[Transfer of participatory research findings to practice: the tool Standortanalyse in municipal health promotion]

In Hamburg wird der Auf- und Ausbau von integrierten kommunalen Gesundheitsstrategien in Sozialräumen gefördert. Für die Beratung entwickelten wir, die Forschungsgemeinschaft des Projekts „Kommunale Entwicklung von Gesundheitsstrategien“, in einem partizipativen Prozess das Instrument „Standortanalyse“. Die Konzeption gründet auf Ergebnissen des Projekts und orientiert sich am Modell „Community Readiness“. Die Standortanalyse dient der Einschätzung eines Sozialraums und richtet sich an Fachkräfte. Dieser Beitrag beschreibt, wie ein Transfer in die Praxis gelingen kann. Hierzu werden Ergebnisse der Erprobungsphase der Standortanalyse, die wir von 2019 bis 2020 in 4 Stadtteilen Hamburgs evaluativ begleiteten, vorgestellt.

Die Standortanalyse umfasst ein Tableau, Themenfelder und Fragekarten sowie ein Arbeitsheft. Im Mittelpunkt steht die Analyse der Themenfelder. Gegenstand unserer qualitativen Evaluation waren die Akzeptanz der Beratungen, die Passung und Handhabung des Instruments sowie mögliche Weiterentwicklungsbedarfe.

Die Ergebnisse gliedern sich in Beratungsvorgehen, Beratungskontext und Wirkungen. Zentrale Erkenntnisse sind: Das Instrument fördert die Vernetzung von Fachkräften, trägt zur Strukturierung und Transparenz in der Entwicklung von integrierten kommunalen Strategien in Sozialräumen bei, schließt Wissenslücken und unterstützt das Handling der Prozesse. Für die Praxis ist eine externe Prozessbegleitung bedeutsam. Neben der Verfügbarkeit eines Instruments ist es künftig wichtig, in die Qualifikation von Beratenden sowie in digitale Angebote zu investieren.

99 BIRTH OF THE FIRST BOVINE EMBRYO TRANSFER CALF IN THE REPUBLIC OF KOSOVA

The objective of this applied field study was to assess the feasibility of successfully performing bovine embryo transfer in the Republic of Kosova—a feat that had not yet been accomplished in this newly independent (2008) eastern European country. Three Holstein heifers at the Iowa State University dairy farm were superovulated with a conventional descending dose regimen of FSH (Folltropin). Approximately 12 and 24 h after the observed onset of oestrus, heifers were inseminated with semen from a single Red Holstein bull. Embryos were non-surgically collected and washed in accordance with IETS procedures for sanitary handling of embryos. Embryos were cryopreserved for subsequent direct transfer. After obtaining an import permit from the Kosovo Food and Veterinary Agency, embryos were approved for export to the Republic of Kosova by the US Department of Agriculture, Animal Plant Health Inspection Service. Embryos were shipped via an express courier service. A total of 19 embryos were received in the Republic of Kosova. Recipients were monitored for signs of naturally occurring oestrus, and immediately before transfer, embryos were thawed by holding in air for 3 to 5 s followed by placement into a 37°C water bath for 25 to 30 s. The first-ever bovine embryo transfer calf in the Republic of Kosova was born July 6, 2015. A total of 9 calves were born from the 19 embryos transferred (47.4% embryo survival rate). Results of this applied field study show that bovine embryo transfer is feasible in the Republic of Kosova. Embryo transfer will be used to improve the quality of dairy cattle genetics in the Republic of Kosova and to subsequently increase the national supply of milk, decrease dependence on milk imports, and increase food security of the nation.

Einfluss des Alters auf die optischen Aberrationen des menschlichen Auges

BACKGROUND

Currently the influence of age on corneal and ocular aberrations is still insufficiently known. The aim of this clinical study was to compare age-related aberrations of human eyes.

METHODS

In a prospective study 98 eyes of 49 healthy patients ranging from 17 to 65 years of age (38.6+/-10.0 years) were consecutively examined. The best corrected visual acuity ranged from 0.8 to 1.6; 48 eyes were emmetropic (SE+/-0.5 D), 42 eyes myopic (SE <-0.5 to -6.75 D), and 8 eyes hyperopic (SE >+0.5 to +3.88 D). The corneal aberrations were derived from corneal topography (Keratron Scout, Optikon). The measurement of ocular aberrations was performed with a Tscherning wavefront aberrometer (ORK, Schwind). The aberrations of the Zernike coefficients and RMS values (1st to 4th order) were determined.

