Dtsch Arztebl Int
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The effectiveness of mammographic screening has been proven at evidence level 1A. Mammography offers the best ratio of benefits to side effects of any screening method tested to date. In this literature review, we ask whether early detection might be improved still further by combining mammography with other imaging modalities. ⋯ Randomized controlled studies are needed for a realistic assessment of the achievable benefits and unavoidable side effects of combined screening. For women whose risk of breast cancer is not elevated, mammography remains the standard screening method.
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In Germany, a large number of biased reports against vaccination have recently been published in all of the news media, and particularly on the internet. This paper discusses the safety profile of modern vaccines and their continuous surveillance and shows why the current criticism of vaccination on safety grounds is unjustified. ⋯ An examination of these data reveals that the expressed doubts about the safety of vaccines are unjustified.
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In the industrialized countries 67 million people suffer from glaucoma, which represents the third most common cause of blindness and thus has a high economic impact. Early diagnosis of glaucoma, which does not necessarily involve raised intraocular pressure, is essential because by the time the patient notices functional impairment the damage is irreversible. Early treatment can decrease the rate of blindness 20 years later by about 50%. ⋯ From the clinical perspective sensitive, specific, and cost-effective glaucoma screening seems feasible. The high-risk group would need to be defined on the basis of age and family history. A two-stage screening process would then have to be established with initial computer-supported telemedical sorting followed by telemedical ophthalmological diagnosis of cases selected for clarification.
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It is the aim of this study to demonstrate which disorders of the hip joint can and should be treated by hip arthroscopy. ⋯ The published studies attain a level of evidence IV. Although no data on the long-term outcome are available, it can be concluded that hip arthroscopy has become an important option for treatment of disorders of the hip. As an established component of the treatment algorithm, hip arthroscopy closes the gap between conservative and invasive procedures.
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Clinical environmental medicine deals with environmental effects on human health in individual patients. Patients seek medical advice for problems of many different kinds that may be due to environmental exposures; such exposures must be considered carefully along with other potential causes. An environmental medical assessment should include thorough medical history-taking and physical examination, the formulation of a differential diagnosis, and (whenever indicated) human biomonitoring, site inspections, and ambient monitoring. ⋯ Despite the relative rarity of verifiable environmentally related health disturbances, these must be clearly identified and delimited to avoid further harmful exposures. Environmental medical counseling should include risk assessment and behavior recommendations for all patients who attribute their medical problems to their environment. Physicians performing specific environmental-medical diagnostic procedures must be aware of their limitations in order to avoid performing tests whose results have no therapeutic consequences and are thus of no help to either the physician or the patient.