Ein Sohn der freien Erde...

Die 48iger...

...Vor allem für die Deutschamerikaner ist er ein Held. Ihre Spenden ermöglichen ihm und anderen Achtundvierzigern die Flucht in die USA, die große Republik jenseits des Atlantiks. Hecker geht nach Belleville im südlichen Illinois. Der Ort gilt als ein »kleines deutsches Athen, eine Hochburg deutscher Bildung und freiheitlicher Gesinnung«, wie es in einem Buch der Jahrhundertwende heißt...


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Hier gehen die Uhren andersherum

...Dennoch haben Gábor und András eine Mission, und die verbindet sie mit Rabbi Hurwitz. Gemeinsam hüten sie einen beinahe verloren gegangenen jüdischen Schatz: Das letzte »Stiebl« von Budapest, vielleicht sogar das letzte in Ungarn. Der jiddische Begriff Stiebl stammt vom österreichischen Wort »Stüberl«, Stube, und bezeichnet eine kleine Synagoge innerhalb eines Wohnhauses. »Vor allem unter chassidischen Juden waren Stiebl weit verbreitet«, erklärt Rabbi Hurwitz, »denn die Chassidim ziehen das private Gebet dem kommunalen vor.« Gegen Ende des 19. Jahrhunderts kamen zahlreiche chassidische Juden aus Galizien, dem heutigen Westzipfel der Ukraine, nach Budapest. Sie siedelten sich im achten Gemeindebezirk an, der Josefstadt...


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Aging brains- Use it or lose it...

Ageing brains and challenging thoughts

Jane Smith, deputy editor, BMJ

jsmith@bmj.com

I was heartened by this week’s Analysis on the ageing brain, which tries to counter some of the fear of cognitive decline that accompanies ageing (doi:10.1136/bmj.d6288). Marcus Richards and Stephani Hatch acknowledge that some cognitive skills do decline with age, but point out that people continue to learn and develop a rich set of cognitive skills. While recall of detailed information "bound to time and space" is sensitive to age related decline, memory for more abstract information is well preserved, and may actually improve with age. Cognitive capability and mental wellbeing are mutually supportive—and, say the authors, there is some evidence that continuing to work beyond traditional retirement may benefit cognitive function, possibly on the principle of "use it or lose it."
So what is there in the rest of this issue that might provide food for detailed recall for younger readers and prompt mature reflection in older brains?
Let’s start with perhaps the most challenging subject of all. Last week the BMJ hosted a conference on the health and security aspects of climate change (see last week’s editor’s choice (doi:10.1136/bmj.d6789 and http://climatechange.bmj.com/) and in this week’s feature Henry Nicholls describes the scenarios painted by the various experts from the military, population health, and earth and environmental sciences—and their insistence that global warming needed to be reduced radically from the temperature rise of 4-5°C that it is currently heading for (doi:10.1136/bmj.d6893). He quotes one speaker’s attempt to bring that close to home. "My younger son will be in his early 50s at that point, and that’s not a world he will survive in."
Tony Delamothe touches on other sorts of survival in his Observations article on child sex offenders (doi:10.1136/bmj.d6908). Against a background of vilification of paedophiles—including a savage murder of a paedophile in a British prison and views that such people "should be killed at birth"—Delamothe starts to probe what we know about paedophilia: it’s relatively common (as prevalent as schizophrenia), reconviction rates are low compared with other violent crimes, and there is evidence that treatment can help. He wants to see more enlightened attitudes towards paedophiles, though he concedes that if Lolita were published now it would be unlikely to be lauded as one of the world’s greatest novels.
The tool published in this week’s Research Methods and Reporting is much less controversial. It’s a tool for assessing the risk of bias in randomised trials (doi:10.1136/bmj.d5928) and it’s necessary, say Julian Higgins and colleagues, because discrepancies between the results of systematic reviews examining the same question, and between meta-analyses and subsequent large trials, show that the results of meta-analyses can be biased, often because the included trials have biased results. So the tool, put together by Cochrane Collaboration methodologists, enables systematic reviewers to explicitly assess the risk of bias caused by the methods of randomisation, allocation concealment, blinding of participants, blinding of assessors, attrition from the trial, selective reporting—and any other source of bias. The authors hope their tool will improve the appraisal of evidence and ultimately lead to better designed trials.
And finally, James Owen Drife offers a selection of seminars to keep the brain active, illustrating that the status of "emeritus" brings with it no decline in the cognitive ability to make jokes (doi:10.1136/bmj.d6867).

