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With the co-operation of a further 13 institutes and as a continuation of our own epidemiological-statistical survey, we recorded the total and relative distribution (frequency profile) of the blood alcohol concentration of car drivers for the 3rd quarter 1990 and the 1st quarter 1991. The participating institutes recorded almost 27,000 blood samples and compared them with results of the first part of the study (1989). The survey dealt separately with sex-, age- and time of day-distribution of drivers involved and not involved in road accidents. One of our repeatedly presented field research into the problem of "alcohol and road safety", once again, provided to be a useful method in the run-up to the unprejudiced alcohol test which we are striving for. We noticed characteristic changes in the frequency profiles of the old and the new counties (Bundesländer) in Germany in the 1st (1989) and the 2nd (1990/91) report of the study. The results of Police supervisory operations in the administrative district of Cologne have basically given useful indications as to their epidemiological-statistical value as evidence.

Mortality from ischemic heart disease (ICD 410-414) is changing. Remarkable decreases have been observed in the age groups from 35-64 years, while overall mortality (all age groups) has remained approximately stable. In Switzerland this has meant a gain of some 4700 life years in the period 1988 to 1993 in the working population (35-64 years). The object of this study was to assess the associated change in indirect costs (productivity losses) due to premature death, using the human capital approach. The indirect costs were CHF 519 million (CHF 7.5 million per 100,000 population) in 1993. This represents approximately half of all indirect costs (and 25% of the total costs generated by the disease). Compared with the year 1988, a decrease in productivity losses due to premature death was observed amounting to CHF 46 million (-11%) in constant Swiss francs. Society benefits from this decrease in indirect costs, a desirable development hardly ever mentioned.

The first to create a "needle-free injector" was the American anesthetist Robert A. Hingson, 65 year ago. Since that time those devices underwent a changeful history. In 1986 an outbreak of hepatitis B among patients receiving injections from a needle-free multiple-use-nozzle injector was documented and related to the use of the injector device. Due to such risk of transmission of infection with these reusable devices, their application has been restricted. In 1998 the WHO recommended that only conventional needles and syringes should be used for immunization until safe needle-free injectors are identified through independent safety testing. Since needle-free injection has shown numerous advantages in comparison to conventional injection, new systems were developed that combine the advantages of needle-free injection with sufficient safety in mass vaccination programs. As an alternative to this early injector type, the disposable-cartridge injectors were developed. The newest research field in the area of the needle-free injection systems opened with the development of powder injectors, in which the drug preparation is no longer a suspension or solution, but a powdered solid. This injector type using powder formulations shows a number of advantages in comparison with the conventional needle/syringe injection technique as well as towards the liquid jet injectors. Due to this new kind of injectors the comeback of the needle-free injection technique in large-scale vaccination programs of the WHO seems reasonable and within reach.

Ambulatory rehabilitation concepts for women with psychosomatic disorders and with pre-school children are rare and moreover not yet assessed. An economic concept for the evaluation of indirect costs and (patient) time costs is being developed in this article and applied to an ongoing ambulatory rehabilitation programme for mothers at the Hanover Medical School. In health economic evaluations time cost is expressed by loss and reduction of working time, time for housework, and leisure time. These are indirect cost items (working time) and direct non-medical costs (housework and leisure time). To estimate the loss of working time (and hence production loss) the human capital approach and the frictional cost approach can be applied. Loss of time due to housework can be estimated either by the production of goods and services or by the opportunity costs of the equivalent working time. Loss of leisure time can be partial or total whereas a total loss and a loss of working time are considered to be analogous. The health economic evaluation of the ambulatory rehabilitation programme for mothers is designed as a randomised controlled study with repeated data collection. The parameters of indirect and direct non-medical costs are measured at the beginning of the rehabilitation programme and until twelve months later by means of questionnaires, face-to-face and telephone interviews. So far, results of the evaluation show that the actual time cost of the rehabilitation programme is DM 6,162 for each mother and the time cost because of the utilisation of the health care system is DM 996 per four weeks. Therefore, the patient costs are obviously higher than the direct medical costs for the programme which makes it clear that taking into account the costs of the patient (especially the time costs) can make a decisive difference in the evaluation of alternative treatment programmes and may possibly reverse the advantages of an alternative.

