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PubMed1980

[Various methods for the determination of preservatives in food. I. Extraction and spectrophotometric determinations (author's transl)].

In the Federal Republik of Germany formic acid, benzoic acid, propionic acid, sorbic acid and the esters of p-hydroxybenzoic acid were permitted as food-additives. They can be extracted together from acidified materials by means of perforation with ether. During distillation the preservatives are fixed by sodium hydroxide. The alkaline extract can then be used directly for various photometric (Part I) and chromatographic (Part II) determinations. All preservatives except propionic acid can be identified and determined by simple and specific color reaction. From the alkaline extract, benzoic acid, sorbic acid and the esters of p-hydroxybenzoic acid can be separated as the free acid by thin-layer chromatography on silica gel. Determination of the remission at 232 nm and 260 nm and of the reduction in fluorescence are employed for the photometric in situ evaluation of the thin-layer chromatograms.

Benzoates↗

PubMed1981

[Ocular side effects of digitalis (author's transl)].

In the Federal Republic of Germany nearly 4 million patients receive cardiac glycosides. Intoxication rates of up to 20% have been reported. About 80% of digoxin-intoxicated patients show generalized color vision deficiencies. Ophthalmologists should pay more attention to color vision disturbances due to digitalis.

Color Vision Defects↗

PubMed1981

[Experiences with rehabilitation of children after severe head injuries (author's transl)].

In the Federal Republic of Germany, there are at present too few centers which are responsible for the rehabilitation of children and adolescents who receive severe head injuries. Up to now, attempts have been made to seek out the institutions responsible and to tabulate the rehabilitation opportunities they offer. Furthermore, the typical follow-up grades after severe head trauma will be mentioned and the necessary methods of treatment in each case ordered accordingly. The opportunity for clinical rehabilitation should first of all be accessible to all children and adolescents who suffer from such injuries; this can later be converted into out-patient rehabilitation. Time spent on the wards during this period in hospital varies, depending on the grade of retardation, ranging approximately from 6 weeks to 1 year for the less severe cases up to 4 years and occasionally longer for the severely retarded.

Acute Disease↗

PubMed1999

[Ethical and legal aspects at the emergency department]

OBJECTIVE: To discuss ethical and legal aspects of physicianś attitudes in emergency departments under the light of Braziĺs codes and laws.METHODS: The authors raise questions based upon case reports and comment using the medical ethical code, laws that protect children and adolescents, hospitalized children and adolescents rights statement and medical federal council decisions.RESULTS: The authors discuss child patients' rights and the parents disclosure right; the problem of domestic violence and abuse and the physician duty to denunciate this kind of practice for the child security and protection; the medical responsability even under workplace adverse conditions, as well as the concerns related to transportation of patients to another hospital; the dilemma between withholding and withdrawing life support measures at the emergency department and the prohibition to certificate death in violent death situations; the autonomy and decision-making capa-city of adolescent patients and their limitations, including violation of confidentiality.CONCLUSIONS: The commentaries presented in the article try to explain to the pediatrician how to identify ethical and legal conflicts in the emergency department and to prepare him (her) to assume attitudes based on codes and legal statements, as well as to respect the patient's rights.

Journal Article↗

PubMed1995

State Medicaid reform under Section 1115 demonstration authority.

Given the complexity of federal Medicaid law and the limitations it imposes on state flexibility, it is likely that states will continue to ask the Secretary to grant waivers under Section 1115 to allow them to pursue new approaches to health care reform. The results of currently operational Section 1115 projects involving statewide managed care systems will be useful in evaluating the Medicaid reform measures currently under discussion in other states and at the federal level. In particular, the ability of the states to control Medicaid and indigent care costs and to utilize federal dollars more efficiently should prove important in evaluating a block grant approach to federal Medicaid funding. Moreover, Section 1115 project results that bear on the sufficiency of various Medicaid capitation rate methodologies will also be of value as more states expand the use of managed care arrangements for their Medicaid populations.

Aid to Families with Dependent Children↗

PubMed1975

[Studies on simian viruses as possible contaminants of inactivated virus vaccines. I. Direct and serologic detection of simian adenovirus SV20 (author's transl)].