Cite this as: BMJ 2011;343:d6953

Dieses Land hat mir das Leben gerettet...

Wollen wir sie verraten?

...Dieser mechanische Pessimismus ist blind für das wirkliche Afghanistan, das mehr als ein ewiger Problemfall ist. Es ist ein Land, in dem es mitnichten nur Krieger gibt, sondern ebenso Krankenschwestern und sogar Soziologieprofessoren. Normalität und Fortschritt sind brüchig, bedroht, aber sie sind real, und viel davon verdankt sich der Intervention und ihren Folgen. Der frühere UN-Gesandte in Kabul, der deutsche Grünen-Abgeordnete Tom Koenigs, hat kürzlich festgestellt, dass die internationale Hilfe in Afghanistan nirgends sonst so effektiv und erfolgreich ist wie im Bildungswesen. Nicht Rückzug, sondern Aufstockung wäre hier nötig, gerade durch ein Land wie die Bundesrepublik, das sich mit seinem militärischen Einsatz unwohl fühlt. Doch das alles wird erschlagen vom Klischee einer Stein- und Gewaltwüste, die keine Mühe und kein Opfer lohnt.


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...Weiterreichen von Zeitbomben...

...mit unbekanntem Auslösedatum...
...Meinhard Miegel: „Manche meinen, dann käme so etwas wie ein finaler Crash. Doch final oder nicht final - wir sollten auf wirklich tiefgreifende Veränderungen vorbereitet sein.“ So sehen es auch die Analytiker der Boston Consulting Group.

In einem Papier vom vergangenen September mit dem Titel „Back to Mesopotamia“ untersuchen David Rhodes und Daniel Stelter die den europäischen Regierungen verbliebenen Möglichkeiten. Es sind nicht mehr viele. 

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Stadt meiner Träume

Sie tanzen den ganzen Tag...

www.stekovics.at
FAS 23. Oktober 2011 Nr 42 Gesellschaft Seite 56

Büchertisch

Dummheit

...Hat irgendwer bei der Deutschen Bank inzwischen ein paar erklärende Worte darüber gesagt, wie es dazu kommen konnte, dass die amerikanische Tochterbank einerseits mit dem Finanzschrott handelte - und andererseits auf dessen Wertlosigkeit spekulierte? Was vielleicht nicht ganz illegal war. Aber ungefähr so seriös, wie wenn mein Arzt mir eine Therapie verordnete, von deren Schädlichkeit und Wirkungslosigkeit er längst überzeugt ist....
Wie konnte es soweit kommen?
...Es waren Dummheit und Gier, Inkompetenz, Kurzsichtigkeit und Arroganz, es waren Banker, denen man noch nicht einmal Bösartigkeit unterstellen kann. Sie hatten nur keine Ahnung, was sie da taten - und wer wirklich wissen will, wie überwältigend diese Ahnungslosigkeit war, der sollte...Michael Lewis lesen: "Boomerang"...oder am besten "The Big Short"...

Claudius Seidl
FAS 23. Oktober 2011 Nr 42 Feuilleton Seite 26

Kamera.Erzählungen...

W. Eugene Smith, geboren 1918 in Wichita / Kansas und gestorben 1978 in Tucson / Arizona, hat sich seit den 1940er Jahren als politisch und sozial engagierter Fotojournalist in den USA einen Namen gemacht. Viele seiner Bildreportagen sind bei Life erschienen, dem wichtigen Magazin für Fotojournalismus, das 1936 in New York gegründet wurde. Smith sah in der Fotografie mehr als nur die Illustration zu einem Text und hat oft bei den Redakteuren mehr Mitsprache beim Gestalten eines Fotoessays eingefordert. Seine immens aufwendig recherchierten und emotional bewegenden Reportagen setzten in den 1940er und 1950er Jahren neue Maßstäbe für die fotojournalistische Praxis.


