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Zusammenfassung Ziel der Studie Der suchtspezifische Qualifikationsstand von Jobcenterfachkräften hat einen Einfluss auf die berufliche Integration von Arbeitslosengeld II-Beziehenden mit Suchtproblemen. In der vorliegenden Studie wurde der suchtspezifische Weiterbildungsbedarf von Jobcenterfachkräften in 4 Grundsicherungsstellen in Nordrhein-Westfalen (NRW) ermittelt, um auf der Grundlage dieser Bedarfsanalyse ein passgenaues Weiterbildungskonzept zum Thema Sucht für Beschäftigte in den Jobcentern zu entwickeln. Methode Um die Weiterbildungsbedarfe sowie geeignete Rahmenbedingungen zu identifizieren, wurde eine standardisierte Onlinebefragung in 4 Jobcentern in Nordrhein-Westfalen (im Rechtskreis des Sozialgesetzbuchs II (SGB II)) durchgeführt. Diese orientierte sich inhaltlich an der bundesweiten Erhebung zu den Rahmenbedingungen für suchtkranke Leistungsbeziehende und enthielt neben Items zu Schulungs- und Beratungsbedarfen auch Fragen zu bisher besuchten suchtspezifischen Weiterbildungen sowie geeigneten Rahmenbedingungen für eine bedarfsorientierte Umsetzung einer Schulung zum Thema Sucht. Ergebnisse Insgesamt nahmen an der Befragung 511 Jobcenterfachkräfte teil. Es konnte eine Netto-Rücklaufquote von 64,1% erzielt werden. 76% der Befragten geben einen suchtbezogenen Schulungsbedarf an, wobei insgesamt 29,4% der Stichprobe hierzu bereits geschult worden sind. Die größten Bedarfe werden bereichsübergreifend im Erkennen von Suchtproblemen (55,1%) und im Ansprechen auf Suchtverdacht (52,1%) gesehen. Je nach Fachkräftegruppe zeigen sich unterschiedliche Schwerpunktsetzungen in den Bedarfen: Integrationsfachkräfte geben neben den genannten Aspekten einen hohen Bedarf in der Bedeutung der Sucht für die Arbeitsfähigkeit (54,3%) und im Überblick über suchtspezifische Behandlungsangebote (51,4%) an, Leistungssachbearbeiterinnen und -bearbeiter in Deeskalationsstrategien (49,8%). Eine Präsenzschulung wird von 85,8% gegenüber Online- oder Blended-Learning-Angeboten bevorzugt. Diese soll eher von einer externen Bildungsleitung (90,1%) als von internen Mitarbeitenden (9,9%) durchgeführt werden. Schlussfolgerung Der Bedarf an suchtspezifischen Schulungen ist trotz verschiedener Bemühungen und Initiativen der letzten Jahre weiterhin hoch. Die wichtigsten Schulungsbedarfe beziehen sich eher auf konkrete Integrationsangebote und praktische Unterstützungsmöglichkeiten der Betroffenen als auf Informationen zu Sucht oder Methoden und Vorgehensweisen im Beratungsprozess. Auch Leistungssachbearbeiterinnen und -bearbeiter sollten in Schulungen einbezogen werden. In diesem Bereich sind jedoch stärker Beratungsstrategien relevant.

Palliative care (PC) involves many health care providers leading to a high complexity of structures that requires efficient coordination as provided by case management (CM). Our study aimed to evaluate the effects of CM newly implemented in a specialised palliative care unit by evaluating team members’ tasks and time resources before (T0) and after implementation (T1). It was hypothesised that team members would be able to spend less time on organisational and administrative tasks and more time on patient care. A prospective pre-post study design was used. Time distribution of different tasks at T0 and T1 was compared between three different professional groups: physicians, nursing staff and social work. To document their tasks and time required, a documentation form with several items for each profession was developed. Data was analysed using t tests for independent samples. After Bonferroni correction, a significant pre-post difference was found for the time spent on “discharge interview and discharge” as rated by the physicians (p