In the Federal Republic of Germany inactivated vaccines against poliomyelitis and measles are still produced in monkey kidney cell cultures which may be contaminated by simian viruses. One of these viruses is the oncogenic adenovirus SV20. A control of monkey sera from the institute's monkey house showed a high incidence of hemagglutination-inhibiting and neutralizing antibodies against this virus (table 1). Experimentally could be demonstrated that inactivated virus vaccines may be contaminated with SV20 antigen. Vero cells were infected at the time of their seeding with small doses of SV20. After 7 and 14 days CPE and hemagglutinin were frequently undetectable although infectivity could be shown by passages (table 2). Vaccines experimentally contaminated with SV20 were injected into guinea-pigs or rabbits (tables 3-6). In this way small amounts of the contaminating virus antigen could be detected by demonstrating neutralizing and hemagglutination-inhibiting antibodies. It is suggested to include passages of control cultures and of the virus harvest, after neutralization of the vaccine virus, for the control of virulent extraneous viruses. Alternatively to the last suggestion high amounts already inactivated virus pools could be inoculated into animals for the detection of antibodies against extraneous virus antigens. These controls are necessary until inactivated virus vaccines will be produced in safer substrates.

Adenoviridae↗

PubMed1993

[Employment of cross-border workers in the Federal Republic of Germany].

The author analyzes the cross-border movement of labor migrants in Germany. The impact of increased integration among European Community countries is considered, and the pressure of migration from neighboring Eastern European countries is discussed. "Employment of workers from border regions [provides the] possibility of meeting the labour demand in the region, of alleviating the pressure to migrate by legalizing inflows and of balancing the interests of employers and cross-border workers, thus avoiding some of the negative side-effects or social costs of traditional labour migration." (SUMMARY IN ENG AND FRE AND RUS)

Demography↗

PubMedDate not supplied

[Incidence of primary benign and malignant neoplasms and bone pseudotumoral lesions. An epidemiologic analysis of 585 cases diagnosed at the Faculdade de Medicina of the Universidade Federal de Minas Gerais].

The authors present an epidemiological study of 585 primary bone neoplasms and tumor-like lesions in order to investigate their incidence and distribution according to age, sex and skeletal location. A statistical agreement between the pertinent literature and the collected data was found. In this series, the most common benign neoplasms were the osteochondroma (45.3%) followed by chondroma (19.6%). Among the intermediate and malignant neoplasms, osteosarcoma was the most frequent (30.0%) followed by myeloma (16.0%). Fibrous dysplasia accounted for 46.6% of all tumor-like lesions, followed by solitary bone cyst (18.6%).

Adolescent↗

PubMed1979

[Possibilities and problems in the rehabilitation of aged patients with mental illness (author's transl)].

In the Federal Republic of Germany as in other Western Countries institutions suitable for the rehabilitation of aged patients with mental illness are lacking. As long as "psychiatry of the higher age" is synonymous to "psychiatry of demented patients" the term "rehabilitation" means only a slogan, not a maxime. Jurisdiction in the Supreme Court though, has shown the way of going on. It will depend also on the attitude of the doctors in charge of the patients to fulfill the expectations posed in that jurisdiction and to reach so the far set marks in the interest of the patients. Big institutional deficits have to be ameliorated as far as possible; of prime importance here is the necessity to place the opportunities for the employment of qualified employees. Rehabilitation instead of custodial care here is synonymous for efficiency and humanity. The change from an obsolete and nonorganized "system" of care to a modern network of rehabilitation should be obtained by voluntary cooperation and by voluntary coordination of medical and social institutions. So an integration of all possibilities of help to a network could be reached.

Aged↗

PubMed1979

[Microdocumentation of x-ray film via the "linear system" (author's transl)].

The new Federal German Roentgen Law in operation for the last two years governs not only the proprietary rights in respect of x-ray documentation but also the obligation regarding its accountability. Similar regulations are in preparation in other European countries. Since the discussions on individual problems of maintaining and cataloguing x-ray films and on approaches towards solving the production of duplicates, are common knowledge, there is no need to go into them once again, not lease because of their complex nature. Nevertheless, these problems are touched upon in the present article in the manner of key words in order to illustrate to what extent the Linear System meets the requisite demands.

