Der Internist
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While in younger age groups prevention of acute diseases is the primary goal of therapeutic intervention, in the elderly the up-rise of disabilities due to chronic conditions must be focused. Underestimated risk factors like cognitive decline, depression, falls and lack of social contacts are highly correlated with disability. A comprehensive functional diagnostic is therefore important in order to identify risk factors and to develop preventive strategies. ⋯ On the other side, specific tools for nursing home residents are lacking. We highlight the epidemiological context and the dimension of disability of a population in which preventive models for the elderly can play a major role. Than, we point out models that put their emphasis on preventive strategies for frail elderly persons.
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Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. ⋯ We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.
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The patient reported here was admitted because of severe dehydration caused by watery diarrhea. As underlying disease we found bacterial overgrowth of the small bowel due to myopathic dysmotility of the small bowel as a manifestation of CREST syndrome. An important clue to the diagnosis was the result of a ward round: the patient showed Raynaud's phenomenon when exposed to the cold at an open window airing the room. A leading tool for diagnosis and therapy proved to be small bowel manometry which is further discussed in this case report.