Joachim Siegert

Preclinical and clinical results with an ultrasonic contrast agent.

Fritzsch Th, Schartl M, Siegert J. Preclinical and clinical results with an ultrasonic contrast agent. Invest Radiol 1988;23(Suppl 1):S302‐S305. In comparison to diagnostic radiology, ultrasound diagnostics has had no real contrast media. Theoretical considerations indicate that gas liquid systems seem to be favorable. The echocontrast agent SH U 454 is a system that releases minute gas bubbles that provide the contrast properties. Preclinical and clinical trials in more than 500 patients with right‐heart lesions proved the efficacy and tolerance of the agent. Initial investigations showed that SH U 454 also may be useful in fields (eg, urology, gynecology) other than cardiology.

Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws.

BackgroundWith the emergence of influenza H1N1v the world is facing its first 21st century global pandemic. Severe Acute Respiratory Syndrome (SARS) and avian influenza H5N1 prompted development of pandemic preparedness plans. National systems of public health law are essential for public health stewardship and for the implementation of public health policy[1]. International coherence will contribute to effective regional and global responses. However little research has been undertaken on how law works as a tool for disease control in Europe. With co-funding from the European Union, we investigated the extent to which laws across Europe support or constrain pandemic preparedness planning, and whether national differences are likely to constrain control efforts.MethodsWe undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states.ResultsResults of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws.ConclusionThese differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

Influence of a Fat-Rich Meal on Bioavailability of Extended-Release and Immediate-Release Propiverine

The muscarinic receptor antagonist propiverine is unique insofar as extended‐release (ER) tablets are of higher bioavailability than immediate‐release (IR) tablets; this is caused by lower “first‐pass” elimination of propiverine via CYP3A4 and efflux transporters in the distal small intestine and colon. Food may influence gastrointestinal transiting and, in turn, may affect regional absorption of propiverine IR and ER. Therefore, food effects on disposition of 30 mg IR and 45 mg ER were measured in a randomized, open, 4‐period interaction study in 24 healthy participants. In fasting participants, ER had higher bioavailability than IR (Frel = 169%, P = .03). Fat‐rich meal did not change the disposition of ER markedly (AUC0‐∞ ratio, 1.00 [90% confidence interval (CI), 0.90–1.11], Cmax ratio, 0.97 [0.87–1.09]). However, Cmax and renal Ae of the major N‐oxidized metabolite (M‐5) significantly increased, whereas t1/2 decreased. By eating a fat‐rich meal before administration, the differences in absorption of IR and ER were nearly abolished (AUC0‐infin; ratio for propiverine, 1.12 [90% CI, 0.95–1.33]; AUC0‐∞ ratio for M‐5, 0.89 [0.82–0.95]). In conclusion, propiverine ER has higher bioavailability than IR and no positive food effect because it reaches, independently of food, intestinal absorption areas with lower metabolism and efflux transport, which results in constant absorption rates.

Smart Textiles: A New Drug Delivery System for Symptomatic Treatment of a Common Cold

Smart textiles provide the possibility of being coated with cineole, menthol, and camphor. Due to over‐the‐counter availability, ethereal oils are frequently used to treat a common cold. The existing pharmaceutical forms entail the risk of oral ingestion by children, which can cause severe intoxications. This risk could be limited by a smart textile application. Prior to applicability tests in children, the principal traceability of smart textile–applied ethereal oils at their site of action in the alveoli has to be demonstrated. Therefore, a crossover trial (ointment vs smart textiles) with 6 healthy volunteers was carried out as a proof‐of‐concept study. As a result, the principle proof is given that smart textile–applied ethereal oils are available at their site of action. Because of the volatility of the active ingredients, a close‐fitting textile form has to be developed for further clinical development of smart textiles to achieve higher concentrations in the alveoli. Slower liberation properties and a more convenient skin sensation in comparison to available pharmaceutical forms may provide advantages for the applicability in both children and adults.

