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T Kohlmann

Publications and source records attributed to T Kohlmann.

34 records · Page 2Linked to original sources
PubMed1996

Nocturnal blood pressure elevation is related to adrenomedullary hyperactivity, but not to hyperinsulinemia, in nonobese normoalbuminuric type 1 diabetes.

We tested the hypothesis that insulin is an independent risk factor for elevated blood pressure. As our model we selected type 1 diabetes with peripheral circulatory hyperinsulinemia induced by sc insulin treatment. In 15 nonobese normoalbuminuric patients with type 1 diabetes (23.7 +/- 0.8 yr old) and in 15 healthy controls matched for age, sex, and body weight, ambulatory blood pressure was recorded over 24 h. The areas under the curve of free insulin (605 +/- 135 vs. 275 +/- 35 pmol/L.h; P = 0.03) and basal plasma epinephrine concentrations were higher (170 +/- 10 vs. 130 +/- 10 pmol/L; P = 0.02), and the basal aldosterone level was lower (220 +/- 40 vs. 410 +/- 50 pmol/L; P = 0.009) in the patients. The nocturnal decline in systolic blood pressure was less pronounced (13 +/- 1 vs. 19 +/- 2 mm Hg; P = 0.007) in the patients. Multivariate adjustment (r2 = 0.75; P = 0.0002) showed an effect of basal plasma epinephrine and norepinephrine levels and body mass index on the mean nocturnal systolic blood pressure, but showed no effect of age, sex, hemoglobin A1c, aldosterone, or, in particular, insulin. We found a blunted nocturnal fall in blood pressure in nonobese, normoalbuminuric type 1 diabetic patients. These patients showed increased adrenomedullary activity, and this predominantly contributed to the blood pressure alterations. We also found hyperinsulinemia in these patients, but, after controlling for covariates, blood pressure was independent of the insulin level.

Adolescent↗
PubMed1996

[A leukemia cluster in the Pinneberg district. Results of an incidence study by the epidemiologic task force of the Schleswig-Holstein Medical Association].

After regional media had reported in early 1995 of multiple leukaemia cases in a small community in the state of Schleswig-Holstein, an "Epidemiological Task Force" was asked to review the existing evidence for a possible cluster. The Task Force is a small group appointed in 1994 by the regional Medical Association and the state's ministry of social affairs. It includes five professionals from the fields of environmental toxicology and hygiene, Public Health, epidemiology and cancer pathology. In agreement with the local Public Health administration and the ministry the Task Force organized a retrospective screening of all incident leukaemia, lymphoma and myeloma cases (ICD-9 codes 200-208) within a (5-10 km) around the small community (population on December 31st 1993: 72000) that had occurred after January 1st 1990. Any practising physician (response rate 78%), hospital (100 %), oncological centre (100%), and tumour registry (100%) serving the region were asked to notify all relevant cases to the Task Force. Additionally spontaneous case reports were elicited, and all death certificates from the a.m. time period were screened for by two Public Health administrations. We identified 202 single cases for further analysis. Comparative data for the entire region and single communities came from two cancer registries, the Danish and that of the state of Saarland/FRG, and allowed for calculating the expected number of cases by indirect standardisation. While Hodgkin's lymphomas and myelomas were (insignificantly) less frequent than expected, an excess of non-Hodgkin's lymphomas and leukaemias (all types combined) was observed. Standardised incidence ratios for the whole region varied between 1.54 and 1.68 with significant and consistent increases only for the group of leukaemias among adults (aged 15+). All results were reported to both the public and administrative/professional bodies together with specific recommendations. The reactions showed a good acceptance of the Task Force and its work.

Adolescent↗
PubMed1996

[Hannover Functional Questionnaire in ambulatory diagnosis of functional disability caused by backache].

This paper describes conceptual and clinimetric aspects as well as fields of application of the Hannover Functional Ability Questionnaire for measuring back pain-related disability (FFbH-R). The FFbH-R belongs to a series of short self-administered questionnaires for the assessment of functional limitations in activities of daily living among patients with musculoskeletal disorders. In addition to the FFbH-R, a specific version is available for patients with polyarticular diseases (the FFbH-P), as well as a combined version of both questionnaires. A new questionnaire for patients with osteoarthritis is currently being developed. Data from various studies indicate that the FFbH-R meets the relevant psychometric criteria of acceptability, reliability, validity, and sensitivity to change. It has been successfully applied in (observational and controlled) clinical studies, in epidemiologic surveys, and in compensation disability evaluation.

