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Biomedical subjects

U Koch

Publications and source records attributed to U Koch.

At least 19 recordsLinked to original sources
PubMed2007

Construction and characterization of efficient, stable and safe replication-deficient foamy virus vectors.

As serious side effects affected recent virus-mediated gene transfer studies, novel vectors with improved safety profiles are urgently needed. In the present study, replication-deficient retroviral vectors based on feline foamy virus (FFV) were constructed and analyzed. The novel FFV vectors are devoid of almost the complete env gene plus the internal promoter - accessory bel gene cassette including the gene for the viral transcriptional transactivator Bel1/Tas. In these Bel1/Tas-independent vectors, expression of the lacZ (beta-galactosidase) marker gene is directed by the heterologous, constitutively active human ubiquitin C promoter (ubi). Env-transcomplemented vectors have un-concentrated titers of more than 10(5) transducing units/ml. The vectors allow efficient transduction of a broad array of diverse target cells, which can be increased by repeated vector exposure. However, the number of lacZ marker gene expressing cells decreased slightly upon serial passages of the transduced cells. Vectors carrying a self-inactivating (SIN) deletion of the TATA box and most parts of the viral promoter were not rescued by wt FFV whereas those with the intact or a partially deleted promoter were readily reactivated. This finding indicates that the viral promoters are in fact non-functional, pointing to a highly advantageous safety profile of these new FFV-ubi-lacZ-SIN vectors.

Animals↗
PubMed2007

[Sexual medicine].

Explore the source record for details and available documents.

Clinical Medicine↗
PubMed2006

Stressful life events and cancer risk.

In a prospective cohort study in Denmark of 8736 randomly selected people, no evidence was found among 1011 subjects who developed cancer that self-reported stressful major life events had increased their risk for cancer.

Female↗
PubMed2006

Unmet needs in the diagnosis and treatment of dyslipidemia in the primary care setting in Germany.

OBJECTIVES AND METHODS: DETECT is a cross-sectional study of 55,518 unselected consecutive patients in 3188 representative primary care offices in Germany. In a random subset of 7519 patients, an extensive standardized laboratory program was undertaken. The study investigated the prevalence of cardiovascular disease, known risk factors (such as diabetes, hypertension and dyslipidemia and their co-morbid manifestation), as well as treatment patterns. The present analysis of the DETECT laboratory dataset focused on the prevalence and treatment of dyslipidemia in primary medical care in Germany. Coronary artery disease (CAD), risk categories and LDL-C target achievement rates were determined in the subset of 6815 patients according to the National Cholesterol Education Program (NCEP) ATP III Guidelines. RESULTS: Of all patients, 54.3% had dyslipidemia. Only 54.4% of the NCEP-classified dyslipidemic patients were diagnosed as 'dyslipidemic' by their physicians. Only 27% of all dyslipidemic patients (and 40.7% of the recognized dyslipidemic patients) were treated with lipid-lowering medications, and 11.1% of all dyslipidemic patients (41.4% of the patients treated with lipid-lowering drugs) achieved their LDL-C treatment goals. In conclusion, 80.3% of patients in the sample with dyslipidemia went undiagnosed, un-treated or under-treated.

Blood Chemical Analysis↗
PubMed2006

[The development of evidence-based prevention. Health promotion and education as an approach to continuous quality improvement of health care].

Evidence-based health promotion and education relies on the systematic and critical discussion of the best available research on the effectiveness of interventions. In the last decade, evidence-based reviews provided decisive proof for the effectiveness of health promotion and education. The approach is also capable of identifying high-quality interventions and deficiencies. Nevertheless, there is an ongoing dispute concerning the transfer of evidence-based medicine to health promotion and education. Arguments concern databases, research strategies, validity and practical applicability of results. A discussion of these issues suggests that the methodology of evidence-based medicine is pertinent and informative. Some adaptations for health promotion and education would make sense, though: contexts and characteristics of interventions should be documented and published in rather more detail in order to reach better causal models. Pre-post studies which are of particular importance for health promotion and education should be elaborated according to the psychological multi-trait multi-method strategy (multiple measurements, modelling of process levels, multidimensional operationalization of complex outcomes). All relevant knowledge including qualitative studies should be integrated into cycles of theory formulation and evidence testing. Finally, a reappraisal of expert opinion is proposed relying on specific criteria for the transparency and plurality of consensus procedures ruling out conflicts of interest.

