Acute side-effects are comparable to those reported after intradermal vaccination for infectious diseases. Specific risks for anaphylaxis, autoimmune or graft versus host disease were not detected.

PurposeRecurrent miscarriage (RM) is a stressful condition which gives rise to extensive diagnostic evaluation and is seen as a potentially curable maternal disease. Nevertheless, epidemiological data have shown that outcome is related to fertility. In addition to maternal age and number of preceding miscarriages, further markers derived from the past history may support counselling.MethodsObservational trial comprising 228 couples who were referred between 1996 and 2003 for immunological evaluation at maternal ages 20–39 years after three or more spontaneously conceived primary first trimester miscarriages. They were interviewed in 2005, ongoing pregnancies were followed up until birth in 2006. Past obstetric history was correlated with 2 year cumulative pregnancy and delivery rates (CPR, CDR).ResultsCPR and CDR were 206/228 (90.4 %) and 174/228 (76.4 %). Duration of infertility was associated with lower CPR (up to 3/>3 years, p < 0.01), whereas age and number of preceding losses inversely correlated with CDR (<35 years/35–39 years, p < 0.002; 3/>3 miscarriages, p < 0.002). Detection of an embryonic heart beat in 2–3 of the first three miscarriages resulted in favourable outcome (CPR: p < 0.02, CDR: p < 0.002). Prognosis was excellent in younger fertile women after three miscarriages where vital signs had been detected; under less favourable conditions not only risks for further miscarriage, but also for secondary infertility were elevated.ConclusionSecondary infertility is a feature of RM. Embryonic vital signs in preceding pregnancies are prognostic markers and should be regarded as a strong confounding factor in trials on therapeutic interventions. Prevention may be more appropriate than treatment.

The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA.

BackgroundAs mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives’ experiences with severely mentally ill patients in different integrated care service providers.MethodsSemi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories.ResultsFour main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges.ConclusionRelatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.

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The aim of the qualitative study was the evaluation of experiences with integrated care especially with the care in network "NetzWerk psychische Gesundheit" (NWpG) from the perspective of mental ill patients. The patients were recruited from the NWpG. Focus groups were conducted in five of these networks and analyzed with qualitative content analysis. 40 mental ill patients participated on the focus groups. Overall, they were very positive about their care in such a network. Especially, aspects like need orientation, 24/7 telephone hotline, involvements of relatives as well as outreach care has been experienced as a support for their own care. The health care in NWpG seems to be important for an independent existence and presents relevant components for an autonomous life.

ZusammenfassungFragestellung: Bei Paaren mit habituellen Frühaborten oder wiederholtem Implantationsversagen im IVF/ICSI-Programm besteht in ausgewählten Fällen ein therapeutischer Ansatz in der allogenen i. c. Immunisierung (AI) der Frau mit Lymphozyten des Partners. Hier stellen wir dar, welche akuten Beschwerden nach einer Behandlung auftreten können. Material und Methodik: Prospektiv wurden Daten der Paare ausgewertet, die zwischen 2000 ± 2003 behandelt wurden und vier Wochen später zu akuten örtlichen oder systemischen Reaktionen per Fragebogen Auskunft gaben (Rücklauf 2587/ 3246 = 83% der Behandlungen). Ergebnisse einer weiteren Erhebung 2 ± 3 Jahre nach AI (Erstbehandlung 1996± 2002, Rückmeldung 1914/3041 = 63% der Paare) flossen ein. Ergebnisse: Verglichen mit den Literaturangaben zur i. c. Applikation von Impfstoffen waren die örtlichen Nebenwirkungen nach intrakutaner AI tendenziell etwas häufiger. Sie waren nach der ersten AI stärker als nach einer weiteren und korrelierten positiv mit der Zahl der injizierten Zellen. Die Lokalreaktionen bildeten sich folgenlos zurück, Abszess-oder Narbenbildung wurden nicht beobachtet. Als Spezifikum der AI wurde Bläschenbildung an den Einstichstellen von 6 ± 14% der Patientinnen angegeben, wobei die Unterschiede zwischen Empfängerin und Spender in den HLA-Klasse I-Merkmalen keinen erkennbaren Einfluss hatten. Systemische Symptome waren denen einer Schutzimpfung vergleichbar. In zeitlichem Zusammenhang mit der AI traten bei 14 von 2587 (0,5 %) Behandlungen Exantheme auf, die in Abstract Purpose: For some women with recurrent first trimester abortions or repeated implantation failure during an IVF/ICSI-program lymphocyte i.c. immunization therapy (LIT) with partnerderived lymphocytes is a therapeutic option. Here we describe the acute symptoms which can occur after LIT. Materials and Methods: A prospective 4 week follow-up of all couples who underwent LIT from 2000 to 2003 for acute local and systemic side effects (feedback 2587/3246 = 83% of treatments) was carried out. Data raised in another survey (first LIT 1996(first LIT ± 2002(first LIT , feedback 1914/3041 = 63 % of the couples) are included. Results: After LIT, local reactions were slightly stronger than those reported after i.c. vaccination. After the first LIT they were significantly more marked than after a subsequent LIT and also correlated positively with the number of injected cells. They subsided without abcess formation or scarring. Blistering at the injection sites seems to be specific for LIT and was reported by 6 ± 14% of the patients but was not influenced by the HLA class I matching between patient and donor. Systemic reactions were equivalent to those occurring after vaccination. 14 of 2587 LIT treatments (0.5%) were accompanied by various forms of rashes; in 10 cases these were unexplained and possibly caused by LIT. We did not recognize specific risks of anaphylaxis, autoimmune or graft versus host disease (GvDH). Conclusion: Local and systemic reactions after i.c. LIT are comparable to th...

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