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1000 Jahre

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Erektile Dysfunktion bei Darmkrebspatienten

Research: Men's experiences of erectile dysfunction after treatment for colorectal cancer: qualitative interview study
http://www.bmj.com/cgi/doi/10.1136/bmj.d5824
Editorial: Erectile dysfunction after treatment for colorectal cancer
http://www.bmj.com/cgi/doi/10.1136/bmj.d6366
Male bowel cancer patients are very likely to suffer from erectile dysfunction (ED) after treatment and yet the majority are not receiving adequate information about the condition, according to a study published on bmj.com today.
Bowel cancer affects over 38,000 people every year in the UK with around half of patients surviving for more than five years after treatment. This figure is set to increase, says the study. Men are more likely to develop bowel cancer and many will suffer from ED after their treatment, say the authors, led by Professor Sue Wilson at the University of Birmingham.
The research team carried out a series of in-depth interviews with 28 patients in the West Midlands who had been treated for bowel cancer.
Most of the respondents experienced ED as a result of their treatment. Yet many had been uninformed and unprepared for it. Almost none were receiving adequate, effective and affordable care for the condition.
The interview results also reveal evidence of ageism among health professionals - several respondents said their doctor or stoma nurse said ED would not matter to a patient of their age.
The authors conclude that information and treatment for ED are not routinely offered to male bowel cancer patients, as they are for prostate cancer patients. They add that "the wide diversity of this patient group calls for greater coordination of care and consistent strategies to tackle unmet needs."
In an accompanying editorial, Larissa Temple, a colorectal surgeon at the Sloan-Kettering Institute in New York, says the study would have benefited from examples of men who had been successfully treated for erectile dysfunction so that effective systems could be identified.
Temple adds that the role of the partner merits analysis and that "this is probably an important component of sexual rehabilitation for men with colorectal cancer."
Contacts:
Research: Tariq Ismail, Consultant Surgeon, Queen Elizabeth Medical Centre, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Email: Tariq.ismail@uhb.nhs.uk
Editorial: Larissa Temple, Colorectal Surgeon, Memorial Sloan-Kettering Cancer Center, Sloan-Kettering Institute, New York, USA
Email: templel@mskcc.org

Spekulation mit Nahrungsmitteln stoppen!

Spekulation mit Nahrungsmitteln stoppen!

Chirurgie des Magenkrebs

...After a median follow-up of 15 years, D2 lymphadenectomy is associated with lower locoregional recurrence and gastric-cancer-related death rates than D1 surgery. The D2 procedure was also associated with significantly higher postoperative mortality, morbidity, and reoperation rates. Because a safer, spleen-preserving D2
resection technique is currently available in high-volume centres, D2 lymphadenectomy is the recommended surgical approach for patients with resectable (curable) gastric cancer.

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How on earth do we combat climate change?

Fiona Godlee, editor, BMJ

fgodlee@bmj.com

The greatest risk to human health is neither communicable nor non-communicable disease, it is climate change. Saying this, as I and others have started doing at conferences, seems to take a certain courage. We’ve been emboldened by clear statements from WHO’s director general Margaret Chan and from the Lancet (www.thelancet.com/climate-change). But this week, at a meeting hosted by the BMJ in collaboration with an extraordinary alliance of organisations (http://climatechange.bmj.com, doi:10.1136/bmj.d6775), it became clear that we are going to have to get braver still.

Let me begin by acknowledging that putting climate change at the top of the list of things to worry about is hard when faced with the daily challenges of clinical care: supporting the family of a suicidal person (doi:10.1136/bmj.d5801), advising a woman with polycystic ovaries about the possible outcomes of a pregnancy (doi:10.1136/bmj.d6309), telling a young person he or she has maturity onset diabetes (doi:10.1136/bmj.d6044), or treating asylum seekers while under pressure not to do so (doi:10.1136/bmj.d6637).