Activities of Daily Living↗
PubMed1996

[Measuring functional capacity in backache patients in rehabilitation: a comparison of standardized questionnaires].

In recent years, subjective assessment of functional ability by patients has become an important diagnostic instrument in rehabilitation medicine. We compared three self-administered standardized questionnaires for measuring functional capacity in patients with back pain (the back pain-specific version of the Hannover Functional Ability Questionnaire, the Roland & Morris Scale, and the Measurement of Patient Outcome Scales) with respect to feasibility, reliability, and validity. The sample comprised 119 patients treated for back pain in a rehabilitation clinic in North Germany. Besides measures of functional ability, anamnestic and psychosociological data were collected in addition. Mobility of the spine was assessed by simple clinical tests. The three questionnaires differed only slightly with regard to their psychometric properties and appeared to be equally well suited for measuring functional ability in patients with back pain. The decision for one of the instruments should be based on practical considerations (time for completion, feasibility, availability of reference data).

Activities of Daily Living↗
PubMed1996

[Backache in East and West Germany].

On the basis of data of the East German Health Survey (1991/92) and regional studies from West Germany (Bad Säckingen 1990, Lübeck 1991/92, Bad Säkingen 1993/94) results on the prevalence of back pain, other rheumatic complaints and general health problems are compared. East German respondents report on back pain and all other rheumatic complaints definitely less often than West German respondents but suffer equally from general health complaints. Apart from the differences in the prevalence of rheumatic complaints there are remarkable structural analogies between East Germany and the West German cities. In any region, the back is the most often affected part of the body, followed by the neck, the shoulder, and the knee. Beyond that, there are similar age-related and sex-specific differences in prevalence rates of rheumatic complaints. In the groups of elderly people, a pattern of declining or constant prevalence rates can be noticed with many complaints. However, there are differences in pain intensity and functional limitations between East and West. The East German respondents particularly mention mild pain more rarely than respondents of the West German cities. They also report fewer functional limitations. This may indicate that in East Germany people attach less importance to rheumatic pain and deal with it in a different way. Possibly, the differences in prevalence can be explained thereby. To what extent they reflect real differences in morbidity cannot be clarified by the present data.

Activities of Daily Living↗
PubMed1994

Disorders characterised by pain: a methodological review of population surveys.

OBJECTIVE--To review a series of conceptual and methodological problems encountered in surveys primarily devoted to pain disorders. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES--Published reports were systematically collected by electronic database searches (Medline), citations in existing publications, and through personal contacts. Relevant articles from clinical and epidemiological research on pain were included and special attention was given to epidemiological research on back pain. CONCLUSIONS--Surveys of pain disorders should be based on a multidimensional pain model that includes nociceptive input, pain perception, suffering, and pain behaviour as major components. Because of the limited applicability of diagnostic procedures or genuine "non-specificity" of pain states, or both, epidemiological surveys may result in a considerable proportion of cases without an identifiable pathophysiological basis. Staging and grading procedures for pain disorders (as distinguished from classification) may comprise various aspects of pain perception: regional distribution, pain intensity, temporal characteristics, sensory qualities, and dimensions of cognitive-emotional appraisal. Description of temporal development and chronification (staging) should refer to different components of the multidimensional pain model. Explicit a posteriori procedures for grading are preferable to implicit grading based on question wording. Evidence from several sources suggests that localistic concepts of pain may be misleading. Identification of complex pain syndromes should be one primary target for epidemiological pain surveys. Of the many factors that may impair the reliability and validity of data collected in pain surveys, recall biases seem to deserve special attention.

Back Pain↗
PubMed1994

[The current backache epidemic].

