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The effects of extracts of airborne particulate matter (APM) on morphology and mediator release from enriched basophils (HBC) and from purified neutrophils of pollen-allergic and nonallergic individuals were investigated. APM was collected on glass fiber filter sheets using high volume samplers HVS150. After preparing an aqueous extract, in which allergens are absent, followed by extraction of organic substances, the mediator-releasing activity of the APM extracts was studied under defined and physiological in vitro conditions. The results indicate that APM potentiates anti-IgE-induced histamine release (HR) and that this enhancement is significantly higher in HBC samples from pollen allergic donors than from nonallergic individuals. Electronmicroscopy of APM-exposed HBC reveals basophil degranulation in addition to strong activation of platelets and neutrophils, the latter sticking onto the surface of HBC and forming clusters with them. Incubation of purified PMN with APM prior to zymosan stimulation showed that these substances also enhance the release of LTB4, LTC4, PGE2 and IL-8. The results show that substances adsorbed to APM interfere with mediator cells of the allergic inflammation and exhibit ‘priming’ effects on them. Therefore, exposure of individuals to high concentrations of APM can provoke enhancement in symptoms of allergy and continuation of allergic inflammation.

Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children as well as the association between early stressful life events and atopic eczema (AE). Within the LISA plus (Life style - Immune system - Allergy) study, blood samples from children of 6 years of age were analyzed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines IFN-γ and IL-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. Furthermore, lifetime prevalence of AE and incidence after the assessment period of life events were compared. Our data suggest that separation/ divorce of parents increase childrens risk of developing AE later in life. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-γ concentrations in childrens blood but not with neuropeptide levels. Thus, the neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2-shifted immune response in children with separated/divorced parents.

Background and objective: Allergic diseases of the respiratory tract are common atopic diseases in the population. Pollen of plants are one of their main causes. Pollen of trees, grasses, and weeds like mugwort are of particular importance in this context. The purpose of the present study was to determine the association between typical respiratory symptoms due to pollen allergens and the sensitization to pollen of ragweed and mugwort in adults.Methods: 1039 participants (18 to 66 years) from Southwest Germany were included in this cross-sectional study. Complains typically for aeroallergens were recorded by questionnaire. In-vitro existing sensitizations were determined for grasses/early bloomer (gx1), trees (tx6), mugwort (w6 and Art-v1) and ragweed (w1 and Amb-a1) by testing for specific IgE-antibodies.Results: In a screening test with a mixed allergen sample (sx1) 36.0 % of the participants showed an aeroallergen sensitization. Consecutive investigations of these 374 positive samples revealed a sensitization to grasses/early bloomer, trees, ragweed (w1), mugwort (w6) and the major allergens ragweed (Amb-a1) and mugwort (Art-v1) in 61.8 %, 54.5 %, 29.9 %, 24.3 %, 1.9 %, and 12.3 %, respectively. This corresponds to 22.2 %, 19.6 %, 10.8 %, 8.7 %, 0.7 % and 4.4 %, respectively, in the whole study population. The participants tested positively stated significantly more disorders. On average, 51.1 % had known hay fever, 65.2 % sneezing without cold and 41.5 % sneezing due to contact with grasses or flowers. In contrast, participants tested negatively stated disorders in only 4.4 %, 32.5 %, and 3.9 %, respectively.Conclusion: In Southwest Germany, sensitizations to plant pollen mainly are still caused by grasses, trees, and weeds like mugwort. A sensitization to pollen of ragweed alone is rare until now. However, in case of continuous allergic disorders of the respiratory tract in late summer, a sensitization to ragweed can be important for differential diagnostics.

Objective To analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems and to further investigate the influence of trimester-specific exposure to maternal smoking and the impact of paternal smoking at home on the same outcome. Methods Data of 3097 German children recruited at birth for a population-based, prospective study were used. Detailed information on children's tobacco smoke exposure was collected by self-administered questionnaires at each follow-up. Behavioural outcomes were measured by the Strengths and Difficulties Questionnaire applied at 10-year follow-up. Results Children exposed to environmental tobacco smoke at home showed increased risks of hyperactivity/inattention problems. Only smoking during the entire pregnancy increased the risk for conduct and hyperactivity/inattention problems (proportional odds ratio (pOR)=1.58, 95% confidence interval (CI)=1.06–2.37 and pOR=1.67, CI=1.03–2.72). Pre- and postnatal exposure to paternal smoking was associated with hyperactivity/inattention problems in children of non-smoking mothers (pOR=1.97, CI=1.06–3.65). Effect estimates were adjusted for study centre, sex, parental educational level, mother's age at birth, having a single parent and time spent in front of a screen. Conclusions Not only maternal smoking during pregnancy but also paternal smoking at home should be considered as a risk for hyperactivity/inattention problems in children.