But to the top of your list climate change must go. The meeting of over 300 delegates from healthcare, the military, climate science, industry, business, and politics, heard frightening news that none of us want to hear, made more frightening by the measured way it was delivered. As Lord Michael Jay said in his opening remarks, there is no need for hype; the cold hard science is scary enough. Chris Rapley, former director of the Science Museum and head of the British Antarctic Survey, told us that "the science is overwhelming and settled." His conclusions were unflinching: "Is the planet warming? Yes. Is it us? Yes. Does it matter? Yes. Must we do something about it? Yes."

To prevent catastrophic climate change, global temperatures will need to rise by less than 2°C above pre-industrial levels by 2100. At or above such temperatures, health and military experts painted a picture of economic and social breakdown, with death and disease on a massive scale caused by resource shortages, migration, and conflict (BMJ 2011;342:d1819). Business as usual will raise temperatures by 5°C. Even if all current pledges on carbon emissions are met, we will hit 4.3°C. The consequences of such global temperatures are unsurvivable. A statement released at the meeting calls for governments to aim for a safer, lower rise of 1.5°C by 2100 (doi:10.1136/bmj.d6760). But how on earth to achieve this?

Professor Hugh Montgomery of University College London, who instigated the meeting, concluded with stark honesty: "What can we do? I don’t know." The UK’s Climate and Energy Security Envoy, Rear Admiral Neil Morisetti, agreed that there was no clear answer but that we now need to own the problem and the solutions, both as individuals and at an institutional level. "No more talk of them and us," he said. The meeting concluded that we must give politicians the ammunition they need if we are to create radically different ways of living, and we must develop better narratives to articulate the health and economic benefits of tackling climate change. An editorial this week takes up the challenge (doi:10.1136/bmj.d6520).

To read and sign the statement, go to http://climatechange.bmj.com/statement.

Cite this as: BMJ 2011;343:d6789

Therapie des Magenkrebs

Magenkrebs - Gastric Cancer

Die Aufständischen...

Der Euro hat heute Zulauf. Aus allen Richtungen strömen die Menschen zu ihm, aus den Häuserschluchten des Frankfurter Bankenviertels kommen sie, sammeln sich vor der Europäischen Zentralbank, rund um die riesige Statue des Euro-Symbols mit dem blauen € und den gelben Sternen drum herum. Hier, am Ort, der wie kein zweiter in Deutschland für die Bedeutung des Geldes steht, kommen fast 5.000 Menschen zusammen, um gegen die Macht des Geldes zu demonstrieren – gegen das, was sie als Herrschaft der Finanzmärkte über die Wirtschaft, die Politik, und ihr ganz persönliches Leben wahrnehmen.


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A Sunshine Act for Europe

...But thinking that individual doctors can avoid links with industry is unrealistic, says Gale. "Money from drug companies and the influence it buys [are] integral to the way medicine is done, and the carefully nurtured belief that clinicians can navigate all this amid the odour of sanctity and scientific objectivity is mere illusion." What is needed, he says, is a change of culture "in which serving two masters becomes as socially unacceptable as smoking a cigarette."

BMJ 2011;343:d6593

...Mit krimineller Energie haben sie große Mengen Geld bewegt...

...Doch die strafrechtliche Aufarbeitung des Geschehens hat bisher nicht stattgefunden...
Wolfgang Hetzer fragt nach den Gründen und untersucht, welche Straftatbestände greifen könnten.

Five Decades of MRSA

...new challenges have arisen in the past decade. Community MRSA has re-emerged as a major issue, particularly in the USA. The Panton-Valentine leukocidin toxin was found in several community MRSA clones and some are now established in hospitals. European countries are reviewing their experiences and reflecting on prevention and control measures. Livestock MRSA have also emerged, with MRSA of pig origin colonising or infecting patients with close pig contact in several European countries; were these to become established widely, they would alter the dynamics and need new prevention and control measures.