All available data presented show that we are confronted with a back-pain (BP) epidemic; it affects numerous industrialized countries. More severe forms of BP make up one fifth of the prevalence. The greater part of BP seems to be mild, especially among persons aged 25 to 54. The social insurance statistics, too, show an alarming trend. Cases of work incapacity and medical rehabilitation have increased drastically: one sixth of all cases of work incapacity as well as one third of all medical rehabilitations are to be accounted to BP. It is not easy to interpret the data. Do they represent an increasing BP epidemic? A long-term secular trend towards higher BP prevalences at the population level is to be assumed but cannot be proven at the moment. Is there any evidence that BP-related risk factors have increased? To our knowledge there are no reliable data. It is also to be considered that the 'natural' course of BP may have changed. Is the epidemic a consequence of an increasing 'chronification' of BP due to physical, psychosocial or medical influences? Do 'back-schools' and other factors regarding the BP business have only health-promoting effects? Does the date represent a changing perception and appraisal of pain and/or a changing 'pain-reporting behaviour'? Is 'pain' today what would have been 'discomfort' in former times? Does one complain about BP today when one would have been silent in former times? There are no valid data for these hypotheses, either. Finally, has the transition probability from pain to disability and to social benefits changed?(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Grading of backache].

Back pain is occurring in a broad spectrum of severity; therefore, a grading procedure which is derived from a sound conceptual basis and can be easily applied is of crucial importance in clinical research and in epidemiologic studies. Following a grading procedure which has been developed in epidemiologic studies in the U.S., a hierarchical model for grading is proposed. This comprises pain intensity and functional limitation as basic criteria as well as aspects of time, pain-related cognitions/emotions and concomitant complaints. An application of a simple grading procedure is used to illustrate the predictive utility of the proposed model.

Activities of Daily Living↗
PubMed1985

[Clinico-psychologic studies on the problem of functional psychotic deterioration in schizophrenia].

Our concept of the functional-psychotic mental deterioration of schizophrenia approximately characterizes the same point of view as Kraepelin's terminus "Dementia praecox". The first result of our psychological examination on 225 schizophrenic persons with defect psychotic symptoms was the statement of the deficit in achievement between the former school education (average IQ of the school-type) and the results of examination of intelligence during our research. The functional-psychotic mental deterioration as well appears as a decrease of memory and psychomotoric speed deficiency, furthermore as mental deconcentration and increase of psychoorganic signs in the Rorschach-Test. The psychometric results of this research were statisticly significant.

Adolescent↗
PubMed1975

[Clinical psychological studies on adolescent and adult mongols (author's transl)].

A group of 20 mongol adolescents and adults with an average age of 19 years was strictly parallelized with a group of 20 brain-damaged adolescents and adults of other diagnostic groups with respect to age and intelligence level (average age 19 and average intelligence 50.65--52.90). The hypothesis of a possible deterioration of performance and personality was checked with the following battery of tests: Hamburg-Wechsler intelligence test for adults, the motoricity test according to Walther and the Rorschach experiment. The average difference in the sub-tests of HAWIE primarily emphasize the psycho-organic disturbance in visual-motor coordination, which is seen to a much greater extent in mongols than in non-mongols. The significant difference in completing pictures indicates an intensification of psycho-organicity. In agreement with the observations of WUNDERLICH, the psychomotoricity of the mongols is significantly slower and less adroit than the psychomotoricity of non-mongol oligophrenias. Non-significant differences in the psycho-organic sign (P%, F+%) in disfavor the mongols were seen in the Rorschach experiment. Factorial analysis distinguished the two groups very clearly. In the three most important factors, the mongol group showed stronger signs of psycho-organicity and weak mental performance associated with an intensified neuroticism factor compared with the brain-damage oligophrenia group of other diagnostic origin.

Adolescent↗
PubMed1975

[Correlations of the Personal Sphere Model and Rorschach Projection tests. (A factorial examination of the validity of the Personal Sphere Model using the Rorschach Test)].

The most important results of the factor analysis of 11 variables of the Personal Sphere Model and 14 variables of the Rorschach-Test have shown in both tests common radicals appearing in the evaluation as well of the structure of personality as of the behaviour of man. Both tests emphasize the possibility of objectivating pathological traits of personality: the difference consisting in the fact, that this traits are coming out more distinctly in the Rorschach-Test, while in the Personal Sphere Model the psychodynamic factors of the ability of building object relationships of overcoming seperations are appearing more clearly. The most relevant conformity of both tests is the possibility of distinctly projecting the defense mechanism of aggression.