Der vorliegende Beitrag beschaftigt sich mit der sog. Leistungsanalyse des offentlichen Rettungsdienstes in der Bundesrepublik Deutschland, deren Ergebnisse seit Mitte der 1980er Jahre regelmasig im Unfallverhutungsbericht Strasenverkehr der Bundesregierung bzw. seit Anfang der 1990er Jahre zusatzlich als Bericht der Bundesanstalt fur Strasenwesen (BASt) veroffentlicht werden. Die Themen Leistungsmessung und Qualitatssicherung bilden seit langerer Zeit einen Schwerpunkt in den einschlagigen Fachdiskussionen, nachfolgend werden daher die Ergebnisse der Leistungsanalyse fur den Zeitraum 2004/05 als reprasentative Leistungsbilanz fur den Rettungsdienst in Deutschland vorgestellt.

BACKGROUND AND OBJECTIVE: Allergic skin and respiratory diseases show a high prevalence in most industrial countries. In addition, during the last years ragweed colonization has increased in Europe. Ambrosia pollen ( AMBROSIA ARTEMISIIFOLIA L. - common ragweed) are highly allergenic. Due to the late flowering time (august/September) of ragweed this can result in increasing health threats for allergic populations. This is of particular importance for those who already are sensitive to some grass or tree pollen. These individuals can then suffer from allergies during nearly the whole year. The present study examined the prevalence of sensitization to ragweed in German children and possible health implications. METHODS: Between 2004 and 2007 sera of 1323 10-years old children in Baden Wurttemberg were tested in-vitro for specific IgE-antibodies against common aeroallergens including ragweed pollen. RESULTS: Specific IgE-antibodies to extracts of common ragweed pollen were present in 10 - 17 % of the tested sera depending on the year of investigation. CONCLUSION: The determined specific IgE-antibodies may be the result of a direct sensitization to ragweed pollen or correspond to cross-reactivity to other plants of the asteraceae subfamily or some nutritional allergens. The detection of sensitization to ragweed pollen does not prove actual allergic disease. However, a ragweed derived allergy should be considered in the differential diagnosis when allergic symptoms are present in direct connection to the flowering-time of ragweed. Ragweed plants should be removed and the spread of the plant'restricted', as experiences in other countries with already wide spreading show.

Mastocytosis is characterized by an increase of mast cell numbers in the skin and/or in other tissues. Symptoms result mainly from the release of mast cell mediators, especially of histamine. A curative therapy is not available, however, treatment may eliminate or reduce symptoms of mild disease and may delay the progression of aggressive forms of disease. In the last two years, new therapeutic approaches have been developed on the area of anaphylaxis, topical therapy of cutaneous mastocytosis, and therapy of aggressive forms of mastocytosis with antineoplastic drugs and tyrosine kinase inhibitors. Anaphylaxis is not uncommon in adult patients with mastocytosis. Patients at risk for anaphylaxis need an emergency set for self-medication. For children, this is normally not required. General anaesthesia is normally well tolerated in children, when precautionary measures are taken. Specific Immunotherapy with insect venoms may be conducted in patients with mastocytosis. In cases of recurrent anaphylaxis, anti-IgE antibodies (Omalizumab) is a new option. New approaches for topical therapy of cutaneous mastocytosis have been studied. For aggressive forms of mastocytosis, new tyrosine kinase inhibitors and cytostatic drugs have been used with partial success. It may be expected that a combination of different cytostatic drugs will lead to better response rates. Recent insights into the pathogenesis and therapy of mastocytosis immensely broaden the therapeutic spectrum for mastocytosis, so that hopefully adequate treatment modalities will be available for this disease in future.

The capability of eight nutrient models to predict annual nutrient losses (nitrogen and phosphorus) at catchment scale have been studied in the EUROHARP project. The methodologies involved in these models differ profoundly in their complexity, level of process representation and data requirements. This evaluation is focused on model performance in three core catchments: the Vansjø-Hobøl (Norway), the Ouse (Yorkshire, UK) and the Enza (Italy). These three different model applications have been evaluated by comparing calculated annual nutrient loads (total N or nitrate and total P), based on observed flow and total nitrogen or nitrate and total phosphorus concentrations, and the annual nutrient loads that were simulated by the eight nutrient models. Four statistics have been applied for this purpose: the root mean squared error (RMSE), the mean absolute error (MAE), the mean error (ME), and Nash¿Sutcliffe¿s model efficiency (NS). The results show that all model approaches can predict the calculated annual discharges. Depending on the observed statistics (RMSE, MAE, ME and NS) the scores of the model application differed, therefore no overall ¿best model¿ could be identified. Although the water and nutrient loads from (sub)catchments can be predicted, the modelled pathways of nutrients within agricultural land and the nutrient losses to surface waters from agricultural land vary among the catchments and among those model approaches which are able to make this distinction., JRC.H.5-Rural, water and ecosystem resources