Crop plant residues may enter aquatic ecosystems via wind deposition or surface runoff. In the case of genetically modified crops or crops treated with systemic pesticides, these materials may contain insecticidal Bt toxins or pesticides that potentially affect aquatic life. However, the particular exposure pattern of aquatic ecosystems (i.e., via plant material) is not properly reflected in current risk assessment schemes, which primarily focus on waterborne toxicity and not on plant material as the route of uptake. To assist in risk assessment, the present study proposes a prioritization procedure of stream types based on the freshwater network and crop-specific cultivation data using maize in Germany as a model system. To identify stream types with a high probability of receiving crop materials, we developed a formalized, criteria-based and thus transparent procedure that considers the exposure-related parameters, ecological status--an estimate of the diversity and potential vulnerability of local communities towards anthropogenic stress--and availability of uncontaminated reference sections. By applying the procedure to maize, ten stream types out of 38 are expected to be the most relevant if the ecological effects from plant-incorporated pesticides need to be evaluated. This information is an important first step to identifying habitats within these stream types with a high probability of receiving crop plant material at a more local scale, including accumulation areas. Moreover, the prioritization procedure developed in the present study may support the selection of aquatic species for ecotoxicological testing based on their probability of occurrence in stream types having a higher chance of exposure. Finally, this procedure can be adapted to any geographical region or crop of interest and is, therefore, a valuable tool for a site-specific risk assessment of crop plants carrying systemic pesticides or novel proteins, such as insecticidal Bt toxins, expressed in genetically modified crops.

The current study investigates the association of estimated personal exposure to traffic-related air pollution and acute myocardial infarction (AMI). Cases of AMI were interviewed in the Augsburg KORA Myocardial Infarction Registry from February 1999 through December 2003, and 960 AMI survivors were included in the analyses. The time-varying component of daily personal soot exposure (the temporally variable contribution due to the daily area level of exposure and daily personal activities) was estimated using a linear combination of estimated mean ambient soot concentration, time spent outdoors, and time spent in traffic. The association of soot exposure with AMI onset was estimated in a case-crossover analysis controlling for temperature and day of the week using conditional logistic regression analyses. Estimated personal soot exposure was associated with AMI (relative risk, 1.30 per 1.1 m−1 × 10−5 [95% confidence interval, 1.09-1.55]). Estimated ambient soot and measured ambient PM2.5 particulate matter 2.5 µm and smaller in aerodynamic diameter were not significantly associated with AMI onset. Our results suggest that an increase in risk of AMI in association with personal soot exposure may be in great part due to the contribution of personal soot from individual times spent in traffic and individual times spent outdoors. As a consequence, estimates calculated based on measurements at urban background stations may be underestimations. Health effects of traffic-related air pollution may need to be updated, taking into account individual time spent in traffic and outdoors, to adequately protect the public.

Da es sich bei suchtbezogenen und komorbiden Storungen im Alter um komplexe Phanomene handelt, geht es in diesem Beitrag auch um eine sozialwissenschaftliche Reflexion sowie die Betrachtung gesellschaftlicher Dimensionen und Gegebenheiten fur eine differenzierte Wahrnehmung des Gegenstandsbereiches. Nach einer grundsatzlichen Annaherung an das Thema mit Blick auf den Sucht- und Altersbegriff werden zunachst zwei soziologische Erklarungsperspektiven suchtigen Verhaltens erlautert. Daran anknupfend stellt der Beitrag einen Bezug her zum aktuellen Altersbilderdiskurs sowie zum Wert des Alterwerdens in unserer Gesellschaft. Es werden sodann aktuelle gesellschaftliche Entwicklungsprozesse beschrieben, die die Grundlage der Rahmen- und Lebensbedingungen fur altere Menschen darstellen. Die gesellschaftliche Betrachtungsebene auf Sucht und komorbide Storungen im Alter in diesem Herausgeberwerk soll zudem durch eine Erlauterung des soziologischen Konzepts der Lebenslage erganzt werden, wodurch differenziert soziale Ungleichheitsprozesse im Alter erklart werden konnen. Eine spezifische Interpretation des Konzepts der Lebenslagen im Zusammenhang mit Luhmanns systemtheoretischer Perspektive nach Engels (2006) soll den Abschluss des Kapitels bilden.

Vor dem Hintergrund der steigenden Lebenserwartung infolge der komplexen Veranderung der Bevolkerungsstruktur und des tiefgreifenden Wandels des Sozial- und Gesundheitssystems, gewinnt das Thema Gesundheit im Alter heute und auch zukunftig immer starker an Bedeutung. Dies fuhrt dazu, dass auch immer mehr altere Menschen von Missbrauch und Abhangigkeit von Alkohol, Medikamenten, illegalen Substanzen und Tabak betroffen sind. Dabei geht es um alter gewordene und werdende Suchterkrankte, ebenso um Menschen mit Substanzkonsumstorungen, die erst im hoheren Lebensalter eine Sucht entwickeln.

