Die Qualität der reisemedizinischen Beratung in Deutschland : Beratungsstellen im Vergleich

Aufgrund der immensen Bedeutung der Prävention von Infektionskrankheiten und nicht-infektionsbedingten Problemen bei jährlich mehreren Millionen in tropische und subtropische Regionen reisenden deutschen Passagieren sowie des derzeit nur fragmentarischen Bildes von der Qualität der reisemedizinischen Beratung in Deutschland widmete sich diese Datenerhebung der Feststellung der Vollständigkeit und in Teilen der Korrektheit der Empfehlungen zu präventiven Maßnahmen. Die Untersuchung hatte zum Ziel, die Inanspruchnahme einer Beratung bei verschiedenen Beratungsstellen zu eruieren und diese mit erfassten Personen- und Reisedatenmerkmalen in Beziehung zu setzen. Weiterhin wurden die reisemedizinische Beratung in Deutschland auf Schwachstellen hin überprüft und die Empfehlungen der Hausärzte mit denen der nicht-hausärztlichen professionellen Berater (Apotheken, Tropeninstitute, Gesundheitsämter und die Flughafenklinik Frankfurt am Main) verglichen. In einem 27 Punkte umfassenden Erhebungsbogen wurden umfangreiche Daten von Passagieren zu fünf repräsentativen Reisezielen (Dominikanische Republik, Kenia, Senegal, Südafrika, Thailand) am Flughafen Frankfurt am Main zur Zeit der Herbstferien 2001 gesammelt. Die Ergebnisse erfuhren in einem weiteren Schritt eine vorwiegend deskriptive Auswertung, Unterschiede zwischen den Beratungsstellen und -gruppen (Hausärzte, nicht-hausärztliche Berater, Laiengruppe) wurden im Rahmen der induktiven Statistik mittels des exakten Fisher-Tests genauer betrachtet. Von 603 Passagieren haben 91% reisemedizinische Informationen in irgendeiner Form eingeholt, wobei die Anteile für die verschiedenen Reiseziele zwischen 89% und 96% variieren. Eine Mehrfachberatung der Reisenden hat bei 77% der Teilnehmer stattgefunden, wobei sich keine Abhängigkeit vom Risikograd eines Bestimmungsortes zeigt. ...Aim: The huge number of travellers to tropical and subtropical destinations and the fragmentary knowledge of travel medicine advice situation in Germany gave reason to study the quality of travel medicine advice in consideration of all health advisors and topics. Material, methods: A questionnaire about personal, travel and individual occurred travel health advice was administered to travellers to five exemplarily chosen destinations at Frankfurt Airport in autumn of 2001. Special interest was applied to travel health advisors, deficiencies of advice and to the comparison between general practitioners (GP) and non-GP advisors. Beside a descriptive analysis Fisher´s exact test was used. Results: 551 from 603 travellers (91%) with evaluable questionnaires tasked a travel health advice in any form. Most frequently general practitioners were called on (32%), in case of multiple advice (77%) travellers assessed GPs in even 45% as most important information centre. In complex advice situations, e.g. trips with destination to Kenya, the interest in non-GP travel health advisors, in particular tropical medicine institutes, relatively rose. Information from internet / literature, friends and travel agencies were often obtained complementarily (40%). Travel experience had a negative effect on the actual travel advice behaviour. These passengers frequented travel health advisors rarelier (p<0.05). Deficiencies in travel health advice appeared to infection and non-infection related topics. Concerning prophylaxis to infectious diseases travel health advice was incomplete in insect exposition prophylaxis (21%), prevention of Larva migrans (32%), bilharziosis (39%) and sexual transmitted diseases (38%). With regards to non-infectious health risks travel advice failures especially occurred in the fields of notices to call on the dentist before journey (23%), risks of accidents at swimming and in road traffic (18%), dangers from poisonous animals (16%) and information about psychological problems. In comparison with general practitioners significantly more frequent and adequate advices (p<0.05) to travellers in the topics of chemoprophylaxis of malaria (94% vs. 86%), vaccination protection (81% vs. 56%), to special infectious diseases (Larva migrans, bilharziosis and rabies) and climate associated health risks (38% vs. 29%) resulted from non-GP advisors with emphasis on tropical medicine institutes. Conclusions: Beside the as well in this study evident necessity of continuing education of all travel health advisors, particularly the general practitioners, it becomes apparent that travel health advice will only be efficient by inclusion of several information centres. Optimisation strategies should involve especially the disproportionately high unconsidered non-infectious health risks

