The article shows, through a study of the Berlin-Brandenburg region, that children and juveniles who were subjected to the killings of diseased and disabled, or mentally retarded persons during the Third Reich did not only fall victim to the operations of the "Reichsausschuss"("Reich Commission for Registration of Severe Disorders in Childhood"). Many were also included in the gas chamber killings of the "T4"-action and in various decentralized killing actions. To gain scientific knowledge, the brains of many of these patients were examined by German neuropathologists. It will be shown that the purpose of the killings was not the painless ending of individual suffering, but that they constituted a means of freeing the public from so-called "ballast existences", whose lives were only prolonged if they could be of scientific use.

Past research suggests that age differences in measures of cognitive speed contribute to differences in intellectual functioning between young and old adults. To investigate whether speed also predicts age-related differences in intellectual performance beyond age 70 years, tests indicating 5 intellectual abilities--speed, reasoning, memory, knowledge, and fluency--were administered to a close-to-representative, age-stratified sample of old and very old adults. Age trends of all 5 abilities were well described by a negative linear function. The speed-mediated effect of age fully explained the relationship between age and both the common and the specific variance of the other 4 abilities. Results offer strong support for the speed hypothesis of old age cognitive decline but need to be qualified by further research on the reasons underlying age differences in measures of speed.

The primary focus of this article is on the presentation of wisdom research conducted under the heading of the Berlin wisdom paradigm. Informed by a cultural-historical analysis, wisdom in this paradigm is defined as an expert knowledge system concerning the fundamental pragmatics of life. These include knowledge and judgment about the meaning and conduct of life and the orchestration of human development toward excellence while attending conjointly to personal and collective well-being. Measurement includes think-aloud protocols concerning various problems of life associated with life planning, life management, and life review. Responses are evaluated with reference to a family of 5 criteria: rich factual and procedural knowledge, lifespan contextualism, relativism of values and life priorities, and recognition and management of uncertainty. A series of studies is reported that aim to describe, explain, and optimize wisdom. The authors conclude with a new theoretical perspective that characterizes wisdom as a cognitive and motivational metaheuristic (pragmatic) that organizes and orchestrates knowledge toward human excellence in mind and virtue, both individually and collectively.

A comparative study of adverse drug reactions (ADR) leading to hostpial admission showed that 103 (4.1%) out of 2499 medical admissions in Jerusalem and 167 (5.7%) out of 2933 admissions in Berlin were due to such reactions. Sex distribution in the two patient--populations was almost equal but the Jerusalem patients were younger. The most frequent ADRs were digitalis intoxication (in Berlin) and reactions to antibiotics (in Jerusalem). Other important differences were noted in the relative frequencies of ADRs associated anticoagulants, hypoglycemic agents and oral contraceptives. They were probably related to differences in drug usage in the two countries. The most common major side effects were arrhythmias, allergic reactions, bleeding, congestive heart failure, bronchospasm and hypoglycemia. The following risk factors were identified in both cities: old age, female sex, impaired renal function, previous history of ADR and polypragmasia.

The goal of this article is to examine differential aging in everyday functioning between resource-rich and resource-poor older adults. Four groups of older adults were identified on the basis of 2 distinct resource factors: a Sensorimotor-Cognitive factor and a Social-Personality factor. The resource-richest group consisted of those participants who were above the median in both factors; those falling below the median in both factors comprised the resource-poorest group; and 2 additional groups consisted of older adults who were above the median in either 1 of the 2 factors. At the level of mean differences, the 4 groups differed in the length of the waking day, the variability in activities, the frequency of intellectual-cultural and social-relational activities, and resting times. Considering age differences there are more and larger negative age effects in the resource-poorest group than in the resource-richest one. The metamodel of selective optimization with compensation is used to interpret the findings.

Within the International Collaborative Outcome Study of Eating Disorders in Adolescence (ICOSEDA) we studied the clinical features, treatment, and outcome in consecutive cohorts of adolescent patients at five sites in former West Berlin and East Berlin, Zurich, Sofia and Bucharest. A total of N = 242 patients were followed up after a mean interval of 6.4 years in young adulthood. Using semi-structured interviews it was found that on average the patients were in either inpatient or outpatient treatment for 30% of the entire period between first admission and follow-up. Across the five sites 70% recovered from the eating disorder and a similar rate showed good or fair psychosocial functioning and no other psychiatric disorder. However, the combination of these three criteria showed that at follow-up only every second former patient was a mentally healthy and psychosocially well functioning person. The univariate and joint consideration of a large list of predictors lead to the conclusion that individual prognosis of the course of adolescent eating disorders is a hazardous undertaking.

Within an interdisciplinary research project, the long-term outcome of children with fetal alcohol syndrome was studied. Methods for the assessment of psychopathology, behavior, and intelligence included psychiatric interviews, behavior checklists for parents and teachers, and intelligence tests. The children were assessed during preschool age, early school age (6 to 12 years), and late school age (> or =13 years). An excess of psychopathology,(including hyperkinetic disorders, emotional disorders, sleep disorders, and abnormal habits and stereotypes) with a strong persistence over time was found. Cognitive functioning was marked by a large proportion of mentally retarded children and also did not change considerably over time. This long-term outcome study reflects the handicapping effects of fetal alcohol syndrome.

