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Biomedical subjects

C Krause

Publications and source records attributed to C Krause.

At least 37 records · Page 2Linked to original sources
PubMed1999

Validity of screening procedures for glycopeptide-resistant enterococci.

Screening agars containing different vancomycin concentrations and different susceptibility testing procedures were compared to determine their validity for the detection of glycopeptide-resistant enterococci (GRE). Direct streaking of rectal swabs over the surface of a commercially available agar (Enterococcosel; Becton Dickinson, Germany) containing 4 microg/ml and 16 microg/ml vancomycin was followed by incubation for 24 to 48 h. Susceptibility tests were done by microbroth dilution, disk diffusion, and the E test (AB Biodisk, Sweden). The microbroth dilution method according to National Committee for Clinical Laboratory Standards (NCCLS) was used as the gold standard for detection of GRE. Resistant and intermediately susceptible enterococcal isolates were differentiated to the species level. To detect resistance genes, the polymerase chain reaction was performed on all intermediately resistant isolates, on all isolates of VanB phenotype, and on 30% of isolates of VanA phenotype. Screening agar containing 4 microg/ml vancomycin displayed high sensitivity (97.6%) but only low specificity (35%) for the detection of GRE. Screening agar containing 16 microg/ml vancomycin had a high specificity of 89.3% and only a slightly lower sensitivity (92.7%) than the screening agar containing 4 microg/ml vancomycin. For the disk diffusion test, a breakpoint of < 16 mm yielded the optimal combination of sensitivity (98.8%) and specificity (99.6%). Both sensitivity and specificity of the E test for GRE detection were 100%. However, the E test is too expensive for testing of all enterococci. In conclusion, the combination of an inexpensive screening agar with either the E test or the disk diffusion test constitutes a valid and cost-effective method for the detection of GRE from screening specimens.

Colony Count, Microbial↗
PubMed1999

Prevalence of colonization with vancomycin-resistant enterococci in various population groups in Berlin, Germany.

In order to prevent the spread of vancomycin-resistant enterococci (VRE), the epidemiology of this micro-organism must be defined. The prevalence of colonization with VRE in various population groups in Berlin was investigated and the risk factors associated with VRE colonization assessed. In a cross-sectional study, rectal swabs were taken from seven population groups (healthy students, outpatients, home nursing patients, normal care and critical care patients of a community hospital and university hospital). Every one completed a questionnaire (age, gender, previous hospital stays, antibiotic therapy). Rectal swabs were examined for the presence of normal gut flora and VRE. All VRE isolates were typed by pulsed-field gel electrophoresis (PFGE). VRE colonization prevalence ranged from 0.9% (students) to 4.2% (nursing-home patients) in non-hospitalized subjects; in hospitalized patients prevalence ranged from 1.8% (regular care ward of a community hospital) to 16.3% (ICU patients of a university hospital). Location (university hospital, OR = 3.5) and age (> or = 60 years, OR = 2.2) were independent risk factors for VRE colonization. Within one population group, isolates with identical PFGE patterns were found in up to three people; one strain was found in four subjects belonging to different groups. Our findings suggest that VRE are imported from the community into hospitals with subsequent spread within the institution.

Adult↗
PubMed1999

Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology.

OBJECTIVE: To determine the most effective, evidence-based, postoperative surveillance strategy for the detection of recurrent colon and rectal cancer. Tests are to be recommended only if they have an impact on the outcomes listed below. POTENTIAL INTERVENTION: All tests described in the literature for postoperative monitoring were considered. In addition, the data were critically evaluated to determine the optimal frequency of monitoring. OUTCOMES: Outcomes of interest included overall and disease-free survival, quality of life, toxicity reduction, and cost-effectiveness. The American Society of Clinical Oncology (ASCO) Colorectal Cancer Surveillance Expert Panel was guided by the principle of cost minimization, ie, when two strategies were believed to be equally effective, the least expensive test was recommended. EVIDENCE: A complete MEDLINE search was performed of the past 20 years of the medical literature. Keywords included colorectal cancer, follow-up, and carcinoembryonic antigen, as well as the names of the specific tests. The search was broadened by articles from the tumor marker ASCO panel literature search, as well as from bibliographies of selected articles. VALUES: Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a randomized design. BENEFITS/HARMS/COSTS: The possible consequences of false-positive and false-negative tests were considered in evaluating a preference for one of two tests that provide similar information. Cost alone was not a determining factor. RECOMMENDATIONS: The expert panel's recommended postoperative monitoring schema is discussed in this article. VALIDATION: Five outside reviewers, the ASCO Health Services Research Committee, and the ASCO Board of Directors examined this document. SPONSOR: American Society of Clinical Oncology.