Die Integration alterer Drogenabhangiger in „ubliche“ Strukturen medizinischer Versorgung ist als problematisch anzusehen und stellt die Versorgungssysteme, insbesondere die Alten- und Pflegehilfe, durch den veranderten Hilfebedarf vor enorme Herausforderungen. Es ergibt sich die Notwendigkeit zielgruppenadaquater Veranderungen/Anpassungen von Konzepten fur alt gewordene Suchtkranke und suchtmittelkonsumierende Heimbewohner, vor allem im Bereich der (stationaren) Altenhilfe. Die Versorgung alterer Konsumenten illegaler Drogen erfordert zudem eine enge Zusammenarbeit von Suchthilfe, Altenpflege, Gerontopsychiatrie/-psychotherapie und Altersmedizin. Vor diesem Hintergrund wurde im Rahmen eines Forschungsprojekts ein umfassendes Konzept fur pflegebedurftige Altere in der stationaren Altenpflege mit aktuellem oder fruherem Konsum illegaler Drogen entwickelt. Es integriert Vorgehensweisen im Umgang mit Substanzkonsum und Pflegeinterventionen speziell fur diese Zielgruppe in den Pflegealltag.

Maize is wind pollinated and produces huge amounts of pollen. In consequence, the Cry toxins expressed in the pollen of Bt maize will be dispersed by wind in the surrounding vegetation leading to exposure of non-target organisms (NTO). NTO like lepidopteran larvae may be affected by the uptake of Bt-pollen deposited on their host plants. Although some information is available to estimate pollen deposition on host plants, recorded data are based on indirect measurements such as shaking or washing off pollen, or removing pollen with adhesive tapes. These methods often lack precision and they do not include the necessary information such as the spatial and temporal variation of pollen deposition on the leaves. Here, we present a new method for recording in situ the amount and the distribution of Bt-maize pollen deposited on host plant leaves. The method is based on the use of a mobile digital microscope (Dino-Lite Pro, including DinoCapture software), which can be used in combination with a notebook in the field. The method was evaluated during experiments in 2008 to 2010. Maize pollen could be correctly identified and pollen deposition as well as the spatial heterogeneity of maize pollen deposition was recorded on maize and different lepidopteran host plants (Centaurea scabiosa, Chenopodium album, Rumex spp., Succina pratensis and Urtica dioica) growing adjacent to maize fields.

Preliminary data suggest that hypericum extract LI160 is effective in atypical depression. Reported is the outcome of an 8-week double-blind, placebo-controlled, randomized trial of 600 mg LI160 vs. placebo in patients with vegetative features of atypical depression, i.e. hyperphagia or hypersomnia. One-hundred (100) patients with mild and 100 patients with moderate severity of a major depression according to ICD-10 were randomized. Patients needed to meet a score of 2 in at least one of the items 22-26 of the Hamilton-Depression-Rating-Scale (HAM-D) 28-item version and episode duration of at least 3 months. The primary outcome variable was the relative change of the HAM-D(17) from Baseline. Secondary outcome variables were the depression sub-score of the Patient Health Questionnaire (PHQ-9), the Clinical Global Impression (CGI), a patient's satisfaction scale, the Hamilton-Anxiety-Scale (HAM-A) and the sum score of atypical vegetative symptoms of the HAM-D(28). The percentage reduction of the HAM-D(17) for LI160 compared to placebo approached statistical significance (p=0.051) in the Full Analysis Set (FAS)-population. Using the conventional criterion of the absolute reduction of the HAM-D(17) significance was achieved (p