Delivery of Health Care↗
PubMed2006

[Health services research in psychosocial medicine].

The following article presents aspects of the field of psychosocial medicine in Germany from the perspective of health services research. First, the tasks and topics of health services research are listed. The identification and appropriate treatment of people with mental disorders is one of the core themes of psychosocial health care; therefore, a brief overview of research results on the epidemiology of mental disorders is first presented. The primary focus of this article is then to provide a description and analysis of the structures of psychosocial care in inpatient and outpatient settings. Research findings concerning treatment processes and the result of these processes are additionally presented. The findings show that there is still a considerable lack of research results regarding the treatment of patients with mental disorders, as is also the case in other health care areas. An important empirical basis for rationally founded treatment planning in this area is thus lacking.

Epidemiologic Methods↗
PubMed2006

[Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care].

Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

Attitude to Death↗
PubMed2006

[Structure quality assurance in in-patient medical rehabilitation of children and adolescents].

BACKGROUND: So far, the routine programmes of the statutory pension and health insurance institutes for quality assurance in medical rehabilitation have not included facilities for children and adolescents. Thus, a conjoint project of the statutory pension and health insurance institutes to assess and to describe the structure quality of in-patient medical rehabilitation clinics for children and adolescents was initiated. The aim of the project was a survey and an analysis of the currently existing clinic structures and the development of criteria for an evaluation of the structure quality. The Institute of Medical Psychology, University of Hamburg and the Department of Quality Management and Social Medicine, University of Freiburg were engaged to conduct the project. METHOD: A questionnaire was developed in a multi-stage process with expert involvement which covers general information, characteristics of structure quality as well as structure affiliated process characteristics of clinics. The survey was planned as a cross-sectional study. Data collection was accomplished from 1.12.2004 - 15.3.2005. RESULTS: A total of n = 177 facility addresses were available. The return rate was 83.3 %. Eventually, n = 79 facilities were included in the analysis. In sum, the results underline the heterogeneity of services in the field of child and adolescent rehabilitation. CONCLUSIONS: The results allow an analysis of the current clinic structures as well as a first comparison of clinics on the basis of the assessed structure characteristics.

Adolescent↗
PubMed2006

[Rehabilitation of children and adolescents].

In recent years a significant increase in most chronic mental and physical illnesses among children and adolescents was reported. Thus, medical child and adolescent rehabilitation plays a major role. Therefore, early diagnosis and multimodal intervention in childhood and adolescence is necessary, to prevent a chronic course of disease. Patient education programs have been shown to be effective in the treatment of chronic illnesses. Those programs are mostly aimed to improve the compliant behavior and disease management. Consecutively, the health status and quality of life should be improved. Due to the implementation of guidelines and evaluation studies the quality of rehabilitation programs was ameliorated during the past 15 years. However, future research should develop flexible rehabilitation programs in particular (rehabilitation duration, rehabilitation near or far from place of residence, rehabilitation chain with in-patient, partially out-patient, and out-patient programs), whose effectiveness has to be proven.

Adolescent↗
PubMed2005

Neuropsychological function in high-risk breast cancer survivors after stem-cell supported high-dose therapy versus standard-dose chemotherapy: evaluation of long-term treatment effects.