Colorectal Neoplasms↗
PubMed1999

[1998 environment survey--initial results].

In close connection with the German National Health Interview and Examination Survey 1998, a third round of the German Environmental Survey (GerES III) was carried out using a random subsample of about 4,500 subjects, which are representative for the German population aged 18 to 69 years. The GerES was carried out by the Federal Environmental Agency on behalf of the Federal Ministry for Environment, Nature Conservation and Reactor Safety. The participants had to undergo an examination in human-biomonitoring. An environmental questionnaire was used to get exposure-related information. Preliminary results indicate a reduction of the body burden with metals in 1998 compared with 1990/92. However, some individuals showed elevated values. For those people health effects are possible or cannot be excluded with sufficient certainty. Using the results of GerES III it will be possible for the first time to establish reference values for organochlorine compounds on a representative data basis. The examination of the tap water used in the subjects households shows that the limit and guideline values of the German Drinking Water Ordinance have not always been met in 1998. This holds especially for lead, copper, and zinc which are being used as pipe-material for domestic plumbing.

Adolescent↗
PubMed1998

The effect of lead in tap water on blood lead in children in a smelter town.

Hettstedt, a city in eastern Germany with a long history of mining and smelting of non-ferrous ores, has multiple lead waste deposits and the remains of a former lead smelter and a copper-silver smelter. As part of a cross-sectional study, an analysis of lead concentrations in drinking water and in blood was undertaken to determine the impact of lead in drinking water on the internal burden of lead in children. The geometric mean of blood lead levels among children 5-14 years old was 35.0 micrograms/l with a 95% confidence interval (C.I.) of 33.4-36.7. The geometric mean of lead in the random tap water samples was 0.5 microgram/l (95% C.I., 0.5-0.6) and 0.7 microgram/l (95% C.I., 0.6-0.8) in the stagnant tap water samples. Blood lead levels were somewhat correlated with the random water measures but not the stagnant water measures (random sample: r = 0.12, P = 0.012; stagnant sample: r = 0.04, P = 0.396). After adjustment for relevant confounders, lead in drinking water (random sample) was not significantly associated with blood lead levels. Factors that were significantly associated with blood lead included gender, the city area of residence, lead in house dust, regular contact with dogs and dirtiness of the child after playing outdoors. Based on this study, lead in domestic tap water contributed little to the lead exposure of children in the lead contaminated region of Hettstedt.

Adolescent↗
PubMed1998

Cardiovascular autonomic dysregulation in users of MDMA ("Ecstasy").

The present study examined resting heart rate variability (HRV; an index of parasympathetic tone) and heart rate response to the Valsalva maneuver (Valsalva ratio; an index of overall autonomic responsiveness) in 12 repeat users of 3.4-methylenedioxymethamphetamine (MDMA, "Ecstasy"), and a matched comparison group of presumed nonusers. HRV and Valsalva ratio were smaller in users than in controls. Three out of 12 MDMA users but no controls had Valsalva ratios below 1.50, the cut-off for autonomic dysfunction. In several users, there was a total absence of post-Valsalva release bradycardia. All MDMA users were polydrug users. Parasympathetic cardiovascular tone appears impaired in repeat MDMA users, although the ubiquitous problems in such epidemiologic designs (including lack of testing before the first use of the drug and confounding with use of other drugs) preclude definitive causal interpretations.

Adolescent↗
PubMed1998

Quality of life in individuals with physical disabilities.