Background, aim, and scope Basically, technological innovations are associated with benefits and risks. This is also true for the introduction of genetically modified organisms (GMO) into agriculture. In Germany, precautionary regulations currently demand isolation distances (i. e. buffer zones) for the cultivation of genetically modified maize (Bt-maize) in the vicinity of conventional (150 m) and organic maize fields (300 m). The Bt-toxin may harm non-target organisms (NTO) such as Lepidoptera. Despite this, corresponding regulations for the protection of nature reserves are lacking to date. Conventional and Bt-maize have been grown in the vicinity of the Flora-Fauna-Habitat (FFH) Ruhlsdorfer Bruch in Brandenburg, Germany. The aim of this study was to investigate whether exposure of maize pollen from surrounding Bt-maize fields to NTOs in the nature protection area could be excluded or not. Two types of exposure were investigated: Firstly, whether maize pollen was dispersed by wind into the nature reserve area exposing resident NTOs. Secondly, foraging NTOs from the nature reserve are exposed by roaming the surrounding fields and collecting maize pollen. In order to fulfil the precautionary principle defined by law, the study should help to determine appropriate isolation distances for the cultivation of Bt-maize with regard to sustainable protection of NTOs in the FFH Ruhlsdorfer Bruch. In 2007, the local authorities issued an isolation distance between Bt-maize fields and nature reserves of 100 m and in 2008, this became 250 m in the northern and 500 m in the westerly direction, respectively. Materials and methodsStandardised methods for biological and technical pollen sampling issued by the Association of German Engineers (VDI 4330 Part 3, 2007 and VDI 4330 Part 4, 2006) were applied providing a quality controlled and methodologically harmonised database which does not only serve the needs to be fulfilled by the present case-specific monitoring study but can also be used as a reference database for further investigations. Maize pollen exposure was measured within the FFH Ruhlsdorfer Bruch and its immediate vicinity in July and August 2007 and 2008. In 2007, the sampling was performed at three sites using 12 technical samplers (Sigma-2/PMF) placed at five measuring points at distances from 5 m to 120 m from the maize field edges. Additionally, for biological pollen sampling six bee colonies were situated at these three sites (two colonies at each site). The technical sampler Sigma-2/PMF enables point sampling which is primarily influenced by wind and topography providing information on effective maize pollen input (flow and deposition) at the measuring sites. Honey-bees roaming in the surrounding area with typical foraging distances of several kilometres may act as planar collectors. They may serve as indicators for the exposure to pollen-collecting NTOs. Furthermore, biological sampling is more selective due to the organism’s preferences, whereas the technical sampling is neutral. Hence, both the technical and the biological sampling complement each other in their scope of application. The pollen samples of both matrices were analysed microscopically and the maize pollen loads were quantified. Pollen-DNA was analysed by means of the quantitative PCR-method (qPCR) identifying conventional and Bt-maize pollen by two independent laboratories. In 2008, the monitoring was repeated with additional sites. Eighteen technical samplers were exposed at five sites with eight measuring points at distances from 5 m to 250 m from the maize field edges. Two honey-bee colonies for biological sampling were placed at one site for control purposes. PCR-analyses were performed to measure the amounts of Bt-maize pollen in the samples. ResultsThe results of pollen monitoring at the Ruhlsdorfer Bruch revealed maize pollen exposure for all monitoring sites in both surveys. In 2007, up to 1.75 million maize pollen/m² were deposited at sites closest to the maize field. At 120 m from field edge in the middle of the FFH-reserve, 99,000 maize pollen/m² were detected. In 2008, similar results were found, at distances up to 250 m from the field edges deposition of 164,000 maize pollen/m² was detected. Data on maize pollen deposition show a clear distance relationship and are in accordance with results of further comprehensive surveys based on the same methodology (Hofmann 2007). The results of the microscopic analysis of the pollen pellets demonstrated that bees collected maize pollen at all sites, in 2007 and 2008. Although maize pollen is not the main food source (2007:0.1–0.3 %; 2008:2–3 %) the collection efficiency of the bee colonies resulted in high amounts of sampled maize pollen with 4 to 11 million per site in 2007 and up to 467 million in 2008. Molecular-biological analysis of maize pollen DNA by qPCR demonstrated that transgenic Bt-MON810 DNA was present in all technical and biological samples, corroborated by two independent laboratories. In 2007, the GMO-content in the samples ranged up to 44 % in the bioaerosols and 49 % in the pollen pellets. In 2008, GMO-proportions of up to 18 % were detected. DiscussionThe results of this study provide evidence that NTOs in the Ruhlsdorfer Bruch were exposed to Bt-maize pollen under the cultivation conditions in 2007 with a buffer zone of 100 m. The GMO-content reached up to 48 %. The results of the monitoring in 2008 confirmed these findings. Even though the exposure could be reduced by increasing the isolation distances to 250 m and 500 m respectively, the results still show percentages of up to 18 % Bt-MON810 in the pollen samples. The results on maize pollen deposition at the Ruhlsdorfer Bruch in 2007 and 2008 correspond to the results of an investigation which was conducted over several years applying the same standardised method, but covering a wider range of distances. The correlation between maize pollen deposition (n/m²) and distance to the source field (m) fitted best to a power function of the type y = 1.2086 · 106 · x–0.548. Despite the same trend, the pollen deposition in the Ruhlsdorfer Bruch revealed above-average findings. Also the analysis of the pollen pellets collected by the bees showed an exposure in 2007 with values for the GMO-content of up to 49 %. For both methods, the exposure decreased in 2008 due to the greater buffer zones up to 500 m. Whereas the GMO-content for the biological sampling were reduced to values below 10 %, the values for the technical sampling were still higher indicating that greater buffer zones would be necessary for safety reasons under the precautionary principle. ConclusionsThe results of this investigation proved that maize pollen were dispersed by wind to distances farther than 250 m from field edge leading to maize pollen exposure in the centre of the nature reserve. The results also demonstrated that foraging NTOs living in the nature reserve were exposed to maize pollen from surrounding fields. Considering the cultivation of Bt-maize MON810, the assumption of the Environmental Risk Assessment (ERA) that there will be no relevant exposure beyond the Bt-maize fields, cannot be confirmed. Considering the results of this and related studies and with respect to the precautionary principle, one can state that buffer zones between Bt-maize fields and protected areas are an effective measure to minimise the exposure of Bt-maize pollen to NTOs and, thus, to prevent from adverse effects. Recommendations and perspectivesBecause of still insufficient ecotoxicological data for the risk assessment of Bt-maize MON810 considering butterflies and other protected NTOs, protection standards assuring the precautionary principle have to be implemented to avoid Bt-maize pollen exposure to NTOs. This applies for the case Ruhlsdorfer Bruch and for nature reserve areas in general. In order to exclude risks to protected NTOs occurring in nature reserves, sufficient buffer zones for Bt-maize cultivation should be considered. The statistical analysis revealed that distances of more than 500 m are necessary to decisively reduce exposure to foraging insects. In fact, distances of more than 1,000 m are necessary to prevent maize pollen deposition from values above 100,000 pollen/m² with a certainty of 90 %. An adequate risk assessment can only be attained if based on field measurements accounting for the high variation of pollen deposition due to local environmental site conditions and field management. The monitoring should be based on standardised methods. It should include locations with the highest expected deposition rates, the boundaries of the protected areas and sites of interest within those boundaries, e. g., specific habitats of sensitive species.