The increase in allergic diseases is inter alia explained by the adjuvant effect of environmental pollutants: (1) The interaction between traffic-related airborne particles and pollen grains in the atmosphere may lead to agglomeration of particles on the surface of allergen carriers inducing their activation and to modulation of allergen release, generation of allergenic aerosols and adsorption of pollen proteins to airborne particles. (2) Anthropogenic air pollutants enhance the release of pollen-associated lipid mediators (PALMs) from pollen grains, substances with proinflammatory and immune modulating effects, which can lead to enhancement of allergic symptoms and maintenance of disease. (3) Air pollutants, such as NO(2), ozone, secondhand tobacco smoke, fine and ultrafine particles play an important role as adjuvants and trigger factors for allergic disease development as well as for elicitation and aggravation of allergic symptoms. (4) Polymorphisms in phase II drug-metabolizing enzymes can modulate susceptibility to the adjuvant effects of anthropogenic air pollutants on the IgE-mediated immune response. This highlights gene-environment interactions, which play an important role in the manifestation of allergic diseases.

Die Bundesrepublik Deutschland befindet sich gegenwartig in einem Prozess einer immer alter werdenden Gesellschaft und dieser sogenannte demographische Wandel hat weitreichende Auswirkungen auf den Rettungsdienst als integraler Bestandteil des Gesundheitswesen. Die vorliegenden Ergebnisse uber das zukunftig zu erwartende notarztliche Leistungsgeschehen beruhen auf der Mittleren Variante der 10. Koordinierten Bevolkerungsvorausberechnung und zeigt, dass trotz abnehmender Bevolkerung bis 2050 das Aufkommen an Notarztalarmierungen um ein Viertel steigen wird, wobei normiert auf die Bevolkerung dies einer Steigerung von 56% entspricht. Damit verbunden sind auch deutliche Veranderungen in der Anzahl der durch den Notarzt vorgefundenen Krankheitsbilder, wonach das Krankheitsbild Herz-Kreislauf zukunftig um nahezu die Halfte steigen wird, wahrend die Krankheitsbilder Atmung, Stoffwechsel und ZNS um ein Drittel anwachsen werden. Im Vergleich dazu werden Krankheitsbilder der Padiatrie und Gynakologie zukunftig um ein Viertel bzw. das Krankheitsbild Intoxikation um ein Funftel zuruckgehen.

A high-pressure treatment (>100 MPa) can change the quarternary, tertiary, and secondary structures of proteins. Experiments have shown the prospects of high-pressure treatment for the development of viral and tumour vaccines, for the inactivation of resected infection- and tumour-bearing bone segments and for the decrease of food allergenicity. Allergic patients had minor or no allergy symptoms against high pressure treated foods, which were birch pollen allergy related (hazelnut, carrot, cherry, peach, celery, and apple). Three patients with a heavy allergy against apple could be hyposensitized by means of a specific immuno-therapy with high pressure treated apple.

The ImmunoCAP ISAC 112 platform is the only commercially available molecular allergy IgE multiplex test. Data on the comparison of this rather novel test with the molecular singleplex ImmunoCAP IgE platform are lacking.To compare the multiplex ISAC 112 platform and the singleplex ImmunoCAP platform in regard to IgE to grass pollen allergens in untreated grass pollen-allergic patients in Germany.Serum samples from 101 adults with grass pollen allergy were analyzed for specific IgE (sIgE) to 8 allergenic molecules from timothy grass pollen and to the 112 allergenic molecules included in the ISAC panel. The results for the multiplex and singleplex tests were subsequently analyzed statistically.Comparison of sIgE to grass pollen allergens detected by ISAC 112 and the singleplex ImmunoCAP assay revealed the following correlation coefficients: 0.88 (rPhl p 1), 0.96 (rPhl p 2), 0.70 (nPhl p 4), 0.94 (rPhl p 5b), 0.92 (rPhl p 6), 0.85 (rPhl p 11), and 0.78 (rPhl p 12).Molecular testing with ISAC 112 correlates well with the ImmunoCAP platform for respective molecular timothy grass pollen allergens.

Der Malteser Hilfsdienst fuhrte im Jahr 2005 die zweite bundesweite Patientenbefragung im Rettungsdienst durch. Der vorliegende Beitrag stellt sowohl methodische Konzepte vor, welche sich an die Besonderheiten der Verteilung der Fragebogen durch das Rettungsfachpersonal richtet, als auch wesentliche Ergebnisse und deren Interpretation in Anlehnung zur ersten bundesweiten Patientenbefragung im Jahr 2003.