BACKGROUND: The quality of life among individuals with severe physical disabilities has greatly improved during the last two decades, partly as a result of well-planned intervention programmes. However, some individuals with physical disabilities do not cope well in their everyday life, no matter how long they have had the disability. It has been suggested that those individuals who adjust well do so regardless of the degree of their physical impairment. METHODS: The subjects were 45 adults with physical disabilities from both Finland and Sweden. The participants filled in a questionnaire and were also interviewed individually. RESULTS: The quantitative analyses revealed that satisfaction with one's life situation is a function of the handicapped person's occupation or meaningful occupational activities, social integration and his/her sense of the meaning of life. Further, the length of time since the onset of the disability was a risk factor for the person's feeling of satisfaction. The qualitative analyses of the interviews verified the results of the quantitative analyses. CONCLUSIONS: The disability per se did not decrease the disabled individual's quality of life. The individual's capacity to cope with everyday life was of great importance. Occupation or meaningful occupational activities as well as social integration at different stages of life should be taken into account when planning intervention programmes in the future.

Adaptation, Psychological↗
PubMed1998

[Pyrethroids in house dust of the German housing population--results of 2 nationwide cross-sectional studies].

As a part of the German Environmental Surveys performed in 1985/86 (West Germany), 1990/91 (West Germany) and 1991/92 (East Germany), dust samples were collected in the households of about 1600 randomly selected adults (25 to 69 years) and an analysis of these samples was performed in respect of their content of 8 different pyrethroids and of the synergist piperonyl butoxide (PBO). In the 1990-92 survey about 90% of the samples contained permethrin in concentrations above the limit of quantification. This showed permethrin to be the most widespread of the 8 compounds investigated. The geometric mean of the permethrin content in domestic dust was 0.22 mg/kg. Only about 8% of the samples contained one or more of the other investigated substances (cyfluthrin, lambda-cyhalothrin, cypermethrin, alpha-cypermethrin, deltamethrin, empenthrin, d-phenothrin) in quantifiable amounts. About 76% of the samples contained quantifiable amounts of PBO. In East Germany the geometric mean of the PBO content (0.21 mg/kg) was significantly higher than in West Germany (0.07 mg/kg), but no difference for permethrin was found. Significant associations could be shown for the permethrin content and the application of biocides as well as for the PBO content and regional factors (size of community, type of dwelling area). Samples collected in 1985/86 (West Germany) showed a geometric mean for permethrin of 0.06 mg/kg and for PBO of 0.07 mg/kg. Comparing the values of 1985/86 and 1990/91, a significant increase can be observed for permethrin, whereas the PBO concentration remained constant.

Adult↗
PubMed1997

The internal burden of lead among children in a smelter town--a small area analysis.

Hettstedt, a city in former East Germany with a history of mining and smelting of nonferrous ores, has multiple lead waste deposits and the remains of a former lead and copper-silver smelter. A small-area analysis of lead concentrations in blood and in household dust was undertaken in a cross-sectional study to determine if children living near the sources had particularly high burdens of lead. The overall geometric mean of the region was 38.0 micrograms Pb/liter blood with a 95% confidence interval (CI) of 36.5-39.5. The burden of lead among children living in the region containing the lead tailings piles and adjacent smelters was almost twice as high (77.4 micrograms Pb/liter blood; 95% CI 65.0-92.0). It decreased in the areas farther northeast from the smelter. Lead levels in the children residing in areas southwest of the smelters were not appreciably elevated. The same pattern was found in house dust lead concentrations. This analysis helped target areas where follow-up is needed and found that not only distance from lead sources, but also meteorological factors played an important role in lead exposure.

Adolescent↗
PubMed1996

Arsenic burden among children in industrial areas of eastern Germany.

The internal burden of arsenic among 5- to 14-year-old eastern German children in the heavily polluted areas of Hettstedt, a region of smelting and copper mining, and Bitterfeld, a center of chemical production and coal mining, was compared with that in a control area (Zerbst) by means of urinary arsenic concentrations in 1992-94. The unadjusted geometric mean among the 950 children was significantly higher in Hettstedt (5.1 micrograms/l; 95% C.I. 4.8-5.5) but not in Bitterfeld (4.3 micrograms/l; 95% C.I. 3.7-4.9) compared with the control area (4.0 micrograms/l; 95% C.I. 3.5-4.5). This difference persisted after adjustment for relevant confounders. Despite these regional differences, recent fish consumption was as strongly associated with urinary arsenic levels (42% increase, 95% C.I. 18-71%). Additionally, although the geometric mean among the children in Hettstedt (4.8 micrograms As/g creatinine; 95% C.I. 4.5-5.1) was higher than that found in an environmental survey of eastern German children (3.60 micrograms As/g creatinine; 95% C.I. 3.06-4.24), it was similar to that found among western German children (4.59 micrograms As/g creatinine; 95% C.I. 4.20-5.02). This suggests that the arsenic contamination in Hettstedt is not substantially increasing the internal burden of arsenic among children above that found in other German children.

