[ICF and the Term "Substantial Disability" in the German Bundesteilhabegesetz (BTHG)]

The new law, called "Bundesteilhabegesetz" was rapidly approved by the German legislative institutions in December 2016. It was supposed to be a milestone demonstrating the change from paternalistic care to the right of autonomous participation in all parts of social life. This new law sought to offer new ways, but actually there remains a big space for interpretations in the implementation. The law proposal wanted to claim 5 from the nine areas of life from the ICF. That was not accepted. Until December 2019 there must be found a definition of "substantial disability". It must be clear, that this is no mathematical aspect. Each medical officer/doctor gives his expert decision to his best knowledge and belief. No other instrument would really respect the human dignity and could better guarantee justified social personal support. It must closely be observed until the year 2023 what will be realized in the implementation of this law. Each wrong headed development, which possibly prioritize financial aspects, should be acutely opposed. In this part all medical directors/doctors are required not only in the social medical but in the social political discussion, too.

From antiferromagnetic order to static magnetic stripes: the phase diagram of (La,Eu)2-xSrxCuO4

The magnetic order of (La,Eu)2-xSrxCuO4 ( x</=0.2) has been investigated with &mgr;SR techniques. In this system a low temperature tetragonal (LTT) structure is present in the entire range of doping and it is possible to follow the evolution from the long range antiferromagnetic state at x = 0 to the static magnetic stripes. We find a nonmonotonic change of the Neel temperature with increasing x and the obtained magnetic phase diagram of the LTT phase resembles the generic phase diagram of the cuprates where the superconductivity is replaced by a second antiferromagnetic phase.

Cigarette smoking and progression of retinopathy and nephropathy in type 1 diabetes

The objective of the present study was to analyse the association between cigarette smoking and progression of retinopathy and nephropathy, respectively, in a prospective multicentre study including 636 people with Type 1 diabetes: 81% of the original cohort of consecutively referred patients, aged 15 to 40 years and free of severe late diabetic complications. At baseline, all patients had participated in a 5-day in-patient group treatment and teaching programme for intensification of insulin therapy. Patients were examined at recruitment, and after 1, 2, 3 and 6 years including assessment of smoking status, blood pressure, metabolic control, and degree of nephropathy. Degree of retinopathy was assessed by ophthalmoscopy or fundus photography at baseline and after 6 years. Several logistic regression analyses were performed by describing the responses retinopathy and nephropathy, respectively, either as progression yes/no or as actual status at the 6-year follow-up and by using different measures for smoking. Adjustments for important covariables were made. While significant associations between smoking, and retinopathy and nephropathy respectively, were found, the relations were variable depending on the statistical model used. The results show that the real associations between smoking and retinopathy and nephropathy are complex and that more emphasis should be put on the complete description of the response variables and the statistical models used in clinical and epidemiological research.

Liberalized diet in patients with type 1 diabetes

OBJECTIVE

To document that strict dietary regimen are not necessary in the context of intensified insulin therapy.

DESIGN

German multicentre, prospective cohort study; 6 years follow-up.

SETTING

Ambulatory examination using a mobile ambulance.

SUBJECTS

A total of 636 type 1 diabetic patients (age 33 +/- 7 years, diabetes duration 15 +/- 7 years; mean +/- SD), who had participated in a structured, 5-day, in-patient, group treatment and teaching programme for intensification of insulin therapy and liberalization of the diabetes diet 6 years prior to follow-up.

MAIN OUTCOME MEASURES

Relations between the extent to which patients practise a liberalized diet, the degree of metabolic control (HbA1c, severe hypoglycaemia, body mass index, cholesterol), and the patients' perceived burden through dietary treatment.

RESULTS

In the total patient group, HbA1c was 7.9 +/- 1.6%, and the incidence of severe hypoglycaemia was 0.17 cases per patient during the preceding year; 31% patients injected insulin < or = 3 times per day, 58% 4-7 times per day, and 11% used insulin pump therapy. Only 11% patients reported following a meal plan, whereas 89% continually changed timing and amount of carbohydrate intake; only 5% had the same number of meals every day, whereas as many as 20% varied the number of meals per day by four or more; 53% skipped main meals; 85% habitually consumed sugar or sugar containing foods. Patients with a higher degree of diet liberalization injected insulin or used an insulin pump therapy more frequently, and perceived their dietary treatment to be less burdensome. No clinically significant associations were found between the extent of diet liberalization and metabolic control.

CONCLUSIONS

Under the conditions where type 1 diabetic patients have the opportunity to participate in an intensified insulin treatment and teaching programme, liberalization of the diabetes diet is not associated with adverse effects on glycaemic control, but is associated with less perceived burden through dietary treatment.