Physical activity and cardiovascular performance – how important is cardiorespiratory fitness in childhood?

AimPhysical inactivity is considered to be a major health burden. Evidence has shown that physically active subjects have more longevity with a significant reduction of morbidity and mortality. Physical exercise prevents or reduces the deleterious effects of pathological conditions, such as arterial hypertension, coronary artery disease, atherosclerosis, diabetes mellitus, osteoporosis, Parkinson’s disease and Alzheimers disease. Although there is less evidence of benefit for children, some risk factors for diseases in adults are associated with lower levels of physical activity in childhood. It has recently been demonstrated in a cohort of Swedish and Estonian children that cardiovascular fitness is associated with features of metabolic risk factors in children.MethodsThis review provides a brief update on the available new study evidence in children for the role of physical activity and cardiorespiratory fitness in reducing the general cardiovascular risk in adulthood and clarifies the role of the metabolic syndrome (MetS) as a potential risk marker to be included in public health studies investigating cardiorespiratory fitness.ResultsIdentifying factors that influence physical activity in childhood may help to develop better intervention strategies. Recently published studies add further supportive evidence to the body of knowledge suggesting that cardiorespiratory fitness in children is an important health marker and should therefore be included in a pan-European health-monitoring system.ConclusionsCurrently available study evidence reveals close relationships between physical activity and cardiorespiratory fitness in children and underlines cardiorespiratory fitness as an important health marker in childhood.

[Cost-benefit analysis of [224Ra] radium chloride therapy for ankylosing spondylitis (Bekhterev's disease)].

ZusammenfassungHintergrund und Ziel:Kosten-Nutzen-Analysen sind hilfreich bei der Auswahl der Prioritäten für die Finanzierung der Gesundheitsprogramme. Die Autoren verglichen die Kosten/den Nutzen der Behandlung mit Radium-224 (als 224Radiumchlorid) mit einer Behandlung ohne Radium-224 bei Patienten mit ankylosierender Spondylitis (AS).Material und Methodik:Aus den Daten einer 2-jährigen retrospektiven Beobachtungsstudie wurden die Kosten/der Nutzen der [224Ra]-Therapie ermittelt. Zwölf mit [224Ra] behandelte Patienten stellen die Vollerhebung aus den Datenbanken der AOK Sachsen dar, dazu wurden zwölf konservativ behandelte Patienten ohne [224Ra] nach Alter, Geschlecht und Arbeitsstatus gepaart. Es wurden die Produktivitätsverluste und die direkten medizinischen Kosten (z. B. Arztbesuche, Arzneimittel und stationäre Aufenthalte) 1 Jahr vor und nach der Behandlung verglichen.Ergebnisse:Im Jahr nach der Therapie reduzierten sich die Kostenfaktoren der Interventionsgruppe [224Ra] verglichen mit der Kontrollgruppe beträchtlich (stationäre Kosten um 29,4%, ambulante Kosten um 23,5%, Kosten für Medikamente um 9,4%, Kosten der Arbeitsunfähigkeit um 82,3%). Die dadurch erzielten Einsparungen betrugen durchschnittlich 3 870 Euro. Aufgrund der kleinen Stichprobengröße (n = 12) konnte nur ein Trend, jedoch keine Signifikanz gezeigt werden.Schlussfolgerung:Die Behandlung mit [224Ra] bei Patienten mit AS konnte die Kosten der Produktivitätsverluste und die Kosten der direkten medizinischen Versorgung reduzieren, es sind jedoch zusätzliche Studien, basierend auf einer größeren Stichprobe und längeren Katamnese-/Kostendaten, erforderlich.AbstractBackground and Purpose:Cost-benefit analyses are helpful in setting priorities for funding health-care programs. The authors studied the cost/benefit of treatment with radium-224 compared to the treatment without radium-224 in patients with ankylosing spondylitis (AS).Material and Methods:The data of a 2-year retrospective observational study were used to estimate cost/benefit of [224Ra] therapy. Twelve patients treated with [224Ra], complete recruit in AOK Saxony, matched (age, gender, employment status) with twelve patients receiving conservative treatment without [224Ra], were compared for lost productivity and direct medical costs, such as doctor visits, medication and hospitalization, 1 year before and after treatment.Results:1 year after the first i.v. injection of [224Ra], all cost factors in the case group were reduced compared to 1 year before treatment with [224Ra] (hospitalization 29.4%, doctor visits 23.5%, medication 9.4%, and lost productivity even 82.3%). The total costs decreased by an average of 3,870 Euros. Because of the small sample the differences showed a trend but were not significant.Conclusion:The use of [224Ra] in patients with AS seems to reduce lost productivity and direct medical costs, but additional studies based on more patients and long-term data are needed.