Nutrient emissions by point and diffuse sources were estimated for the Danube River Basin on the basis of a harmonized and integrated database at the sub-catchment level by application of the MONERIS model. The estimation of nutrient emissions was carried out for the period 1998-2000 for 388 sub-catchments as well as the thirteen countries each responsible for more than 1 % of the total area of the Danube River Basin. A total of 756 kt a -1 nitrogen (N) and 68 kt a -1 phosphorus (P) are emitted by the different pathways. 77 % of N-emissions and 53 % of P-emissions were due to diffuse sources. The dominant pathway is groundwater for N-emissions and point source discharges for P-emissions with 48% and 47 %, respectively. The regionalized analysis facilitates the identification of spatial hot spots for the individual emission pathways. This analysis allows one to deduce specific measures for the reduction of nutrient emissions in the river system of the Danube and the Black Sea. Background nutrient emissions were calculated to approx. 6.5 kt a -1 P and 61 kt a -1 N. Consequently, the human impact is about 10 times higher than the background for P and 12 times higher for N, and 54 and 35% of the total N and P-emissions were due to agricultural activities. Urban settlements are responsible for 50% (P) and 22% (N) of the total emissions. The total nutrient loads of the Danube into the Black Sea were estimated to 22.5 kt a -1 for total P, 396 kt a -1 for dissolved inorganic N, and 468 kt a -1 for total N. The comparison of calculated and observed loads shows that the mean load deviation for the investigated sub-catchments of the Danube River Basin was 21 % for dissolved inorganic N (93 stations) and 32 % for P (65 stations).

The Danube nutrient loads are affected by human impacts mainly from agriculture and wastewater discharges. Knowledge about the Danube nutrient loads and the changes of these loads over time is essential for understanding the changes within the ecosystem of the Black Sea, induced by these loads. The paper shows the long term changes of the nutrient load along the Danube estimated by measurements from different countries and institutions. The results show large differences between Dissolved Inorganic Nitrogen (DIN) and Total Phosphorus (TP). For TP, the Danube River loads show a strong decrease since 1988–1992, especially in the Middle and Lower basin. This change is probably partly connected to the dramatic economic changes in the Middle and Eastern European countries following the collapse of the communist system. The DIN load does not show a decreasing trend in the last decade. The data indicate that there may be a decreasing trend in the anthropogenic emissions, but that such a trend is counteracted by a significantly increasing trend of the Danube discharge in the last decade. The accuracy of the available data is analysed in the paper as well.

In the framework of the project daNUbs (Nutrient Management in the Danube Basin and its Impact on the Black Sea) the MONERIS emission model is used for the basin wide calculation of nutrient (nitrogen and phosphorus) emissions in the Danube Basin. The MONERIS model was developed and successfully applied for German river catchments. Based on investigations in selected test regions (case studies) the daNUbs approach is to check the applicability of the MONERIS emission model for the specific conditions of the Danube Basin in more detail than is possible with a basin wide application. Six case studies with areas of 400–3,500 km2 and several subcatchments have been selected in order to represent different conditions along the Danube Basin. In this study region intensive data collection and enhanced monitoring has been performed in order to raise the database significantly above the generally available data. Water balance as well as nutrient balance calculations have been performed with the MONERIS model as well as with other approaches. Results are compared to each other and to data from monitoring. Results up till now showed the applicability and sensitivity of the MONERIS approach in different conditions of the Danube Basin (e.g. emissions via groundwater). They indicated that the nitrogen retention in the catchments is well described with the MONERIS model.

Im Jahr 2003 wurde erstmals bundesweit durch den Malteser Hilfsdienst eine Befragung von durch den Rettungsdienst transportierten Patienten durchgefuhrt. Fur diese Fragestellung wurde eigens hierfur eine Erhebungsmethodik entwickelt, die unter den gegebenen Rahmenbedingungen eine weitestgehend reprasentative Befragung gewahrleistet. Die Ergebnisse der Befragung von insgesamt 5000 Patienten zeigen insgesamt eine grose Zufriedenheit der Patienten mit den Leistungen des Malteser Hilfsdienstes, lassen gleichzeitig aber auch sowohl themenspezifische als auch regionale Unterschiede erkennbar werden, aus denen sich unter dem Gesichtspunkt der Qualitatsverbesserung wichtige zukunftige Optimierungsmasnahmen ableiten lassen. Der Malteser Hilfsdienst wird als Erfolgskontrolle der eingeleiteten Masnahmen die bundesweite Befragung nach 2 Jahren in der ersten Halfte dieses Jahres wiederholen.