Adolescent↗
PubMed1996

[Immuno-hemolytic transfusion reactions. III. Report of 61 cases].

Blood transfusion is mainly bound to immunological and infectious risks. The immunological risk originates from an incompatibility between the blood of the donor and that of the recipient; this risk remains insufficiently assessed. A multicentre study has been carried out by the French Blood Transfusion Society and the National Institute for Blood Transfusion. Sixty-one accidents due to an erythrocyte incompatibility were found: 26 cases with ABO incompatibility, and 35 cases with alloantibodies of other blood group systems. For the former category of accidents, the most frequent cause was due to a failure in the realization of the bedside ABO check. For the latter, the main problem was the achievement and the interpretation of antibody screening. The long term follow-up shows no chronic after-effects of immunological accidents. For each accident, errors have been identified and analysed. It was proven that they all originate from health care establishments.

ABO Blood-Group System↗
PubMed1996

Bolesatine induces agglutination of rat platelets and human erythrocytes and platelets in vitro.

Bolesatine is a toxic glycoprotein isolated from the mushroom Boletus satanas Lenz, which has been shown to inhibit protein synthesis in cell-free systems and cell culture. It is toxic to rodents, the LD50% 24 h being 1 mg kg-1 (i.p.) and 0.15 mg kg-1 (i.v.) in the rat in which it induces hepatic blood stasis. Bolesatine possesses lectinic properties with in particular a sugar binding site for D-galactose and mitogenic activity toward lymphocytes. Tested for cell agglutination on red blood cells and platelets, bolesatine agglutinates both human and rat platelets from threshold concentrations of 30 and 300 nM respectively. EDTA and PGI2 (aggregation inhibitors) do not decrease the agglutination induced by bolesatine, indicating that the process does not involve platelet activation. In contrast, fibrinogen decreases platelet agglutination induced by bolesatine, most likely by masking the binding sites on platelets or by interacting with the toxin. Bolesatine agglutinates all red blood cells without any blood group specificity in the concentration range of 20 to 40 nM. This haemagglutination cannot be prevented by sugars, including D-galactose at a concentration of 0.5 M.

Animals↗
PubMed1995

Delegation: the new driving forces in the home care delivery system.

The new driving forces in the home care delivery system are a reflection of the larger health care changes across our nation. This article will explore what these forces are and how they impact home care, as well as the communities we serve. Delegation issues are part of these forces and will have a major impact on the integrated model. We have the opportunity to move our health care system towards improving the health of our communities and expanding our medical focus to a true continuum of care.

Home Care Services↗
PubMed1992

[Mercury concentration in blood and urine--before and after the placement of dental amalgam fillings].

70 patients of dentist's surgery were given MOD amalgam fillings (non-gamma-2 amalgam) for molars. They were allocated for comparison to four groups defined by their treatment, i.e. the number of old and new restorations and whether a rubber dam was used. Blood and urine samples were collected at regular intervals before and during a 14-day period after treatment and tested for mercury concentration (Hg). Over the observation period the groups with the highest exposure (1-2 old restorations replaced by new ones) showed a tendency, in contrast to the less exposed groups (1 new filling with or without dam), towards increases (p less than 0.10) in group average Hg values of approx. 0.2 microgram/L (blood) and 0.3 microgram/g creatinine (urine) as acute treatment effects. The highest values recorded before and after the treatment, 3.3 micrograms/L (blood) and 16.5 micrograms/L (urine) are higher than normal but do not indicate any increase in the risk to health especially if they are not persistent.

Creatinine↗