Archives↗

PubMed1979

[Emancipatory rehabilitation in logopedics -- comments from the medico-rehabilitative viewpoint (author's transl)].

In the Federal Republic of Germany speech disturbances, as sub-group of communication disorders, are treated by two professional groups: a) free practising logopedists who chose their team themselves as well as logopedists who are working in a clinic team and b) "Sprachheilpädagogen" (speech therapists) working at special education facilities. Irrespective of the age of the patient, treatment by logopedists is paid by the health insurance funds; special education therapy is paid by the financially responsible school agencies. The basis of the disease is not a deviation but a disturbance of the central nervous system which can be determined by medical, phoniatric-neurological diagnostic means.

Germany, West↗

PubMedDate not supplied

Social aspects of therapy with depot neuroleptics in the Federal Republic of Germany.

The authors compare 76 patients (50% paranoid schizophrenics, 30% residual psychotics) successively treated with oral and depot neuroleptics: the mean number of rehospitalizations has dropped from 2.5 to 0.8, while the mean duration of hospital treatment has dropped from 34 to 8 weeks (t test significant). The relationship between the type of treatment and sociodemographic data was analyzed by means of correlation coefficients and variance analyses. There was no relation of age, sex, age of onset, school background, social class and professional achievement, but a significant superiority of depot medication in single patients. The choice of the depot preparation depends on habits, scientific attitudes and year: in 1976-1977, fluphenazine decanoate was prescribed in 70% of all cases; but penfluridol, fluspirilene and to a lesser extent flupentixol decanoate were also administered. Depot forms make for 32% of all neuroleptics. There is no evidence as to whether long-term neuroleptic medication has a prophylactic effect on relapses beyond the third year of treatment; but, without these drugs, it would have been impossible to return many patients to their environment; social psychiatry has received a new impetus from depot neuroleptics; the size of psychiatric hospitals could be reduced by one-third.

Adolescent↗

PubMed1982

[Investigations on the time of first hospital admission of children with chronic renal failure (CRF) (author's transl)].

In the Federal Republic of Germany between 1969-1978 only 63% of the children with CRF who were sent to hospital for the first time, had creatinine values less than 4 mg/100 ml hospitals whereas 37% had creatinine values greater than 4 mg/100 ml, too late for adequate preparation of dialysis and transplantation. This ratio did not change during the 9 years of observation. The stage of CRF at the time of the first hospital admission did not dependent on the type of the basic renal disease.

Child↗

PubMed1976

[Recommendations of the German Society for Clinical Chemistry. Performance of clinical-chemical tests on pharmaceuticals (author's transl)].

In the Federal Republic of Germany, the recommendations of professional bodies for the testing of pharmaceuticals, which were published rather a long time ago, do not refer to clinical-chemical investigations (Report of the executive committee of the German Pharmacological Society and the Commission for the establishment of guide lines for the testing of pharmaceuticals, Naunyn-Schmiedeberg's Arch. Exp. Pathol. Pharmakol 245 (1963) Supplement p. 20; and Report of the Executive Committee of the German Society for Internal Medicine for the establishment of guide lines for clinical testing of pharmaceuticals, e.g. Klin. Wochenschr. 43,698 (1965)). Since the results from animal experiments are of only limited value for the interpretation of the human response to pharmaceuticals, it is essential that clinical chemical studies should be very carefully planned. The German Society for Clinical Chemistry has therefore summarized the body of collective experience in the testing of pharmaceuticals. The following guide lines should also ensure that the accuracy and interpretive value of the results from different investigators are comparable. The recommendations also contain a program for the clinical chemical investigation of body functions. Additional tests are necessary for the assessment of many pharmaceutical preparations. In certain cases (e.g. topical application), a more restricted type of investigation may be sufficient at a later stage of testing.

Chemistry, Clinical↗

PubMed2000

Good cop, bad cop: federal prosecution of state-legalized medical marijuana use after United States v. Lopez.