Paraneoplastic cerebellar degeneration associated with lymphoepithelial carcinoma of the tonsil

Background: Paraneoplastic cerebellar degeneration (PCD) is a classical tumor-associated, immune-mediated disease typically associated with gynecological malignancies, small-cell lung-cancer or lymphoma. Case presentation: Here we present the case of a 38-year old male with an over 12 months rapidly progressive cerebellar syndrome. Extensive diagnostic workup revealed selective hypermetabolism of the right tonsil in whole-body PET. Histological examination after tonsillectomy demonstrated a lymphoepithelial carcinoma of the tonsil and the tongue base strongly suggesting a paraneoplastic cause of the cerebellar syndrome. To the best of our knowledge this is the first case of an association of a lymphoepithelial carcinoma, a rare pharyngeal tumor, with PCD. Conclusions: In cases of classical paraneoplastic syndromes an extensive search for neoplasms should be performed including whole-body PET to detect tumors early in the course of the disease

Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms

Aim: To assess the correlation of lateral recess stenosis (LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index (ODI). Methods: Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study. On magnetic resonance images (MRI) the lateral recesses (LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale (Grade 0-3) as normal, not deviated, deviated or compressed. Patient symptoms and disability were assessed using ODI. The Spearman’s rank correlation coefficient was used for statistical analysis (P < 0.05). Results: Approximately half of the LR revealed stenosis (grade 1-3; 52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression. The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%. We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1, each bilaterally (L4/5 left: rho < 0.105, P < 0.01; L4/5 right: rho < 0.111, P < 0.01; L5/S1 left: rho 0.128, P < 0.01; L5/S1 right: rho < 0.157, P < 0.001). Conclusion: Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis, this study showed only a weak correlation of LRS on MRI and clinical findings. This can be attributed to a number of reasons outlined in this study, underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS

Displacement Behaviour Is Associated with Reduced Stress Levels among Men but Not Women

Sex differences in the ability to cope with stress may contribute to the higher prevalence of stress-related disorders among women compared to men. We recently provided evidence that displacement behaviour--activities such as scratching and face touching--represents an important strategy for coping with stressful situations: in a healthy population of men, displacement behaviour during a social stress test attenuated the relationship between anxiety experienced prior to this test, and the subsequent self-reported experience of stress. Here, we extend this work to look at physiological and cognitive (in addition to self-reported) measures of stress, and study both men and women in order to investigate whether sex moderates the link between displacement behaviour and the response to stress. In a healthy study population, we quantified displacement behaviour, heart rate and cognitive performance during the Trier Social Stress Test, and used self-report questionnaires to assess the experience of stress afterwards. Men engaged in displacement behaviour about twice as often as women, and subsequently reported lower levels of stress. Bivariate correlations revealed that for men, higher rates of displacement behaviour were associated with decreased self-reported stress, fewer mistakes in the cognitive task and a trend towards lower heart rate; no relationships between displacement behaviour and stress measures were found for women. Moreover, moderation analyses revealed that high rates of displacement behaviour were associated with lower stress levels in men but not in women, and that high displacement behaviour rates were associated with poorer cognitive performance in women, but not men. These results point to an important sex difference in coping strategies, and highlight new avenues for research into sex biases in stress-related disorders