression (clinical diagnoses by ICD-10) and depressive symptoms (GDS). The results indicate that the occurrence of depressive symptoms and of depression was associated with less social contacts and less support, even after adjustment for other risk factors (for example, physical and cognitive impairment). This association was more distinct for women (for example, depressive symptoms: moderate versus much contact: OR=2.7; 95% CI: 1.8-4.1) than for men (OR=1.3; 95% CI: 0.7-2.4). Further research is needed to investigate whether women could benefit more than men from programmes promoting social support.

The higher prevalence of depression in specific diseases and older persons is discussed. This prevalence varies greatly according to the method used to collect data. A risk group can only be defined if information on diseases and other influencing factors are collected uniformly. The target diagnoses Parkinson's disease, stroke, myocardial infarction, cancer, diabetes mellitus, chronic pain, multiple infarct syndrome, Alzheimer's and other dementia were recorded from 1208 geriatric patients of the ZAGF municipal hospital in Munich, Germany. Logistic regression was used to identify chronic pain as the main cofactor for an association with depression (clinical diagnoses by ICD-10) and depressive symptoms (via GDS [Geriatric Depression Scale]). This association was also found for multimorbid patients with chronic pain. Impairment of the activities of daily living and the clinical setting were important additional cofactors. Pain patients are therefore at higher risk for depression.

The aqueous solutions of mixtures of various conventional surfactants and dimeric anionic and cationic surfactants have been investigated by electrical conductivity, spectrofluorometry, and time-resolved fluorescence quenching to determine the critical micelle concentrations and the micelle aggregation numbers in these mixtures. The following systems have been investigated: 12-2-12/DTAB, 12-2-12/C(12)E(6), 12-2-12/C(12)E(8), 12-3-12/C(12)E(8), Dim3/C(12)E(8), and Dim4/C(12)E(8) (12-2-12 and 12-3-12=dimethylene-1,2- and trimethylene-1,3-bis(dodecyldimethylammonium bromide), respectively; C(12)E(6) and C(12)E(8)=hexa- and octaethyleneglycol monododecylethers, respectively; Dim3 and Dim4=anionic dimeric surfactants of the disodium sulfonate type, Scheme 1; DTAB=dodecyltrimethylammonium bromide). For the sake of comparison the conventional surfactant mixtures DTAB/C(12)E(8) and SDS/C(12)E(8) (SDS=sodium dodecylsulfate) have also been investigated (reference systems). Synergism in micelle formation (presence of a minimum in the cmc vs composition plot) has been observed for the Dim4/C(12)E(8) mixture but not for other dimeric surfactant/nonionic surfactant mixtures investigated. The aggregation numbers of the mixed reference systems DTAB/C(12)E(8) and SDS/C(12)E(8) vary monotonously with composition from the value of the aggregation number of the pure C(12)E(8) to that of the pure ionic component. In contrast, the aggregation number of the dimeric surfactant/C(12)E(8) mixtures goes through a minimum at a low value of the dimeric surfactant mole fraction. This minimum does not appear to be correlated to the existence of synergism in micelle formation. The initial decrease of the aggregation number of the nonionic surfactant upon addition of ionic surfactant, up to a mole fraction of ionic surfactant of about 0.2 (in equivalent per total equivalent), depends little on the nature the surfactant, whether conventional or dimeric. The results also show that the microviscosity of the systems containing dimeric surfactants is larger than that of the reference systems. Copyright 2001 Academic Press.

Geriatric care covers a variety of differentiated services and structures, and the well-established system of in- and outpatient treatment has now been expanded to include the day hospital. The 30-bed geriatric day hospital at the "Zentrum für Akutgeriatrie und Frührehabilitation", ZAGF (Center for Acute Geriatric Medicine and Early Rehabilitation) at the Municipal Hospital Munich Neuperlach provides diagnostic and therapeutic services for acute and chronic illnesses with the aim of obviating or shortening hospitalization, helping patients to practise self-help, and preserving social competence. A multi-dimensional interdisciplinary geriatric assessment is used to clarify indications and contraindications, and to plan holistic individual therapeutic strategies.

Trialkyltin fluorides are converted into the chlorides or bromides on treatment with an excess of the corresponding sodium halide in tetrahydrofuran