Kosten-Nutzen-Analyse einer Therapie der ankylosierenden Spondylitis (Morbus Bechterew) mit Radiumchlorid [224Ra]

ZusammenfassungHintergrund und Ziel:Kosten-Nutzen-Analysen sind hilfreich bei der Auswahl der Prioritäten für die Finanzierung der Gesundheitsprogramme. Die Autoren verglichen die Kosten/den Nutzen der Behandlung mit Radium-224 (als 224Radiumchlorid) mit einer Behandlung ohne Radium-224 bei Patienten mit ankylosierender Spondylitis (AS).Material und Methodik:Aus den Daten einer 2-jährigen retrospektiven Beobachtungsstudie wurden die Kosten/der Nutzen der [224Ra]-Therapie ermittelt. Zwölf mit [224Ra] behandelte Patienten stellen die Vollerhebung aus den Datenbanken der AOK Sachsen dar, dazu wurden zwölf konservativ behandelte Patienten ohne [224Ra] nach Alter, Geschlecht und Arbeitsstatus gepaart. Es wurden die Produktivitätsverluste und die direkten medizinischen Kosten (z. B. Arztbesuche, Arzneimittel und stationäre Aufenthalte) 1 Jahr vor und nach der Behandlung verglichen.Ergebnisse:Im Jahr nach der Therapie reduzierten sich die Kostenfaktoren der Interventionsgruppe [224Ra] verglichen mit der Kontrollgruppe beträchtlich (stationäre Kosten um 29,4%, ambulante Kosten um 23,5%, Kosten für Medikamente um 9,4%, Kosten der Arbeitsunfähigkeit um 82,3%). Die dadurch erzielten Einsparungen betrugen durchschnittlich 3 870 Euro. Aufgrund der kleinen Stichprobengröße (n = 12) konnte nur ein Trend, jedoch keine Signifikanz gezeigt werden.Schlussfolgerung:Die Behandlung mit [224Ra] bei Patienten mit AS konnte die Kosten der Produktivitätsverluste und die Kosten der direkten medizinischen Versorgung reduzieren, es sind jedoch zusätzliche Studien, basierend auf einer größeren Stichprobe und längeren Katamnese-/Kostendaten, erforderlich.AbstractBackground and Purpose:Cost-benefit analyses are helpful in setting priorities for funding health-care programs. The authors studied the cost/benefit of treatment with radium-224 compared to the treatment without radium-224 in patients with ankylosing spondylitis (AS).Material and Methods:The data of a 2-year retrospective observational study were used to estimate cost/benefit of [224Ra] therapy. Twelve patients treated with [224Ra], complete recruit in AOK Saxony, matched (age, gender, employment status) with twelve patients receiving conservative treatment without [224Ra], were compared for lost productivity and direct medical costs, such as doctor visits, medication and hospitalization, 1 year before and after treatment.Results:1 year after the first i.v. injection of [224Ra], all cost factors in the case group were reduced compared to 1 year before treatment with [224Ra] (hospitalization 29.4%, doctor visits 23.5%, medication 9.4%, and lost productivity even 82.3%). The total costs decreased by an average of 3,870 Euros. Because of the small sample the differences showed a trend but were not significant.Conclusion:The use of [224Ra] in patients with AS seems to reduce lost productivity and direct medical costs, but additional studies based on more patients and long-term data are needed.