In this paper we show the quantitative and relative importance of phosphorus (P) losses from agricultural areas within European river basins and demonstrate the importance of P pathways, linking agricultural source areas to surface water at different scales. Agricultural P losses are increasingly important for the P concentration in most European rivers, lakes, and estuaries, even though the quantity of P lost from agricultural areas in European catchments varies at least one order of magnitude ( 2.1 kg P ha(-1)). We focus on the importance of P for the implementation of the EU Water Framework Directive and discuss the benefits, uncertainties, and side effects of the different targeted mitigation measures that can be adopted to combat P losses from agricultural areas in river basins. Experimental evidence of the effects of some of the main targeted mitigation measures hitherto implemented is demonstrated, including: (i) soil tillage changes, (ii) treatment of soils near ditches and streams with iron to reduce P transport from source areas to surface waters, (iii) establishment of buffer zones for retaining P from surface runoff, (iv) restoration of river-floodplain systems to allow natural inundation of riparian areas and deposition of P, and (v) inundation of riparian areas with tile drainage water for P retention. Furthermore, we show how river basin managers can map and analyze the extent and importance of P risk areas, exemplified by four catchments differing in size in Norway, Denmark, and the Netherlands. Finally, we discuss the factors and mechanisms that may delay and/or counteract the responses of mitigation measures for combating P losses from agricultural areas when monitored at the catchment scale.

Background Children treated for Hodgkin disease are at risk for gonadal damage. Since most children were treated with radiotherapy (RT) in combination with chemotherapy, the presumed detrimental effect of MOPP (mustine, vincristine, procarbazine, and prednisone) (in contrast to schemes with less or without alkylating agents) could not be discerned completely from the effects of RT. Procedures Children with Hodgkins disease treated without RT were included in sequential protocols containing six courses of MOPP (n = 24), six courses of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) (n = 17), or three courses of MOPP/ABVD (n = 35). Of these 76 patients, 48, who had completed treatment and had reached puberty, were investigated for gonadal damage. Results Of the male patients, 81% of MOPP treated patients had increased follicular stimulating hormone (FSH) values, in 23% luteinizing hormone (LH) values were abnormal. In ABVD treated patients, no elevated levels of FSH or LH were noted. In 30% of patients treated with MOPP/ABVD, FSH values were abnormal, but no abnormal LH values were found. Median testicular volume per group decreased in relation to a higher number of MOPP courses. Sperm analysis revealed azoospermia in nearly all MOPP treated patients. In ABVD and MOPP/ABVD treated patients both oligospermia and azoospermia were noted. The number of sperm samples were too less to make any sound conclusions. Menarche occurred in all females, however in some at a relatively later age. One female patient treated with MOPP/ABVD had a normal pregnancy. Conclusions Limitation of MOPP therapy to three courses, in children treated without any RT, results in less gonadal damage as compared with six MOPP courses. From our data, MOPP damages Sertoli cells and may also damage Leydig cells as suggested by the higher LH values in conjunction with normal testosterone levels. © 2003 Wiley-Liss, Inc.

Der vorliegende Beitrag beschaftigt sich mit einer definierten „Leistungsanalyse“ des offentlichen Rettungsdienstes in der Bundesrepublik Deutschland, deren Ergebnisse seit Mitte der 1980er Jahre in einem regelmasigen Turnus von 2 Jahren im Unfallverhutungsbericht bzw. seit Anfang der 90er Jahre zusatzlich als Bericht von der Bundesanstalt fur Strasenwesen (BASt) veroffentlicht werden. Da die Themen „Leistungsmessung“ und „Qualitatssicherung“ seit langerer Zeit schon einen Schwerpunkt in den einschlagigen Fachdiskussionen bilden, werden im Anschluss an eine kurze Einfuhrung in die Methodik und Berichterstattung der Leistungsanalyse ausgewahlte Ergebnisse fur den Zeitraum 2000/01 als Leistungsbilanz vorgestellt. Uber die aktuelle Zustandsanalyse hinaus ist es grundsatzlich anzustreben, dass auch zukunftig aufgrund von Erhebungen eine kontinuierliche und vergleichende Analyse von Struktur- und Leistungsentwicklungen im Rettungsdienst moglich ist, um den Einsatz der vorhandenen Ressourcen rentabel zu machen und zu optimieren. Ziel ist eine wirtschaftliche Betriebsfuhrung und eine leistungsfahige Organisation, anhand derer sich durch Berechnung von rettungsdienstlichen Kennzahlen die Effizienz des Systems empirisch belegen lasst. Dies steht auch im Einklang mit den Forderungen des Sachverstandigenrates fur die Konzertierte Aktion im Gesundheitswesen zu mehr Transparenz uber Leistungen und Kosten im Rettungswesen.