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Büchertisch

1. Der FC Bayern und seine Juden von Dietrich Schulze-Marmeling, Die Werkstatt
2. Der Narr spricht: Es ist kein Gott von Dorothea Weltecke, Campus
3. The Barbecue Bible von Steven Raichlen, h.f. ullmann publishing
4. Leben retten - Wie sich Armut abschaffen lässt und warum wir es nicht tun von Peter Singer
5. Die Verfolgung und Ermordung der europäischen Juden durch das nationalsozialistische Deutschland 1933-1945. Band 4: Polen. September 1939-Juli 1941 von Klaus-Peter Friedrich, Oldenbourg
6. Juden in Krakau unter deutscher Besatzung 1939-1945 von Andrea Löw, Wallstein
7. The Philosophical Breakfast Club von Laura J Snyder, Broadway Books
8. Der Pinsel der Liebe - Leben und Werk des Penis von Bo Coolsaet

Südtirol - Abendstimmung

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Geduld am Hindukusch

Ein überstürzter Abzug wäre unseren Sicherheitsinteressen abträglich und setzte jene Afghanen einem tödlichen Risiko aus, die am Neuanfang mitgearbeitet haben. Wie düster oder hell die Bilanz auch aussieht: Verteidigungsminister de Maizière mahnt zu Recht zu strategischer Geduld. Er weiß selbst, wie schwer es ist, die zu haben.


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Deutsche Jüdische Soldaten

Die Ausstellung »Deutsche Jüdische Soldaten« behandelt auf 69 Bildtafeln das Schicksal jüdischer Soldaten in Deutschland von der Epoche der Judenemanzipation zu Anfang des 19. Jahrhunderts bis zum Zeitalter der Weltkriege. Im Zentrum steht dabei der Zusammenhang zwischen Integration bzw. Ausgrenzung auf der einen sowie dem Militär bzw. dem Militärdienst auf der anderen Seite.


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Vom 13.10.2011 – 06.11.2011 wird die Ausstellung in
GELNHAUSEN, Main-Kinzig-Forum ausgestellt werden.

Rauchen als Risikofaktor an Tuberkulose zu sterben

Smoking could lead to 40 million excess tuberculosis deaths by 2050
(Research: Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis) http://www.bmj.com/cgi/doi/10.1136/bmj.d5506
Between 2010 and 2050, smoking could be responsible for 40 million excess deaths from tuberculosis (TB), according to research published on bmj.com today.
The study, led Dr Sanjay Basu from the University of California, used a mathematical model to determine the effect of smoking on future tuberculosis rates. The research finds that because smoking increases the risk of contracting TB, there will be 18 million more cases worldwide between 2010 and 2050.
Once smokers develop the disease, they are more likely to die from it, meaning that smoking can single-handedly undermine the Millennium Development Goal to reduce TB mortality by half between 1990 and 2015, say the authors. They add, however, that "aggressive tobacco control could avert millions of deaths from tuberculosis."
It is established, say the authors, that smoking tobacco is a TB risk factor. They add that nearly one fifth of the world's population smokes and that most cigarettes are smoked in countries with high TB prevalence and where the tobacco industry has expanded its market. Given this, the authors wanted to predict how much impact smoking will have on future TB rates.
The research team developed a mathematical model to investigate the issue. Similar models have previously been used for HIV, TB detection systems and drug resistance, but not smoking.
In their analysis, the authors found that smoking may have a substantial impact on future TB rates because a moderate increase in individual risk translates into a large population-level risk because so many people smoke.
The results show that from 2010 to 2050 worldwide smoking could lead to 40 million excess TB deaths (from 61 to 101 million). They also conclude that if current smoking trends continue, the number of excess TB cases could rise from 256 to 274 million - 18 million new cases in total.
Furthermore, the authors found that the number of people with current TB infections may be falsely reduced by smoking. This is because smoking can kill so many people with TB that the number of people living with TB is reduced by smoking, even though smoking also causes a rise in new cases.
According to Basu's model the African, Eastern Mediterranean and Southeast Asian regions would experience the greatest increase in new TB cases attributable to smoking.
The authors argue that "aggressively lowering the prevalence of tobacco smoking could reduce smoking attributable deaths from tuberculosis by 27 million by 2050".
Contact:
Sanjay Basu, Department of Medicine, University of California, San Francisco, USA
Email: sanjay.basu@ucsf.edu

Fußball - Wenn einem Geschäftsmodell die Rechtsgrundlage fehlt...