Ziel und Hintergrund Die Verordnung uber die gute fachliche Praxis bei der Erzeugung gentechnisch veranderter Pflanzen (Gentechnik-Pflanzenerzeugungsverordnung (GenTPflEV 2008) sieht aus Vorsorgegrunden Abstandsregelungen fur den Anbau von gentechnisch verandertem Mais – Bt-Mais – zu konventionellem Maisanbau (150 m) sowie zu Biomaisanbau (300 m) vor, nicht jedoch zu Naturschutzgebieten. Ziel dieser Studie war es, zu prufen, inwieweit Maispollen in das Schutzgebiet Ruhlsdorfer Bruch eindringen. In der Umgebung wird sowohl konventioneller als auch gentechnisch veranderter Mais der Sorte Bt-MON 810 angebaut. Die Untersuchungen sollen dazu dienen, geeignete Sicherheitsabstande fur den Anbau von Bt-Mais im Hinblick auf den nachhaltigen Schutz von Nichtzielorganismen (NZO) im Ruhlsdorfer Bruch zu begrunden. Material und Methoden Die Erfassung der Maispollenexposition im Ruhlsdorfer Bruch erfolgte im Juli und August 2007 an drei Standortbereichen im FFH-Gebiet bzw. in dessen Nachbarschaft unter Verwendung von zwolf technischen und drei biologischen Pollensammlern ( je zwei Bienenvolker). Mit dem technischen Sammler Sigma-2/PMF wird die Maispollenimmission am Messpunkt uber den Bluhzeitraum erfasst. Sie ist in erster Linie von Wind und Topografie abhangig und gibt Auskunft uber den tatsachlichen Eintrag, den Maispollenfluss und die Maispollendeposition am Ort des Pollensammlers. Der technische Sammler indiziert damit die Exposition am Messort. Die Honigbienen durchstreifen Areale und sind somit Flachensammler. Als solche geben sie Auskunft uber die bluhenden Pflanzen in einem bestimmten Sammelbereich und dienen als Indikator fur die Exposition von umherstreifenden NZO. Zudem werden die biologischen Praferenzen bei der Sammlung erfasst, wahrend der technische Sammler keine artspezifische Selektion vornimmt. Somit erganzen sich beide Sammler in ihrer Aussagekraft. Die Pollenproben wurden mikroskopisch bestimmt, quantitativ ausgezahlt und die Pollen-DNA anhand von PCR-Verfahren auf ihren GVO-Anteil hin analysiert. Ergebnisse An allen Messstandorten im Ruhlsdorfer Bruch wurden Maispolleneintrage festgestellt. Die Pollendepositionen erreichten Werte von 1,75 Mio. Maispollen/m² im Nahbereich. An dem 120 m entfernten, mitten im Schutzgebiet gelegenen Standort, wurden noch 99.000 Maispollen/m² nachgewiesen. Bei 1.000 m Abstand ist im Mittel noch mit 28.000 Maispollen/m² zu rechnen. Die Ergebnisse der mikroskopischen Pollenanalyse der Bienenhoschen belegen, dass die Bienen an allen drei Standorten Maispollen sammeln. Wenngleich Mais nicht die Haupttracht darstellt, ergaben sich aufgrund der grosen Sammelleistung der Bienen uber den Bluhzeitraum erhebliche Mengen an Maispollen, die eingetragen wurden. Der molekularbiologische Nachweis von Pollen-DNA mit quantitativer Polymerase-Kettenreaktion (PCR) konnte in den Freilandproben sowohl aus der technischen als auch der biologischen Pollensammlung von zwei unabhangigen Laboren mit ubereinstimmenden Ergebnissen gefuhrt werden. Die Ergebnisse aus diesen qualitatsgesicherten Analysen belegen eindeutig, dass unter den Anbaubedingungen von 2007 ein Eintrag von Bt-Maispollen in das Schutzgebiet Ruhlsdorfer Bruch bestanden hat. Diskussion Die Maispollendeposition im Ruhlsdorfer Bruch zeigt einen ahnlichen Abstandstrend wie uberregionale Erhebungen, die andernorts uber mehrere Jahre mit derselben Methode erfolgten. Allerdings sind die Polleneintrage in das Ruhlsdorfer Bruch im Mittel uberdurchschnittlich. Mogliche Grunde dafur konnen die Grose der Maisfelder (> 10 ha), die geografische Anordnung zwischen Maisfeldern und Schutzgebiet (Windrichtung, tieferes Bruch, Thermik) sowie Witterung und Maisblute im Untersuchungszeitraum Juli und August 2007 sein. Nach der statistischen Auswertung ist ein Abstand von 1.000 m notwendig, um mit einer 90-prozentigen Wahrscheinlichkeit Depositionen uber 100.000 Maispollen/m² auszuschliesen. Schlussfolgerungen Die Ergebnisse aus dieser Untersuchung belegen, dass unter den Anbau- und Witterungsbedingungen von 2007 ein Eintrag von Bt-Maispollen in das Schutzgebiet erfolgt ist. Aus den Befunden dieser Studie und aus methodisch identischen Vergleichsuntersuchungen folgt unter Anwendung des Vorsorgegrundsatzes und des immissionsschutzrechtlichen Wirkungsbegriffs, dass ein Schutzabstand zwischen Bt-Maisanbau und den Schutzgebietsgrenzen erforderlich ist, um den GV-Maispolleneintrag und die Wahrscheinlichkeit negativer Effekte bei den zu schutzenden NZO zu minimieren. Empfehlungen Da fur die im Schutzgebiet vorkommenden Schmetterlingsarten keine toxikologischen Untersuchungen vorliegen, ist aus Vorsorgegrunden der hochste Schutzstandard, also die Vermeidung des Eintrages von Bt-Maispollen im Ruhlsdorfer Bruch, anzustreben. Dies bedeutet, die technisch hochstmoglichen Abstande fur den Bt-Maisanbau anzustreben. Wir empfehlen einen Abstand von 1.000 m zur Schutzgebietsgrenze einzuhalten. Damit liese sich erreichen, dass mit 90-prozentiger Sicherheit im Schutzgebiet ein Uberschreiten der Pollendeposition von 100.000 Maispollen/m² (PMF) ausgeschlossen und die Exposition umherschweifender NZO minimiert werden kann. Ausblick Uber das Pollenmonitoring lasst sich die Einhaltung festgelegter Richtwerte empirisch uberprufen. Dies sollte an den Bereichen mit erwarteten maximalen Eintragen, wie an den zu Anbaufeldern gelegenen Schutzgebietsgrenzen oder besonders exponierten Stellen, erfolgen.