A retrospective study was undertaken to determine whether the degree of alcohol intoxication has an effect on the driving performance with regards to both the quantity and quality. A total of 625 accidents caused by drivers who were under the influence of alcohol were reviewed. They were divided into three groups according to the blood alcohol concentration (BAC):0.30 - 1.09 g/kg, 1.10 - 1.99 g/kg and > 2.00 g/kg. In order to exclude the influence of factors unrelated to alcohol, the groups were matched for age, sex, location of accident and the light and road conditions. This resulted in a total of 85 accidents in each group. The accidents were classified with reference to the "Register of causes of accidents" used in road accident statistics. The three groups differed significantly in their causes of accidents (p < 0.025), although those due to speeding dominated in each group. In the group with low BAC, the next most common accidents were the ones caused by failure to give way. In the group with medium BAC, rear-end collisions and accidents occurring during low speed manoeuvres were the second most common. In the group with highest BAC, the next most common causes of accidents were the leaving of the correct traffic lane unassociated with speeding.

«Guided Biofilm Therapy» (GBT) represents a systematic, risk and demand-oriented prophylaxis and treatment concept. A significant difference to conventional methods is - above all - the reduced, tissue-friendly and targeted use of ultrasound and hand instruments. The biofilm is consistently shown with suitable color solutions, the oral hygiene instruction and professional tooth cleaning is optimized. The use of suitable powders guarantees a tissue-conserving and targeted removal of biofilm. While individual treatments, techniques and materials have already been well investigated and described, little data is available on patient acceptance. The aim of the present study was to gain an impression of the acceptance of this method in comparison to the conservative-classical recall care mainly based on hand and ultrasound devices in a survey of 100 consecutive patients from the clinic's internal recall system. The overall results were very positive. The powder jet device showed the best acceptance. The aspect fear before/during the recall session was also interesting: At a low level (10%), an additional reduction to 4% occurred, since hand instruments were probably used much less and only very specifically. mConclusion: The use of plaque elevators makes the work in the recall session more efficient, more effective and guarantees ma higher quality control, which is also highly appreciated by patients.

In the period between 1.1.1974 and 31.12.1978 phage typing of 2058 strains of S. typhi and 1672 strains of S. paratyphi-B was carried out. 45 S. typhi phage types were found, 11 of these occurred in a frequency of more than 1% (relevant to foci). These were E1 a (21.6%), A (17.7%), F1 (5.8%), D1 (5.5%), C1 (4.6%), E1b (4.1%), D2 (2.5%), 40 (1.5%), 29 (1.3%), B2 (1.0%), 46 (1.0%). Among S. paratyphi-B strains 23 phage types or varieties were observed, 11 of these occurred in a frequency more than 1% (relevant to foci): Taunton (46.9%), 1 m.c. (7.8%), 3aI m.c. (7.7%), B.A.O.R. (6.5%), 3aI var. 1 (5.5%), Dundee (4.4%), 3a m.c. (3.0%), 3b m.c. (2.2%), Beccles m.c. (1.9%), Jersey (1.5%), 1 var. 1 (1.4%). In the year 1974 two epidemics of typhoid fever occurred, one with 417 cases (phage type A, subtype Tananarive) and the other with 41 cases (phage type E1a). In the year 1977 there was an outbreak of paratyphoid B fever with 53 cases (phage type 3aI var. 1). The increasing number of imported cases of typhoid and paratyphoid fever from other countries is remarkable. The age distribution of typhoid and paratyphoid bacilli carriers shows that persons who are older than 60 years represent the age group in which carriers occur most frequently.