Ein Urteil des Europäischen Gerichtshof (EuGH) könnte das Geschäftsmodell europäischer PayTV-Anbieter gehörig durcheinanderbringen. Fernsehzuschauer müssen nicht mehr unbedingt einen einheimischen PayTV-Sender abonnieren, um sich Fußball-Übertragungen anzuschauen, teilte der EuGH am Dienstag mit. Die Fußballfans dürfen auch auf ausländische Fernseh-Anbieter zurückgreifen.

Bisher konnten die Bundesliga oder die englische Premier League ihre Fußballrechte in jedem EU-Land einzeln verkaufen - meist für viel Geld an Bezahlfernseh-Konzerne wie Sky Deutschland oder BSkyB in Großbritannien. Die Sender hatten dafür die Exklusivrechte. Ein solches Modell stehe aber im Widerspruch zum EU-Wettbewerbsrecht, erklärte der EuGH. (Rechtssachen C-403/08 und C-429/08).

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Drei Jahre länger leben...

Background

The health benefits of leisure-time physical activity are well known, but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear. We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population.

Methods

In this prospective cohort study, 416 175 individuals (199 265 men and 216 910 women) participated in a standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8·05 years (SD 4·21). On the basis of the amount of weekly exercise indicated in a self-administered questionnaire, participants were placed into one of five categories of exercise volumes: inactive, or low, medium, high, or very high activity. We calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life expectancy for every group.

Findings

Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an average of 92 min per week (95% CI 71—112) or 15 min a day (SD 1·8), had a 14% reduced risk of all-cause mortality (0·86, 0·81—0·91), and had a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4% (95% CI 2·5—7·0) and all-cancer mortality by 1% (0·3—4·5). These benefits were applicable to all age groups and both sexes, and to those with cardiovascular disease risks. Individuals who were inactive had a 17% (HR 1·17, 95% CI 1·10—1·24) increased risk of mortality compared with individuals in the low-volume group.

Interpretation

15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease.

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Truth telling in clinical practice

The English novelist George Eliot wrote “falsehood is so easy, truth so difficult”. Truth-telling can be very challenging in clinical practice, especially when it relates to adverse outcomes. In The Lancet today, Ranjana Srivastava gives a moving account of her professional relationship with a young mother with terminal cancer. Srivastava laments the brave young woman's endurance of multiple rounds of chemotherapy that, clinically, were doomed to failure, yet that she and her family believed would eventually lead to a cure. When the end finally comes, “after 5 years of preparation…nobody had a chance to say goodbye”. According to Srivastava, patients who have a chance to discuss their wishes for the end of life often undergo fewer futile interventions and spend more quality time with their relatives than do patients who are denied this option.

In the past, when paternalism characterised the doctor—patient relationship, some doctors withheld the truth when they perceived that discretion might benefit a patient. With increased patient autonomy and empowerment, as well as developments in treatment, there have been substantial changes in truth-telling attitudes, practices, and policies worldwide. Legal and professional codes have evolved to include requirements for disclosure and informed consent in many countries. For example, New York's Palliative Care Information Act, which took effect on Feb 9, 2011, clearly says that “If a patient is diagnosed with a terminal illness or condition, the patient's attending health care practitioner shall offer to provide the patient with information and counselling regarding palliative care and end-of-life options appropriate to the patient, including but not limited to: the range of options appropriate to the patient; the prognosis, risks and benefits of the various options; and the patient's legal rights to comprehensive pain and symptom management.” Furthermore, patients are increasingly involved in the decision-making processes of diagnosis and treatment. In the Breast Cancer Prevention Trial Participant Advisory Board model, women participate in the design of the trial, outreach efforts to recruit individuals from under-represented populations, and identification of research priorities. While advances in palliative care have allowed clinicians to shift their goals from cure, when no longer possible, to palliation, and have created a pressing need for clinicians to discuss this transition openly and effectively with patients.

 

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Gewinnmaximierung auf dem Rücken Anderer...

Der Film erklärt die Ursachen der Finanzkrise und zeigt Gesichter...

Siehe auch "Der große Crash"