Im Rahmen von 2 getrennten Projekten der Bundesanstalt fur Strasenwesen (BASt) wurde fur die Jahre 1994 und 2000 bundesweit die rettungsdienstliche Infrastruktur zu den Bereichen Leitstellen, Rettungswachen, Notarztstandorte, Vorhaltezeiten, Fahrzeuge und Personal erfasst. Die erhobenen Bestandsdaten gewahrleisten einen dezidierten Uberblick uber die bundesweite rettungsdienstliche Infrastruktur sowie deren Veranderungen uber einen Zeitraum von 6 Jahren. Auffallig in der zeitlichen Entwicklung ist u. a. die Reduzierung der Rettungsleitstellen in den neuen Landern. Zur Erschliesung weiterer Wirtschaftlichkeitsreserven, verbunden mit einer nachhaltigen Qualitatssteigerung durch die Schaffung bedarfsgerechter Dispositionsbereiche und zweckmasiger Strukturen, ist die Reduzierung von Rettungsleitstellen auch weiterhin von hoher Aktualitat. Unter Kostengesichtspunkten ist aber v. a. der zeitlichen Entwicklung des Rettungsfachpersonals besonderes Augenmerk zu schenken, da rund 70–80% der Gesamtkosten des Rettungsdienstes auf den Personalbereich entfallen. So zeigt sich z. B. fur die alten Bundeslander, dass sowohl die Anzahl der besetzten Zivildienstplatze als auch die ehrenamtlich geleisteten Stunden eine rucklaufige Entwicklung aufweisen, wahrend beim hauptamtlichen Rettungsfachpersonal ein deutlicher Anstieg zu verzeichnen ist.

Multiple chemical sensitivity (MCS) or idiopathic environmental intolerances (IEI) (also called ‘eco-syndrome’) describes a syndrome of somatic and/or psychosomatic complaints of mostly subjective nat

Die Klassifizierung der Einsatzentscheidung des Leitstellenmitarbeiters im Hinblick auf die erforderliche Abgrenzung der bemessungsrelevanten Notfalle ist besonders fur die Uberprufung der Einhaltung der rettungsdienstgesetzlichenAufgabenerfullung sowie fur die Ermittlung der erforderlichen Vorhaltekapazitat an Notfallrettungsmitteln des Rettungsdienstes von zentraler Bedeutung, da mit erhohter Haufigkeit der Klassifizierung der Einsatzentscheidung als Notfall auch die statistische Wahrscheinlichkeit fur den kritischen Risikofall uberproportional steigt.Dies hat zur Folge, dass eine zusatzliche Vorhaltung von Notfallrettungsmitteln zur Gewahrleistung eines zuvor festgelegten Sicherheitsniveaus gefordert werden muss. Da der Leitstellenmitarbeiter aufgrund des Meldebildes seine Einsatzentscheidung trifft, ist der Informationsgehalt im Meldebild von grundlegender Bedeutung fur eine schnelle und sachgerechte Hilfeentscheidung. In Ubereinstimmung mit den rettungsdienstgesetzlichen Vorgaben zum Gegenstand der Notfallversorgung und der daraus resultierenden Anordnung der Sonderrechte gemas § 35 StVO sowie der Zeichensetzung gemas § 38 StVO,wenn hochste Eile geboten ist, ist fur Analyse- und Dimensionierungszwecke ruckbezogen das Meldebild des Leitstellenmitarbeiters einer von 2 bemessungsrelevanten Einsatzklassen (Notfall: Anfahrt mit Sonderrechten oder Krankentransport: Anfahrt ohne Sonderrechte) zuzuordnen.

Aim: Aim of the study is to examine the hypotheses of a steeper increase in allergies and allergic sensitisations in East than in West German children between 1991 and 2000. Method: Between 1991 and 2000 we yearly repeated cross-sectional studies (SAWO: Study on school beginners) and asked 36,645 parents about diagnoses and symptoms of allergies in their six-year old children (response: 79%). The study was done in Leipzig, Halle, Merseburg, Magdeburg, small towns in the Altmark region, Duisburg, Essen, Koln and Borken during spring. An allergological investigation was included 1991, 1994,1997 and 2000. Dermatologists diagnosed a prevalent atopic eczema, administered a skin prick test (n = 7,229) and blood was taken for the determination of specific IgE antibodies against common allergens (n = 7,714, RAST). Odds Ratios (OR) for trend were calculated separately for the data from East and West Germany and are given along with their 95% confidence intervals. Results: Allergies and their symptoms (exception: atopic eczema) were less prevalent in East German children born before the reunification than in West German ones. In East as well as in West Germany bronchial asthma was diagnosed more often in 2000 than in 1991 (OR East: 2.42 [1.78-3.28] West: 2.07 [1.43-3.00]). In contrast the prevalence of atopic eczemas was more than halved between 1991 and 2000. Of all symptoms and diagnoses of allergies only hay fever and its symptoms showed an upward trend in East Germany which was steeper than the trend in West Germany (OR East: 4.41 [3.17-6.13] West: 1.74 [1.19-2.57]). This can partly be explained by a parallel trend in sensitisation against grass pollen. Conclusion: The spatial and temporal pattern of the allergic diseases bronchial asthma, hay fever and atopic eczema in six-year old children from Germany is different. The expected steeper increase of allergies in East than in West Germany could only be shown for hay fever.