RESULTS

The mean corneal and ocular Zernike coefficients of higher order were smaller than 0.2 microm. There was an evident decrease of wavefront aberrations with increasing order. Higher order corneal aberrations were larger than the corresponding ocular aberrations. With increasing age higher optical errors increased in complexity, and the correlation of corneal and ocular aberrations decreased with significant differences. Although the corneal ocular RMS value of the 3rd and 4th order correlated in the younger group (r=0.51, p=0.0001), there was no correlation in the older group (r=-0.48, p=0.832). The influence of age caused a significant increase of ocular aberrations of the 3rd and 4th order, in particular a tenfold extension of coma (C07) (p=0.002), a twofold extension of spherical aberration (C12) (p=0.0001), and an increase of the 3rd and 4th order RMS values (p=0.001).

CONCLUSIONS

Increased age induced an increase in optical aberrations of the eye, which demonstrates the influence of the lens on ocular aberrations. The combination of corneal and ocular diagnostic methods is recommendable for a better understanding of visual performance.

["Shrinkage of cruciate ligaments"--a biomechanical study. Shrinkage of elongated cruciate ligaments using an application of radiofrequency energy]

The aim of this study was to evaluate structural properties of native and elongated bovine anterior cruciate ligaments after the application of bipolar radiofrequency. Using a material testing machine typical load-elongation curves were used to determine the initial strength of untreated (group 1, n = 20) and elongated cruciate ligaments (group 2, n = 20) after treatment with bipolar radiofrequency (ArthroCare). After the application of a cyclic loading protocol (1000 x 400 N) elongation, yield load, maximal load, and stiffness were determined. Native ligaments served as a control group (group 3, n = 20). In both groups 4 mm reduction in length was caused by the application of radiofrequency. Elongation was significantly higher; yield load, maximal load, and stiffness of cruciate ligaments treated with radiofrequency (groups 1 and 2) were significantly reduced after the application of a cyclic loading protocol in comparison to the control group (p < 0.05). Group 2 ligaments showed the lowest values. The application of radiofrequency weakens the biomechanical properties of native and elongated cruciate ligaments significantly. When radiofrequency energy is used to shrink elongated cruciate ligaments, a nonaggressive rehabilitation protocol should be applied.

One-way distribution system for water for injection: process management, microbiological quality control, and meeting regulatory requirements

The specifications for pharmaceutical water, the qualification and validation of water preparation facilities, strategies to prevent contamination by water-borne bacteria and lastly, the monitoring of microbiological purity are the topics of frequent seminars on Pharma Water Total Quality Management. The same subdivisions are used in the following paper on the process management and microbiological control of a one-way distribution system for Water for Injection. Since 1990, such a system has been in use in the production department of Pharma Hameln GmbH, a contract manufacturer of parenterals. Using this system as an example, the twin needs for flawless microbiological process control and for suitable measures to monitor water quality are discussed, which, together with extensive documentation of the qualification of the production and distribution system, ultimately led to acceptance of the system by regulatory authorities.

Sit-to-stand manoeuvre in hemiparetic patients before and after a 4-week rehabilitation programme

The objective of the study was to document the sit-to-stand of 35 moderately affected hemiparetic patients before and after a 4-week inpatient rehabilitation programme and to investigate the influence of the side of hemiparesis and impaired proprioception on its outcome. The therapists trained the patients to distribute equal weight on both legs and to avoid lateral compensatory tilt of the trunk. The body weight distribution and the displacement of the centre of mass in the frontal plane were studied by assessment of triaxial ground reaction forces. Symmetrical weight acceptance and minimal lateral sway were not reached during the 4-week rehabilitation, with the exception of the patients with a left hemiparesis (n = 19) and no proprioceptive deficit (n = 18).

Asymmetry of gait initiation in hemiparetic stroke subjects

OBJECTIVE

To investigate symmetry of gait initiation in healthy and hemiparetic subjects.

DESIGN

Survey.

SETTING

Kinematic laboratory affiliated with a hospital-based department of rehabilitation.

PATIENTS OR OTHER PARTICIPANTS

Ten healthy and 14 hemiparetic stroke subjects starting five times with their right and left leg, respectively.

MAIN OUTCOME MEASURES

Duration of defined periods, step length, center of pressure, and center of mass were recorded and calculated using two triaxial force plates, contact switches, and a video camera system.

RESULTS

Healthy subjects displayed a high degree of independence of kinetic and kinematic parameters of the starting limb. Hemiparetic patients showed differences with respect to the starting limb: when starting with the nonaffected leg, the swing period and step length was shorter and the center of pressure displayed a more marked medio-lateral sway with no corresponding initial movement of the center of mass; when starting with the affected leg the movement pattern of the center of pressure and center of mass was comparable to that of normal subjects.

CONCLUSIONS

The trajectories of the center of pressure and center of mass and the symmetry parameters are in accordance with a higher degree of uncertainty when starting with the non-affected limb in hemiparetic subjects.

