[Morbidity differences according to nursing stage and nursing setting in long-term care patients: Results of a claims data based study]

BACKGROUND

We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany.

MATERIALS AND METHODS

The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated.

RESULTS

In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs.

CONCLUSION

Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.

Preparation, Structure and Physical Properties of BEDT-TTF* Nitrates

Electrocrystallization of BEDT -TTF in THF with tetrabutylammonium nitrate as supporting electrolyte leads to the deposition of at least three different phases. The a-phase (C10H8S8)3(NO3)2, Mt = 1277.98, crystallizes in the monoclinic space group P21/n. The structure of this solid was solved: a = 5.890(2), b = 31.125(10), c = 12.915(6) Ä , β = 103.73(3)°, V = 2300 Å 3, Z - 2, Dx = 1.84 gem-3, MoKfα λ = 0.7107 Å , μ = 11.2 cm-1, F(000) = 1300, room temperature, R = 0.057 for 1888 observed independent reflections. Sheets of BEDT-TTF radical cations with short intermolecular S···S contacts (>3.315(4) Å ) are separated by anion layers. Two more BEDT-TTF nitrates have been characterized by their unit cell data. Results of temperature dependent electrical conductivity and thermopower measurements on crystals of the a-phase are presented. They are metallic down to about 30 K

[Should asymptomatic aortic valve disease be treated surgically?]

The problems posed by asymptomatic aortic valve disease with regards to surgery differ according to whether the lesion is aortic stenosis or regurgitation. In stenotic lesions, even severe, the risk of spontaneous evolution is very small when the subject is totally asymptomatic. However, the quality of the results of surgery in asymptomatic or pauci-symptomatic patients and the increased difficulties in the very elderly are incentives not to differ surgery when the stenosis is severe, and especially when left ventricular function begins to degrade. In aortic regurgitation, the risk of progression is also low in asymptomatic patients but left ventricular dysfunction may develop before symptoms occur: this explains the necessity for regular clinical, echocardiographic and eventually radioisotopic examination of patients with severe aortic regurgitation. In dystrophic aortic regurgitation, an aneurysm of the sinuses of Valsalva and/or of the ascending aorta, or progressive fusiform dilatation of the ascending aorta are reasons for not postponing surgery for replacement of the aortic valve and the ascending aorta.

Thoracic splenosis presenting with hemoptysis

Thoracic splenosis (post-traumatic autotransplantation of splenic tissue) is rare and generally asymptomatic. We report a patient with thoracic splenosis presenting with repeated hemoptysis. The blood supply of the hypervascular splenic transplants originated from a bronchial and an intercostal artery. Hemoptysis improved after surgical exeresis of splenosis. Recognizing splenosis presenting with hemoptysis is important, since percutaneous embolotherapy could be hazardous because of the risk of ectopic splenic tissue infarction.