Die rettungsdienstliche Fahrzeugvorhaltung ist eine dynamische Komponente der Bedarfsplanung, die einer regelmasigen Uberprufung bedarf. Die Ermittlung der Fahrzeugvorhaltung erfolgt mit Hilfe der risiko- und frequenzabhangigen Fahrzeugbemessung, deren Ergebnisse im Rettungsmittelvorhalteplan zusammengefuhrt werden. Grundlage der risikoabhangigen Bemessung ist die Abbildung der Wahrscheinlichkeit zeitgleicher Notfallfahrten mit Hilfe der Poisson-Verteilung, um so mit der ermittelten Notfallvorhaltung ein gewahltes Sicherheitsniveau zu gewahrleisten. Der frequenzabhangigen Bemessung liegt dagegen aufgrund der Regelmasigkeit von Krankentransporten ausschlieslich die tageszeitliche Einsatznachfrage zugrunde. Im vorliegenden Beitrag werden beide Bemessungsverfahren dargestellt und an einem konkreten Beispiel erlautert. Aktuelle Forschungsergebnisse der Bundesanstalt fur Strasenwesen zeigen, dass es Verfahren der Zeitreihenanalysen in Kombination mit Regressionsverfahren ermoglichen, die Gesamtnachfrage nach rettungsdienstlichen Leistungen unabhangig von der Einsatzentscheidung des Leitstellenmitarbeiters in ein bemessungsrelevantes Fahrtaufkommen fur die risiko- und frequenzabhangige Bemessung aufzuteilen.

The aim of this study was to assess the long-term effects of cancer treatments on adult height and age at menarche in survivors of various types of childhood cancer. 285 childhood cancer survivors (161 men and 124 women), at least 18 years old and having been off treatment for at least 5 years, were examined. The effects of cranial (CrRT) and craniospinal irradiation (CrSpRT), other treatments and age at diagnosis on adult height and age at menarche were investigated. Patients who did not receive CrRT or CrSpRT, reached normal adult heights. However, a significant reduction in adult height was observed in men and women treated with CrRT or CrSpRT, especially if the treatment was given at the age of 8 years or younger. In girls, CrRT resulted in a significantly earlier menarche, compared with the Dutch population. Chemotherapy, radiation dose and age at menarche did not affect adult height. The relative risk (RR) of attaining an adult height below the 3rd percentile (20% 49/244) of the study population) was 6 times increased (RR=6.4; 95% confidence interval (CI) 1.46–28.52) after CrSpRT, 4 times (RR=4.2; 95% CI 1.81–9.63) after Crth and 5 times (RR=51; 95% CI 2.23–11.59) when irradiation was administered at the age of 8 years or younger. CrRT and CrSpRT and age at treatment are the main determinants of short stature in male and female childhood cancer survivors.

Der vorliegende Artikel zeigt, dass es mit Hilfe unseres Bemessungsmodells moglich ist, eine bedarfsgerechte Besetzung der stundlich vorzuhaltenden Funktionen fur eine Leitstelle rechnerisch und damit objektiv nachvollziehbar zu ermitteln. Dabei geht unser Modell von den 3 Bemessungsgrundsatzen Abfragesicherheit, Bearbeitungssicherheit sowie Sicherstellung der Mindestbesetzung aus. Die Abfragesicherheit wird uber eine risikoabhangige Bemessung unter Einbeziehung der Gesprachszeit sichergestellt, wahrend die Bearbeitungssicherheit uber eine frequenzabhangige Bemessung mit Hilfe der Bearbeitungszeit gewahrleistet wird. Die Sicherstellung der Mindestbesetzung greift immer dann, wenn weder aus der risiko- noch der frequenzabhangigen Bemessung eine 2. Funktionsstelle resultiert. Die Bemessung selbst erfolgt entsprechend den zugrundeliegenden Aufgabenbereichen getrennt nach Tageskategorien und Stundenintervallen und gewahrleistet im Ergebnis, dass die Leitstelle nach Umsetzung der Bemessungsergebnisse ihre Aufgaben unter dem Gesichtspunkt der personellen Erreichbarkeit bedarfsgerecht wahrnehmen kann. Daruber hinaus ist mit Hilfe unseres Bemessungsmodells auch ein sachgerechter Kostenverteilungsschlussel nach Art und Umfang der Inanspruchnahme im Sinne eines Wirklichkeitsmasstabes proportional auf die zugrundeliegenden Aufgabenbereiche gewahrleistet, wie z. B. bei integrierten Leitstellen auf den Rettungsdienst und die Feuerwehr. Aus unserer Sicht sind die Anwendungsgebiete des vorgestellten Bemessungsmodells sehr vielfaltig. So lasst das Modell eine Uberprufung bestehender Besetztzeiten auf ihre Bedarfsnotwendigkeit ebenso zu wie die Ermittlung von bedarfsgerechten Besetztzeiten fur Planungsvorhaben wie z. B. die Zusammenlegung von mehreren Leitstellen zu einer Regionalleitstelle. Unabhangig von den moglichen Einsatzgebieten offenbart das Bemessungsmodell daruber hinaus mit Hilfe von Modellrechnungen grundsatzlich die vorhandenen Optimierungspotentiale, die sich durch Vergroserung der Zustandigkeitsgebiete von Leitstellen ergeben.