Background Risk assessment for GMOs such as Bt maize requires detailed data concerning pollen deposition onto non-target host-plant leaves. A field study of pollen on lepidopteran host-plant leaves was therefore undertaken in 2009–2012 in Germany. During the maize flowering period, we used in situ microscopy at a spatial resolution adequate to monitor the feeding behaviour of butterfly larvae. The plant-specific pollen deposition data were supplemented with standardised measurements of pollen release rates and deposition obtained by volumetric pollen monitors and passive samplers. Results In 2010, we made 5377 measurements of maize pollen deposited onto leaves of maize, nettle, goosefoot, sorrel and blackberry. Overall mean leaf deposition during the flowering period ranged from 54 to 478 n/cm2 (grains/cm2) depending on plant species and site, while daily mean leaf deposition values were as high as 2710 n/cm2. Maximum single leaf-deposition values reached up to 103,000 n/cm2, with a 95 % confidence-limit upper boundary of 11,716 n/cm2. Conclusions Daily means and variation of single values uncovered by our detailed measurements are considerably higher than previously assumed. The recorded levels are more than a single degree of magnitude larger than actual EU expert risk assessment assumptions. Because variation and total aggregation of deposited pollen on leaves have been previously underestimated, lepidopteran larvae have actually been subjected to higher and more variable exposure. Higher risks to these organisms must consequently be assumed. Our results imply that risk assessments related to the effects of Bt maize exposure under both realistic cultivation conditions and worst-case scenarios must be revised. Under common cultivation conditions, isolation buffer distances in the kilometre range are recommended rather than the 20–30 m distance defined by the EFSA. Electronic supplementary material The online version of this article (doi:10.1186/s12302-016-0082-9) contains supplementary material, which is available to authorized users.