BACKGROUND: Studies on cognitive functioning in breast cancer patients point out that a subset of women exhibit chemotherapy-related neuropsychological impairment. Thereby, high-dose therapy may elevate the risk of cognitive dysfunctions. The primary purpose of the study was to evaluate the impact of high-dose versus standard-dose chemotherapy on the late neuropsychological outcome in randomized assigned high-risk breast cancer survivors. Next to focusing prevalence, function specificity and extent of cognitive impairment, the question as to whether doses-dependent group differences occur was investigated. PATIENTS AND METHODS: Twenty-four high-dose and 23 standard-dose patients 5 years, on average, after treatment underwent a comprehensive neuropsychological assessment. In addition, 29 early-stage breast cancer patients matched for age, education and time since treatment were recruited as a comparison group. RESULTS: Global cognitive impairment was observed in 8% of high-dose versus 13% of standard-dose compared with 3% of early-stage breast cancer patients. Compared with normative data, all patient groups performed worse on one attention subtest measuring the simple reaction time (P < 0.001 in each case). By contrast, no significant between-group differences on the late neuropsychological outcome were found. CONCLUSIONS: Five years after treatment, standard-dose patients were slightly, but not significantly, more impaired in cognitive performance than high-dose patients.

Antineoplastic Agents↗
PubMed2005

[User acceptance of health telematics applications].

The user acceptance of health telematics in medical care plays a critical role in mediating the success of its implementation. Model assumptions evolving from different fields such as industry, health care and medical psychology are presented, and various perspectives for patients and providers involved in these models are highlighted. The impact of health telematics on health care results from four components: (a) the improvement of work characteristics and communication processes, (b) the enhancement of diagnostic and treatment quality via telematics, (c) technical and economic advantages and (d) communication tools for patient. The evidence concerning clinical, economic and psychosocial criteria within these domains is reviewed according to the published literature. Despite the fact that a considerable benefit of health telematics has been shown in individual studies, the evidence concerning the improvement of health care, the improvement of work and communication processes as well as concerning its clinical and cost effectiveness is still scarce. It is recommended to further integrate health telematics and health service research.

Attitude of Health Personnel↗
PubMed2005

[Cardiovascular high-risk constellations in primary care. DETECT Study 2003].

DETECT is a nationwide epidemiological cross-sectional and longitudinal study program in a random probability sample of 3,795 primary care settings (response rate: 60.2%). Based on a target day total assessment of n=55,518 consecutive patients (RR 93.5%) in these settings all patients underwent standardized diagnostic assessment, using self-reporting, clinical interview and laboratory measures. DETECT aims at describing the point prevalence and comorbidity of coronary heart disease (CHD), hyperlipidaemia, arterial hypertension and diabetes mellitus and at identifying the behavioural, clinical, laboratory and psychological risk factors associated with these conditions. A random subset of patients (n=7,519) also completed an extensive standardized laboratory screening program and a 12-month follow-up investigation. Findings reveal a high prevalence of hypertension (36.3%), dyslipidaemia (29.1%), diabetes mellitus (14.6%) and CHD (12.4%) in primary care as well as their close association among each other. The study describes for the first time in greater detail the prevalence of specific disorders and the frequency of high-risk constellations in primary care and allows for the evaluation of various risk scores.

Adolescent↗
PubMed2005

Cardiovascular risk factors in primary care: methods and baseline prevalence rates--the DETECT program.

OBJECTIVES: DETECT is an epidemiological study in primary care to examine (a) the prevalence rates and comorbidity of diabetes mellitus, hypertension, hyperlipidaemia and coronary heart disease (CHD), and associated conditions; (b) the frequency of behavioural and clinical risk factors for onset and progression; (c) the 12-month course and outcome; and (d) the met and unmet needs for these patients. METHODS: Three-stage, cross-sectional clinical-epidemiological study with a prospective-longitudinal component in a nationally representative sample of N = 3795 primary care settings [response rate (RR): 60.2%] and N = 55518 patients (RR: 95.5%). Patients completed a standardized assessment, including questionnaires for patients and the physician and diagnostic screening measures (i.e. blood pressure, heart rate, body mass index and waist circumference assessments). A subsample of patients (N = 7519) also completed a standardized laboratory screening program and was followed-up after 12 months. Data were weighted to adjust for non-response, regional distribution and attrition. RESULTS: (1) Doctors and patients sample can be regarded as representative for primary care settings in Germany. (2) The clinician-rated point prevalence of hypertension is highest (35.5%), followed by hyperlipidaemia (29.1%), diabetes (14.1%) and CHD (12.1%); prevalence rates of each disorder as well as their co-incidence rates increase markedly with age. (3) The vast majority (78%) of all patients revealed multiple (3+) behavioural and clinical risk factors. CONCLUSION: The findings of DETECT underline the considerable burden for primary care doctors in managing a highly morbid patient population, with predominantly complex risk factor constellations, in routine care. Our data provide, in unprecedented detail, a basis for calculating age-, gender- and risk-group-adjusted risk-factor profiles in routine care.