Background Prevalence data for atopic eczema based on a dermatological examination have not so far been available for East and West Germany. Possible differences in the proportions of extrinsic and intrinsic types of eczema, and how far these could explain differences in the prevalence of eczema, need to be clarified. Objectives To compare the prevalence of atopic eczema in pre-school children between different locations in East and West Germany, and over a period of 7 years, at three time points. Additionally, to determine the proportions of intrinsic and extrinsic types of eczema by taking skin prick test reactivity into account. Methods Repeated cross-sectional studies in 1991, 1994 and 1997 in 5–6-year-old pre-school children at five different locations in West Germany (n = 2075) and six in East Germany (n = 1926) were carried out. Individuals with eczema were identified by an examination performed by physicians of the Department of Dermatology. In addition, a skin prick test and a standardized questionnaire were used. Results The overall prevalence of atopic eczema in these children was 10·4%. At all three times of investigation (1991, 17·5% vs. 11·2%; 1994, 12·6% vs. 8·7%; 1997, 11·2% vs. 4·5%) and in the total group (12·9% vs. 8·2%), the prevalence was significantly higher in East than in West Germany. After controlling for influences of sex, parental history of atopic diseases, observer and socio-economic status in multiple logistic regression analyses, these differences remained significant for 1991, 1994 and for the overall group (odds ratio, OR 1·78, 95% confidence interval, CI 1·43–2·21). Girls (OR 1·56, 95% CI 1·27–1·92) and children whose parents had a higher level of school education (OR 1·17, 95% CI 1·00–1·37) were affected more frequently. Of all children, 26·6%, and of those with eczema, 41·9% exhibited at least one reaction in the prick test (OR 2·21, 95% CI 1·75–2·80; sensitization in eczema vs. no eczema). Whereas 50·4% of the children with eczema in West Germany were sensitized, only 36·5% of the diseased children in East Germany reacted positively in the prick test (OR 1·77, 95% CI 1·12–2·79). Conclusions These results are in accordance with findings regarding allergic sensitization and hay fever and might indicate that factors other than allergy are responsible for the higher prevalence of atopic eczema in East Germany.

Most patients with Hodgkin's disease are treated with chemotherapy in conjunction with radiotherapy, but at the end of treatment a residual mass is often present. After combined therapy, it has been assumed that no additional treatment is needed. However, for children treated without radiotherapy, no data exist on the relevance of a residual mediastinal mass to risk of relapse. We report on the findings of follow-up thorax radiographs of a group of 27 children with initial mediastinal involvement, who were treated with chemotherapy only. We conclude that the regression rate of the mediastinal mass was not related to a later recurrence. Regression after chemotherapy without radiotherapy is probably slower than after combined therapy. We consider chest radiograph examinations to be appropriate for the follow-up of tumour regression. When the data were compared with a group of children with Hodgkin's disease without mediastinal involvement, we found that survival was not related to initial mediastinal involvement.

Das Lupusantikoagulanssyndrom (LAS) ist eine Gerinnungsstorung mit Verlangerung der partiellen Thrombinzeit (PTT) und erhohtem Risiko fur Thromboembolien, welches selten als paraneoplastisches Phanomen bei Tumoren auftreten kann. Die Diagnose des LAS erfolgt mittels spezieller Gerinnungstests mit Nachweis von Lupusantikoagulansantikorpern. Wir prasentieren den Fall einer 57-jahrigen Patientin mit einer paraneoplastisch bedingten Gerinnungsstorung durch Lupusantikoagulansantikorper im Rahmen des Rezidivs eines klarzelligen Nierenzellkarzinoms im Bereich der ipsilateralen Nebenniere 18 Monate nach erfolgter Tumornephrektomie. Nach der Adrenalektomie unter der Gabe eines niedermolekularen Heparins kam es zu einer Normalisierung der PTT und negativem Nachweis der Lupusantikoagulansantikorper.