Gesundheitsförderung im Setting Schule

ZusammenfassungHintergrundFür das Unterrichtsfach Wirtschaft-Technik-Haushalt/Soziales sächsischer Mittelschulen wurden unter wissenschaftlicher Leitung Unterrichtskonzeptionen entwickelt. Die Erarbeitung erfolgte in enger Zusammenarbeit mit den Fachlehrern. Dabei war die Implementierung von ernährungs- und verbraucherbezogenem Wissen stets leitend.MethodenZu Beginn wurde eine Bestandsanalyse mit umfassender Literatur- und Internetrecherche durchgeführt. Weiterhin erfolgte eine Kontaktaufnahme zu verschiedenen Einrichtungen der Gesundheitsförderung als auch zu Experten in den einzelnen Themenfeldern. Die daran anschließende Aufbereitung des Wissensstandes als auch die Konzepterstellung fand für jedes Thema nach einem einheitlichen Muster statt. Nach Erprobung der Konzeptionen gaben alle Fachlehrer sowie ausgewählte Schüler in einem teilstandardisierten Interview Rückmeldung.ErgebnisseDie praktische Umsetzung der neuen Lehrpläne stellt die Lehrer vor hohe Anforderungen in ihrem schulischen Alltag. Es besteht erheblicher Bedarf an Musterkonzeptionen im Lernfeld Ernährung. Dadurch werden die Fachlehrer in der Umsetzung neuer Lehrplaninhalte gestärkt. Unsicherheiten in der Anwendung ernährungsbezogener Inhalte werden verringert. Den Auswertungen der teilstandardisierten Interviews sind Anregungen zur Überarbeitung und Neustrukturierung einzelner Inhalte zu entnehmen. Insgesamt wurde die positive Grundhaltung der Lehrer als auch der Schüler deutlich.SchlussfolgerungenDie Realisierung der Vorhaben kann als erfolgreich angesehen werden. Mit der Aufnahme der genannten Themen wurden bereits wichtige Schritte hin zum informierten und bewusst auswählenden Verbraucher realisiert.AbstractBackgroundThe aim was to develop lesson plans for the subject of household economics and technology in secondary schools in Saxony, Germany. It was of great importance to focus on nutrition-related topics.MethodsFirst, a comprehensive literature and Internet search was carried out, and experts in national health promotion institutes were contacted. All lesson plans were developed according to a standardised procedure. After the lesson plans were tested, all of the teachers involved gave feedback via interview for qualitative analysis. Pupils were asked to answer a questionnaire, and their responses were evaluated.ResultsTeachers must meet high demands in daily school life. Because well-structured and high-quality lesson plans in the field of nutrition are lacking, teachers as well as pupils appreciated the complex and scientifically based concepts and materials. The consulted teachers emphasised that the developed plans can be regarded as fundamental preparation for their further work. If necessary, they can be adapted to a teacher’s ideas and special circumstances within a school.ConclusionWith this project, important steps were realised within the restructuring process of curricula in Saxony, and implementation of nutrition-related topics in school curricula can be achieved.

Comparability of health information activities—a co-ordinated framework for health information activities on nutrition and physical activity in the EU, EEA and candidate countries

BackgroundMany health information activities related to nutrition and physical activity have been initiated in recent years by several institutions at the national and international level as well as by European networks. A multitude of projects with different scopes and methodologies has arisen. This variety makes it necessary to bring the results of these activities into a co-ordinated framework.AimThe report “Nutrition and physical activity—health information sources in EU Member States, and activities in the Commission, WHO, and European networks” aims to give a structured overview of the availability of routinely repeated or repeatable data on the health determinants nutrition and physical activity in European countries.ResultsThe report provides a structured overview of health information activities related to nutrition and physical activity as well as a state-of-the-art investigation about available data in European countries.ConclusionIt was the intention of the report to give an overview of existing health information activities related to nutrition and physical activity covering actions in all countries belonging to the European Union up to 2006, the European Economic Area and all candidate countries and including all age groups. A multitude of health information activities related to nutrition and physical activity were considered. Common data reporting guidelines and standardised methods, which encompass public and private sector health information activities, should be developed. Regular revision and adaptation concerning developed strategies, policies and practices as needed for health and population dimensions have to be realised. In order to provide for concerted action in health policy at the European level, quality, relevant and timely data are needed.