Pyelonephritis provokes growth retardation and apoptosis in infant rat renal cortex

Childhood pyelonephritis is a common cause of renal cortical scarring and hypoplastic kidneys. To understand the mechanisms underlying the cortical lesions, urinary tract infection was induced in three-week-old rats by an intravesical infusion of E. coli, type 06 K13 HL a rat nephropathogenic strain. Four days after infection, histopathological examination showed marked infiltration of leukocytes in the medullary tissue adjoining the calyces and pelvis. In the cortex, signs of inflammation were found only in the cortical zone adjacent to the pelvis. No cells indicative of inflammation were observed in other parts of the cortex. Immunohistochemistry for endogenous proliferating cell nuclear antigen (PCNA) demonstrated a marked decrease in immunoreactivity in proximal tubular (PT) cells. The mitotic response of PT cells, assessed by 3H-thymidine autoradiography, showed a highly significant decrease during the first four days after induction of the infection. Four days after infection, a transient increase in apoptotic cells was observed in cortical cells outside the inflammatory areas. No increase in apoptotic cells was detected in the cortex 10 days after infection. Only a few apoptotic cells were detected in the control kidneys. In conclusion, the data indicate that inhibition of cell proliferation and enhancement of apoptosis may contribute to the renal parenchymal loss after childhood pyelonephritis.

Quantitative analysis of rising from a chair in healthy and hemiparetic subjects

In 15 healthy and 20 hemiparetic persons we studied standing-up by two force-plates. Phases before and after the seat-off, force distribution and centre of gravity displacement were assessed. The patients rose significantly slower. The force ratios after seat-off differed significantly between the groups (0.88 vs 0.68). Left/right hemiparetic patients put more weight on the affected limb in 18%/11% of the trials before seat-off, with its insufficient use after it mainly in the left patients. At seat-off, projection of the centre of gravity fell within the support area in hemiparetic patients, and 3 cm behind it in healthy subjects. With larger lateral displacement of the centre of gravity in the hemiparetic group, left hemiparetic patients mostly shifted their weight to the non-affected side and right hemiparetic patients to both sides. Weight distribution and mediolateral displacement of the centre of gravity in the left and right hemiparetic patients were considered.

Mortality in diabetic patients with cardiovascular autonomic neuropathy

Cardiovascular autonomic diabetic neuropathy (CADN) may carry an increased risk of mortality. However, in previous studies the prognosis of patients with CADN seemed to be influenced by life-threatening macro- and microvascular complications which had already been present at the start of the study period. Between 1981 and 1983, 1015 diabetic patients have been examined for CADN (abnormal heart rate variation at rest and during deep respiration) at the Diabetes Research Institute, Düsseldorf. Thirty-five patients (28 with Type 1 diabetes, 7 with Type 2 diabetes) with CADN have been retrospectively recruited and reviewed 8 years later and compared with 35 patients without CADN who were matched for sex, age, and duration of diabetes. Exclusion criteria for entry into the study included severe micro- or macrovascular complications, such as proliferative retinopathy, proteinuria or symptomatic coronary artery disease. During the 8-year observation period, 8 patients with CADN and 1 patient without CADN died. The survival rate estimates steadily declined in patients with CADN over the whole period studied. The 8-year survival rate estimate in patients with CADN was 77% compared with 97% in those with normal autonomic function (p < 0.05). Deaths were mainly due to macrovascular diseases (n = 3) and sudden unexpected deaths (n = 3). One patient with CADN died after an episode of severe hypoglycaemia. Among the decreased patients, coefficient of variation of R-R intervals during deep breathing was significantly reduced when compared with those who survived (1.04 +/- 0.5% vs 1.87 +/- 1.0%; p < 0.05), and symptoms of autonomic neuropathy (orthostatic hypotension, gastroparesis, gustatory sweating) were more frequent (7/8 vs 10/27 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Aging of liver: morphological and biochemical changes

Light-microscopically there are no significant age-dependent changes in the liver, due to the slight increase in biochemically determined connective tissue components. Electron-microscopical comparison of young and old animals show a larger size and decreased numbers of liver cell mitochondria in older animals. Collagen synthesis in liver is accelerated during growth, as demonstrated by assay of the [3H] proline incorporation rates and of the specific activity of hydroxyproline, corresponding to a decrease in the prolyl hydroxylase activity with age. The neutral salt-soluble collagen fraction may be regarded as a parameter for collagen synthesis, which is activated during the growth period and then remains constant without age and sex differences. Not much is known about the significance of these changes with increasing age or about their initiating factors, although there are parallel findings for liver intoxication and inflammation.