Aggression↗
PubMedDate not supplied

[Comparative evaluation of a German version of the Health Assessment Questionnaire and the Hannover Functional Capacity Questionnaire].

OBJECTIVE: To translate the Health Assessment Questionnaire Disability Index (HAQ) into a German version, to validate and to compare its properties with two different versions of the Hannover Functional Ability Questionnaire (HFAQ) in a German speaking population. METHODS: The test-retest reliability was tested by Pearson correlation in 32 outpatients of the Department of Rheumatology of the Medizinische Hochschule Hannover. For retesting, the questionnaire was mailed to them 1 week later. To validate the questionnaire it was administered to 110 inpatients in three different hospitals. All patients fulfilled the American College of Rheumatology 1987 revised criteria of rheumatoid arthritis (RA) or the Rome criteria of definitive inactive RA. The internal consistency was measured by Cronbach's coefficient alpha (CCA). To assess criterion validity we compared the HAQ and the two versions of the HFAQ with Keitel's test (KT) and the modified Steinbrocker classification (mSC). Construct validity was assessed by comparing these instruments with different clinical and laboratory variables. A multivariate analysis was used to identify the most important factors that are influencing the HAQ- and HFAQ-scores. RESULTS: Test-retest reliability of the HAQ was r = 0.94. CCA was 0.91 (HAQ), 0.90 (HFAQ-P) and 0.93 (HFAQ-PR). The KT Pearson correlation coefficients reached r = -0.73 (HAQ), r = +0.74 (HFAQ-P) and r = +0.71 (HFAQ-PR). The mSC correlated r = +0.75 (HAQ), r = -0.72 (HFAQ-P) and r = -0.70 (HFAQ-PR). The correlation coefficients of HAQ/HFAQ-P was r = -0.87 and of HAQ/HFAQ-PR r = -0.88. The correlations between other clinical and laboratory variables reached from r = +/-0.58 (pain/HAQ) to r = +/-0.11 (number of swollen joints/HFAQ-PR). In backward multiple regression analysis 59-64% of the variance of disability measured by the questionnaires was explained predominantly by pain (32-33%) and by range of motion (16-21%). CONCLUSION: The German version of the HAQ presented here and the two versions of the HFAQ are reliable and valid instruments for measuring functional disability in a German-speaking population with RA. The construct measured by the HAQ and both versions of the HFAQ showed a high degree of correspondence.

Activities of Daily Living↗
PubMedDate not supplied

["Interface problems" in medical rehabilitation: development of a brief questionnaire for assessing the need for information and communication among general practitioners].

Against the background of current and future demographic changes the relevance of medical rehabilitation in the German health care system is generally acknowledged. It is a central element of treatment programmes especially for elderly and chronically ill patients. In recent years, problems due to lack of co-operation and communication as well as insufficient links between acute care and rehabilitation treatment have found increasing attention. Previous attempts to increase involvement especially of general practitioners in the rehabilitation process were only slightly successful. In a pilot study conducted by the Rehabilitationswissenschaftlicher Arbeitskreis Schleswig-Holstein a new procedure was tested to increase involvement of general practitioners. A brief questionnaire was attached to the report of discharge of rehabilitation patients and was sent to 130 practitioners. With this questionnaire the general attitude and need for information of the practitioners should be analysed. Knowledge about these variables should help to improve communication and co-operation. The response rate was quite high: about 75% of the contacted practitioners answered the questionnaire. All practitioners described medical rehabilitation as important and also had a quite positive attitude toward the same. Two-thirds of the physicians were interested in more intensive contacts and requested further information.

Aged↗
PubMedDate not supplied

[Change in functional capacity and pain intensity of 81 cP patients treated with Azulfidine RA or aurothioglucose. Preliminary statistical assessment of the German multicenter study of the treatment of chronic polyarthritis with Azulfidine RA].

A 36 week treatment with either salazosulfapyridine or aurothioglucose on 81 patients with definite and active rA, most of them from outpatient clinics, did not lead to significant differences in disability and pain intensity. Under both medications 40% were able to reach a statistically significant and clinically relevant improvement, while 25% remained in an unsatisfactory state.

Activities of Daily Living↗