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Biomedical subjects

F M Böcker

Publications and source records attributed to F M Böcker.

11 recordsLinked to original sources
PubMed1991

[Prescription of narcotics to drug addicts? decision aids and guidelines for problem situations].

The proposal is presently being discussed in public that further spread of HIV-infections should be prevented by prescribing substitute drugs. As a rule, no narcotic drug should be prescribed to addicts--to this rule there are a few quite specific exceptions. For instance opiate substitution may be indicated in drug addicts with advanced AIDS who are so debilitated that detoxification measures can no longer be applied, for example by oral long-acting levomethadone. For this particular situation, treatment guidelines are proposed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Treatment of drug dependent patients with methadone. 1: Goals, types and results of methadone programs].

Is the medical prescription of narcotics an adequate way to treat opiate addiction? This question has been controversial in Germany for the last two decades. In 1987, a clinical trial of levomethadone treatment has been started in North-Rhine-Westfalia. Recently, aspects of public health have come to the fore, as methadone programs are hopefully believed to contribute to the prevention of HIV-infections among intravenous drug users. Principles and models of methadone treatment are briefly discussed, international experiences reported, and major objections reviewed.

Europe↗
PubMed1990

[Disability in everyday tasks and subjective status of patients with advanced amyotrophic lateral sclerosis].

Out of 49 former inpatients diagnosed as suffering from myatrophic lateral sclerosis, 21 with a median illness duration of 33 months and severe physical handicaps took part in follow-up examinations as outpatients (n = 8) or have been visited at home (n = 9) or in nursing institutions (n = 4) another 21 patients had already died from the disease). Investigations included medical history (course of illness), neurological and psychiatric examination and interviews with relatives. Measures of daily living handicaps, quality of medical care, density of social network and amount of social support were obtained. In 16 cases, patients and relatives have been able to answer rating scales concerning patient's physical complaints, present mood, depression and anxiety. According to independent, but corresponding judgements of patients (selfrating), relatives and investigators, three out of four patients suffered from moderate or severe reactive depression. The severity of mood disturbance depended on the degree of physical disability in basic daily functions, rated as "loss of autonomy", and on measures of social isolation (number of relatives available). Handicapped and lonely patients seemed unable to cope with their fate, even if regular care was provided. According to former reports, ALS patients have a reputation of heroic stoicism with a low frequency of depression. Our own findings, obtained in patients with advanced disease, do not support these observations. The medical care--e.g. prescription of specific medication, nursing care, physiotherapy, supply of auxiliary devices and aids, nutrition--could often be considerably improved. Special emphasis is given to the indication and appropriate timing for a gastric feeding tube resp. a percutaneous endoscopic gastrostomy (PEG). A second focus of the discussion is the urgent need for communication devices for paralysed speechless patients.

Activities of Daily Living↗
PubMed1990

[Assessment of "coping with disease" in patients with amyotrophic lateral sclerosis (ALS): on the use of an interviewer assessment rating scale].

Theories on "Coping" try to explain which resources people use to master crises and conflict situations. Reactions to challenges of life are considered as "coping strategies". In psychosomatic research, the notion of "coping" serves to describe how patients can handle physical or mental illness. Myatrophic (or amyothrophic) lateral sclerosis (ALS) is a rare chronic progressive disease of the nervous system with a gradual loss of motor neurons, resulting in muscular atrophy, weakness and spasticity. Since the etiology is unknown and no curative treatment available, most patients die from respiratory failure within a few years. In a follow-up study on physical disability, medical care and social support in 21 patients with advanced ALS, we tried to address the question how patients get along with such a threatening condition. After semi-standardized clinical interviews with patients and close relatives, two investigators gave independent descriptions of reported or observed "coping strategies" (rated as "not at all-barely-possibly-probably-very probably present"). Considering 17 patients assessed by both raters, significant agreement (Kendall's W) was achieved in three patients only. A comparison of aggregated answers (chi 2-Test) revealed different response sets, since one rater tended to choose extreme scale points, while the other preferred undecided answers. Differences of mean scores were observed in 8 out of 21 items, while significant correlations between investigators were obtained in another 8, including, though, only 2 of those 5 items which both had rated as "probably present" in no less than 50% of the patient sample ("Dejection & Flight-Brooding-Keeping the Situation Open-Distraction-Self-Isolation").(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1986

[Progressive lipodystrophy (Barraquer-Simon syndrome): differential diagnosis and clinical aspects].

"Progressive lipodystrophy" or "partial lipodystrophy of the cephalothoracic type" is a rare, acquired condition of unknown aetiology with onset in childhood and a complete loss of subcutaneous fat of face, neck, trunk and upper extremities. The disease is more common in females than males and causes a disfigurement of the face; that it cannot be regarded only as a harmless variation, is above all due to a typical concomitant disease, membranoproliferative glomerulonephritis with hypocomplementaemia. Laboratory investigations nearly always reveal a complement-activation by the "alternative pathway" with consumption and lack of complement-component C3, a finding which allows a clear distinction between partial lipodystrophy and congenital or acquired forms of total lipodystrophy ("Berardinelli-Seip-Syndrom", lipoatrophic diabetes) and other circumscript lipodystrophies.

Adipose Tissue↗
PubMed1984

[Social integration and contacts to reference persons of the normal social environment in inpatient treatment in the psychiatric hospital. A prospective catamnestic study of patients admitted for the first time with schizophrenic and cyclothymic psychoses].

Fifty first-admission inpatients (27 women, 23 men; mean age 35.1 years) with schizophrenia (n = 35) or affective disorders (n = 15) participated in a standardized, half-open interview about contact with people outside the hospital. The frequency of contact was compared with outcome, as based on a 1-year follow-up. Nearly all patients (48 of 50) had "direct" contact with relatives and friends during the week (means = 3/week): 45 patients had visitors, 13 went home on weekends. Thirty-five patients had contact with the outside by telephone, and 21 by letter; only 12 patients indicated no "indirect" contact. The frequency of contact had no relationship to sex, age or diagnosis. The significant factors were: structure of the patient's family, his/her educational and occupational level, social network, means of admission, conditions of hospitalization, and length of stay. The distance between the patient's residence and the hospital markedly influenced the frequency of visits and weekend holidays. The importance of frequent interaction with the usual social environment was verified by follow-up: 11 patients with rare or only average contact had unfavorable results (readmission or suicide by 1 year after discharge or long-term hospitalization); on the other hand, none of the patients with frequent direct contact outside the hospital showed poor results. There is no reason for indiscriminate criticism of the relatives of psychiatric inpatients according to etiological hypotheses of "family research"; above all, patients without relationships with a family or friends have to be regarded as at risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