Kosten-Nutzen-Analyse einer Therapie der ankylosierenden Spondylitis (Morbus Bechterew) mit Radiumchlorid [224Ra]@@@Cost-Benefit Analysis of [224Ra] Radium Chloride Therapy for Ankylosing Spondylitis (Bekhterev's Disease)

ZusammenfassungHintergrund und Ziel:Kosten-Nutzen-Analysen sind hilfreich bei der Auswahl der Prioritäten für die Finanzierung der Gesundheitsprogramme. Die Autoren verglichen die Kosten/den Nutzen der Behandlung mit Radium-224 (als 224Radiumchlorid) mit einer Behandlung ohne Radium-224 bei Patienten mit ankylosierender Spondylitis (AS).Material und Methodik:Aus den Daten einer 2-jährigen retrospektiven Beobachtungsstudie wurden die Kosten/der Nutzen der [224Ra]-Therapie ermittelt. Zwölf mit [224Ra] behandelte Patienten stellen die Vollerhebung aus den Datenbanken der AOK Sachsen dar, dazu wurden zwölf konservativ behandelte Patienten ohne [224Ra] nach Alter, Geschlecht und Arbeitsstatus gepaart. Es wurden die Produktivitätsverluste und die direkten medizinischen Kosten (z. B. Arztbesuche, Arzneimittel und stationäre Aufenthalte) 1 Jahr vor und nach der Behandlung verglichen.Ergebnisse:Im Jahr nach der Therapie reduzierten sich die Kostenfaktoren der Interventionsgruppe [224Ra] verglichen mit der Kontrollgruppe beträchtlich (stationäre Kosten um 29,4%, ambulante Kosten um 23,5%, Kosten für Medikamente um 9,4%, Kosten der Arbeitsunfähigkeit um 82,3%). Die dadurch erzielten Einsparungen betrugen durchschnittlich 3 870 Euro. Aufgrund der kleinen Stichprobengröße (n = 12) konnte nur ein Trend, jedoch keine Signifikanz gezeigt werden.Schlussfolgerung:Die Behandlung mit [224Ra] bei Patienten mit AS konnte die Kosten der Produktivitätsverluste und die Kosten der direkten medizinischen Versorgung reduzieren, es sind jedoch zusätzliche Studien, basierend auf einer größeren Stichprobe und längeren Katamnese-/Kostendaten, erforderlich.AbstractBackground and Purpose:Cost-benefit analyses are helpful in setting priorities for funding health-care programs. The authors studied the cost/benefit of treatment with radium-224 compared to the treatment without radium-224 in patients with ankylosing spondylitis (AS).Material and Methods:The data of a 2-year retrospective observational study were used to estimate cost/benefit of [224Ra] therapy. Twelve patients treated with [224Ra], complete recruit in AOK Saxony, matched (age, gender, employment status) with twelve patients receiving conservative treatment without [224Ra], were compared for lost productivity and direct medical costs, such as doctor visits, medication and hospitalization, 1 year before and after treatment.Results:1 year after the first i.v. injection of [224Ra], all cost factors in the case group were reduced compared to 1 year before treatment with [224Ra] (hospitalization 29.4%, doctor visits 23.5%, medication 9.4%, and lost productivity even 82.3%). The total costs decreased by an average of 3,870 Euros. Because of the small sample the differences showed a trend but were not significant.Conclusion:The use of [224Ra] in patients with AS seems to reduce lost productivity and direct medical costs, but additional studies based on more patients and long-term data are needed.