Since 1988, 295 patients have undergone MCS at the German Heart Institute Berlin; 246 received biventricular support with the extracorporeal pneumatically-driven Berlin Heart Assist Device, 49 received left ventricular support with implantable assist devices (33 Novacor, 16 TCI). Longer waiting periods for heart transplantation has caused the mean duration of MCS to increase from 12 days in 1988 to 76 days in 1994. Of the 24 patients who underwent MCS for more than 90 days, nine were implanted with a biventricular device, 12 with a Novacor device, and 15 with a TCI device. Eight patients with uni-ventricular devices remain on support after 200 days (range 203-600 days). Six of the Novacor patients could be discharged to a nursing home or to their own residences. One patient still on NC support after more than 600 days currently resides at his home and has regained normal physical activity. Minor pocket infections occurred in two TCI and four Novacor patients; one patient died of sepsis. A total of four patients could be weaned from LVAD after 160-347 days of MCS. An initial high level of beta1 receptor antibodies disappeared completely during left ventricular support. This decline in auto-antibodies was paralleled by a dramatic improvement in cardiac function. LVEF remained unchanged up to 6 months after explantation. Long-term mechanical support has become a reality. Heart transplantation after prolonged MCS yields results comparable to primary HTx. Some patients exhibit immunological changes and a dramatic improvement in ventricular function under long-term MCS and can be weaned with extremely satisfying results.

This study examines attitudes toward work, work incentives, and the impact of work on quality of life for people with schizophrenia, and investigates whether these findings differ among Western countries. We interviewed 24 randomly selected subjects with schizophrenia and schizoaffective disorder (12 employed and 12 unemployed) at each of three sites: Boulder, Colorado, United States; Berlin, Germany; and Berne, Switzerland. No significant differences were found in the subjects' attitudes toward work or subjective well-being, although Swiss patients had a higher cost-of-living-adjusted income. Unemployed subjects reported a lower subjective reservation (minimum financially worthwhile) wage than employed subjects in Berlin and Berne, whereas the reverse was true in Boulder. When subjects from all sites were combined, employed patients displayed less psychopathology and significant advantages in terms of objective and subjective measures of income and well-being: They were also more likely to stress the importance of work. The results suggest that work is associated with a markedly better quality of life for people with schizophrenia, but that disability pension programs in the United States might introduce work disincentives.

OBJECTIVE: There is no agreement on how to classify and diagnose reactive arthritis (ReA) and it is also unclear what kind of specific clinical and laboratory investigations are appropriate. We define relevant points of agreement and identify points of disagreement among an international group of experts in the field. METHODS: Prior to the 4th International Workshop on Reactive Arthritis, Berlin, July 1999, we sent questionnaires to 42 experts identified by personal knowledge and recent publications. RESULTS: The response rate was 81%(n = 34). There was agreement on the nomenclature and recommendation to use the term "reactive arthritis" only if the clinical picture and the microbes involved are HLA-B27 and spondyloarthropathy (SpA) associated, whereas the term "infection related arthritis" is used for all other arthritides related to or associated with infections. A differentiation between acute and chronic ReA with a cutoff of 6 months is recommended. The history of a preceding symptomatic infection is thought to be most relevant for a diagnosis of ReA. The minimal interval between preceding symptoms and arthritis is proposed to be 1-7 days, maximally 4 weeks. The joint pattern in ReA is asymmetrical, with predominance of the lower limbs. SpA related symptoms may contribute to the diagnosis. A search for chlamydia in urine/urethra/cervix is recommended, while in the case of diarrhea enterobacteria should be searched for in stool and antibodies against them in serum. There were also areas of disagreement, such as: Is arthritis essential for the diagnosis of ReA?, Is it oligoarthritis or any arthritis?, What are the role and value of polymerase chain reaction investigation?, The role and value of serology?, Is the diagnostic sensitivity of microbiological tests for ReA increased by HLA-B27 determination? CONCLUSION: The points of agreement will support better communication in this area, and clarification of the disagreements will lead to further studies and discussion.

The aim of this study was to obtain data about the contamination of different environmental compartments (102 surface water samples, 59 sediment samples and 165 eel samples) by polycyclic musks (HHCB, AHTN, ADBI, AHMI, and ATII) within the framework of an exposure monitoring program. Results for HHCB (Galaxolide) gave the following mean values in areas strongly polluted with sewage: surface water 1.59 micrograms l-1; sediment 0.92 mg kg-1 d.w. and eel 1513 micrograms kg-1 f.w.(in the edible portion)(6471 micrograms kg-1 lipid). The following average concentrations were found in waters hardly contaminated with sewage: surface water 0.07 microgram l-1, sediment < 0.02 mg kg-1 and eel 52 micrograms kg-1 f.w.(445 micrograms kg-1 lipid). Mean concentrations of 6.85 micrograms l-1 (maximum: 13.3 micrograms/l) could be measured at sewage treatment plants' outlets. It could be shown that these polycyclics are highly suited to use as indicators of the degree of contamination of waters with organic substances originating from sewage. A mean bioconcentration factor (BCF) on wet weight of 862 (HHCB) and 1069 (AHTN) for the transfer from water to eel under natural conditions could be calculated. The corresponding BCF-values based on the lipid content of eel were 3504 (HHCB) and 5017 (AHTN).