The efficacy and tolerance of a capsicum plaster in non-specific low back pain was investigated in a double-blind, randomised, placebo-controlled multicentre parallel group study. A total of 320 patients were randomly assigned to two groups of n=160 subjects treated by the active or the placebo plaster. The main outcome measures used were a compound pain subscore of the Arhus low back rating scale (continuous variable), and a response criterion of a reduction in pain subscore=30% from baseline to final assessment (secondary, non-continuous variable). In addition, the partial pain scores, disability and mobility restriction subscores, the total score of the Arhus low back rating scale, the global evaluation of efficacy by investigator and patient, adverse events, a patient questionnaire on use of the plaster, and an evaluation of tolerance by investigator and patient were obtained. After 3 weeks treatment with capsicum and placebo plaster respectively, the compound pain subscore was reduced by 42% (capsicum) and 31% (placebo) from values on entry. Responder rate was 67% versus 49% (p=0.002). The investigators rated efficacy as "excellent" or "good" by 74% and 36%; the patient's efficacy rating "symptomfree" or "improved" reached 82% and 50%. Adverse local drug reactions were found in 12 patients (7.5%) on capsicum and 5 (3.1%) on placebo. No systemic side-effects were observed. The superiority of the treatment of chronic non-specific low back pain with capsicum plaster compared to placebo was clinically relevant and highly statistically significant. The capsicum plaster offers a genuine alternative in the treatment of non-specific low back pain.