The Supreme Court's recent decisions in United States v. Lopez and United States v. Morrison articulate a vision of federalism under which Congress's regulatory authority under the Commerce Clause is severely limited in favor of returning traditional areas of state concern, particularly criminal law enforcement, to local or state control. The Court's decisions in these cases coincide with ballot initiatives legalizing the medical use of marijuana garnering a majority of the vote in California, Arizona, Alaska, Colorado, Nevada, Oregon, Washington, Maine, and Washington D.C. Those who use marijuana for medical purposes under sanction of state law, however, still face the threat of federal prosecution under the Controlled Substances Act. Medical marijuana proponents have traditionally, and unsuccessfully, contested federal prosecution using individual rights arguments under theories of equal protection or substantive due process. This Comment argues that after Lopez and Morrison, the federal government's authority to regulate intrastate use of marijuana for medicinal purposes is not the foregone conclusion it once was. The author suggests that proponents of medical marijuana use should invoke the federalism arguments of Lopez and Morrison and argue for state legislative independence from the federal government on this issue.

Cannabis↗

PubMed2000

Consumer managed care appeals: are the available procedural protections fundamentally fair?

Managed care incentives to reduce costs have also resulted in incentives to deny care. Anecdotes concerning managed care denials of care have led to a consumer outcry for protection either through the use of procedural due process or by the establishment of patient rights that would include appeal and grievance protections. This Article reviews the procedural protections of constitutional due process, the Consumer Due Process Protocol, and the Patient Bill of Rights. The Article then extensively discusses the availability of these procedural protections in various public and private forums. The discussion of public forums includes proposals contained in recent national legislative initiatives. The author then reviews relevant federal and state law, as well as Uniform Law proposals. Next, the Article analyzes the protections provided by accreditation agencies, dispute resolution organizations, professional organizations, and health insurers. Finally, the author recommends criteria to be used to determine whether a procedure is fundamentally fair.

Aged↗

PubMed1981

Who's on first? Anatomy of the federal response to drug abuse.

Organizational issues inevitably have a crucial impact on policy development, particularly in drug issues. Consequently, an evaluation of the organizational framework of federal efforts was conducted. Based on this examination, innumerable federal agencies which have authority in drug abuse exist in all three branches of government. Unfortunately, this has resulted in many areas of duplication and in arbitrarily drawn lines of responsibilities. Furthermore, the organization of federal drug efforts reflects commonly held misconceptions about the use of psychoactive substances and policy contradictions between economic and public health aspects of the usage of these substances. Finally, the coordination of federal drug efforts remains ill-defined.

Drug and Narcotic Control↗

PubMed1980

[Toxic heavy metals in foodstuffs (author's transl)].

1. In the Federal Republic of Germany two staple foodstuffs, cereals and milk, are regularly checked by means of monitoring programmes for their content of heavy metals, this check being representative for the whole country. Other foodstuffs are analysed in the laboratories of the Food Control Authorities, but these inspections are carried out rather sporadically and are not yet of a "monitoring" nature. 2. The measured values from a number of laboratories are fed into a central data bank (Datenbank-ZEBS) at the Federal Health Office and are thus available for statistical and hygienic evaluation. 3. At present, information is available on the lead, cadmium and mercury content of foodstuffs which represent roughly 70 to 80 per cent of the food consumed by an average adult. The intake of lead, cadmium and mercury due to the consumption of these foodstuffs has been calculated and extrapolated to the complete food consumption. It was found that the value ascertained are clearly lower than the toxicological threshold values published by FAO/WHO. 4. Nevertheless, the intake needs to be limited, because the average heavy metal content of some foodstuffs has increased, probably because of anthropogenic reasons. This is especially likely to apply to the cadmium content of wheat. To attempt a restriction by regulation, is at present not considered in Germany to be the optimal solution. Instead, the Federal Health Office has published guidance values which contain an appeal to the foodstuff industry and food control authorities to investigate the causes, whenever these guidance values are approached or exceeded, with the objective of avoiding high levels.

Cadmium↗