Adolescent↗
PubMed2004

Different genotypes of Yersinia enterocolitica 4/O:3 strains widely distributed in butcher shops in the Munich area.

The distribution of Yersinia spp. in butcher shops in the Munich area was studied. The isolates recovered were then characterised with pulsed-field gel electrophoresis (PFGE) to identify possible contamination routes. A total of 298 samples were collected from eight small butcher shops between June and August in 2001. Of these, 113 were surface samples from carcasses, offal and raw pork products, and 185 were environmental surface samples from tools, equipment and processing areas. The samples were studied with direct plating, overnight enrichment in nonselective broth and selective enrichment in two different enrichment broths. The Yersinia isolates recovered were characterised with PFGE using NotI, ApaI and XhoI DNA restriction enzymes. Yersinia was recovered from all eight butcher shops, and pathogenic Yersinia enterocolitica 4/O:3 was present in six shops. The occurrence of this pathogen on raw pork products varied from 8% to 25%. Pathogenic Y. enterocolitica 4/O:3 was isolated from two environmental samples: a worktable and a chain glove. Most (18/24) of the Yersinia-positive samples were found already after direct plating. Forty-nine Yersinia isolates from 24 samples were studied with PFGE. Twelve genotypes (I-XII) were obtained among Y. enterocolitica 4/O:3 when 33 isolates from 16 samples were characterised with NotI, ApaI and XhoI enzymes. The genotypes of Y. enterocolitica 4/O:3 strains differed among butcher shops. In most (5/6) shops, more than one genotype was found, indicating different contamination sources. In conclusion, raw pork products from butcher shops are frequently contaminated with different genotypes of pathogenic Y. enterocolitica 4/O:3, thus serving as an important transmission vehicle from butcher shops to humans.

Animals↗
PubMed2004

[Assessing the quality of structures, concepts, and processes in prevention, health promotion, and education. Requirements and solutions].

The effectiveness of health promotion is determined by the foundation of evidence, the targeting of health problems, and the adaptation of interventions to specific social and organizational contexts. Methods for the implementation of these objectives must be able to balance interacting intervention goals, to account for the suitability of interventions for specific target groups and settings, and to integrate complex and divergent data. The core methodology underlying these conditions is peer review assessment. A quality assurance system based on this approach is presented: Two inventories elicit detailed self-descriptions characterizing either actors or activities within health promotion and education. Two assessment instruments instruct experts in reviewing these data according to primary and partial dimensions of quality. Thus, systematically structured and quantifiable quality profiles of organizational units or specific activities are produced. On this basis, comparative indicators for benchmarking purposes can be calculated. Quality profiles containing the strengths and weaknesses of organizations or activities, including indicators, benchmarks, and reviewers' recommendations, are communicated to participating organizations in order to stimulate continuous quality improvement by feedback. Moreover, the system offers a database of comparative indicators for monitoring and optimizing health promotion and education.

Germany↗
PubMed2004

[Quality assurance in the field of medical rehabilitation in Germany. State of the art and perspectives].

To a large extent, medical rehabilitation is an independent part of the German health system. Since the middle of the 1980s it has undergone a modification process oriented towards different objectives. Quality assurance programs and strengthened scientific rehabilitation research have been introduced with the aim of optimizing results and user orientation. The quality assurance programs have been routinely implemented for most of the rehabilitative areas of indication. Procedures and instruments for data collection, analysis, and feedback to the clinics involved have been developed with regard to the dimensions of the quality of structures, processes, and rehabilitative outcome. Current demands on the programs relate to the handling of the results in the involved clinics, a convergence of the quality assurance programs of the federal pension insurance with those of the health insurance organizations, and an evaluation of the procedure as a whole.

Forecasting↗