Topically applied capsaicin (CAS 404-86-4) induces the release of substance P, a neurotransmitter, from sensory C-fibres. In addition, there is a specific blockade of transport and de-novo synthesis of substance P. As a result, repeated applications of capsaicin bring about a long lasting desensitisation to pain (increase of pain threshold). The desensitising effect is fully reversible. The confirmed pharmacodynamic actions and a number of double-blind clinical studies indicate that local capsicum preparations are very suitable for the treatment of neuropathic pain or musculoskeletal disorders, with or without inflammatory components. In a double-blind, randomised parallel-group study a capsicum plaster was compared with a placebo for 3 weeks in 154 patients with non-specific back pain. Inclusion criteria were a history of back pain for a minimum period of 3 months and a degree of pain of 5 or more on an eleven grade visual analogue scale. The principal target variable consisted of the score of 3 combined pain scales. Secondary efficacy measures were tests of mobility, a disability index (in the context of Arhus low back rating scale) and global assessments by physicians and patients. For patients to be rated as responders their total pain score at the final examination after 3 weeks of treatment had to show a reduction by at least 30% of the baseline value. The study unequivocally achieved the target criterion with a rate of responders in the capsicum group of 60.8% against 42.1% in the placebo group (p = 0.0219). The sum of the 3 separate pain scales decreased more markedly in the capsicum group than in the placebo group (38.5% compared to 28.0%; p = 0.002). Relatively slight improvements of the impaired mobility and the functional status are explained by the characteristics of the disorder treated. The efficacy ratings by observers and patients was definitely in favour of capsicum. Adverse effects--mostly harmless and resolving spontaneously--were reported by 15 patients in the capsicum group and by 9 in the placebo group. The tolerance ratings by investigators and patients were superior to the placebo product. This, however, partly is due to the local pharmacological actions of the drug. As in comparably positive randomised studies with capsaicin cream in patients with osteoarthritis or fibromyalgia it was shown that a capsicum plaster preparation can also be used to advantage in chronic non-specific back pain.

In a randomised double-blind comparative trial, the antidepressant efficacy of a daily dose of 800 mg of the St. John’s wort extract LoHyp-57 (dry extract of St. John’s wort, drug extrakt ratio 5-7: 1, solvent, ethanol 60% [w/w]) was shown to be equivalent to that of 20 mg fluoxetine (CAS 54910-89-3) in elderly patients with mild or moderate depressive episodes according to ICD 10 (International Statistical Classification of Diseases and Related Health Problems). Treatment was given for six weeks. 149 out-patients (129 females and 20 males) were included in the intention-to-treat analysis. 72 of these patients were assigned to the ICD 10 diagnostic criterion F32.0 (mild depressive episode), while 77 patients were suffering from moderate depressive episodes, corresponding to F32.1. The principal target criterion was the patient’s global score on the HAMILTON Depression Scale (items l-l 7). During the six-week course of treatment with LoHyp-57, the HAMILTON global score fell from 16.60 points at entry to 7.91 points, and in the fluoxetine sample it fell from 17.18 to 8.11 points. In the group of patients with mild depressive episodes, the score showed a mean fall from 14.21 to 6.21 points on LoHyp-57, and from 15.21 to 7.46 points on fluoxetine. In patients with moderate depressive episodes, the score showed a mean fall from 18.73 to 9.43 points on LoHyp-57 and from 19.10 to 8.75 points on fluoxetine. The efficacy of both medications was found to be equivalent both in mild and moderate depressive episodes. Both treatment groups showed adverse drug reactions (ADRs). Twelve ADRs with a possible relationship to the study medication were reported during treatment with LoHyp-57. Six patients were prematurely withdrawn from treatment with the study medication for this reason. On fluoxetine 17 ADRs occurred with a possible relationship to the study medication. These led to abandonment of treatment and therefore premature withdrawal from the study in 8 cases.

Background In Germany, case management in a palliative care unit was first implemented in 2005 at the Department of Palliative Medicine at the University Hospital Cologne. One of the purposes of this case management is to deal with enquiries from patients and their relatives as well as medical professionals. Using the Case Management Process Model of the Case Management Society of America as a reference, this study analysed (a) how this case management was used by different enquiring groups and (b) how patients were identified for case management and for palliative care services. The first thousand enquiries were analysed considering patient variables, properties of the enquiring persons and the content of the consultations. Results Most enquiries to the case management were made by telephone. The majority of requests regarded patients with oncological disease (84.3 %). The largest enquiring group was composed of patients and relatives (40.8 %), followed by internal professionals of the hospital (36.1 %). Most of the enquiring persons asked for a patient’s admission to the palliative care ward (46.4 %). The second most frequent request was for consultation and advice (30.9 %), followed by requests for the palliative home care service (13.3 %). Frequent reasons for actual admissions were the need for the treatment of pain, the presence of symptoms and the need for nursing care. More than half of the enquiries concerning admission to the palliative care ward were followed by an admission. Conclusions Case management has been made public among the relevant target groups. Case management as described by the Case Management Process Model helps to identify patients likely to benefit from case management and palliative care services. In addition, with the help of case management palliative patients may be allocated to particular health care services.