[CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) in Germany. A model for life style oriented, medical primary care for the population]. / CINDI Germany. Ein Modell zur lebensstilorientierten, ärztlichen Primärversorgung der Bevölkerung.

The WHO project "CINDI" (Country-wide Integrated Noncommunicable Diseases Intervention) is being implemented in 23 European countries and in Canada. The central goal of this project is the development of across-country strategies to combat chronic diseases caused by unhealthy lifestyles. The more Europe grows together the more it will be necessary to have such strategies. The health sector of the individual countries is shaped by cultural and/or civilizatory conditions. Such a strategy has to account for the country's specific shape of the health sector and the experience made in this point has to result in the establishment of structures and the creation of measures across Europe and worldwide. In the first step, members of the CINDI family are to ascertain country specific informations which in the second step should be used for the development of the strategy. The paper refers to the contribution made so far by CINDI Germany with regard to the first step. The "3 Level Conception of Family Physicians"-recommended by the Society of physicians of Germany the model "Community - related behavioural medicine" - which has been developed to put the above mentioned conception into practice - and quality assurance in the framework of medical primary care from the focus of the paper.

[Clinical studies on acid inhibition by ranitidine given simultaneously with pentagastrin]. / Klinische Untersuchungen zur Säurehemmung durch Ranitidin bei gleichzeitiger Gabe von Pentagastrin.

In recent years there have been some reports of tolerance occurring in man with the antisecretory effect of H2 antagonists. We, therefore, studied the effect of 300 mg and 600 mg ranitidine (CAS 66357-35-5) daily and increasing i.v. doses of pentagastrin (0.37 microgram/kg, 0.75 microgram/kg, and 1.5 micrograms/kg body weight) on gastric acid output (mmol HCl/30 min) in 9 healthy volunteers. The study design was double-blind, randomized and cross-over. Pentagastrin stimulation was performed on day 1, day 8, and day 16. Increasing i.v. doses of pentagastrin induced an almost identical enhancement of volume secretion, total acid output as well as titratable acidity on the 3 study days. A 16-days treatment period with 300 mg and 600 mg ranitidine led to 80% and 90% inhibition of pentagastrin stimulated acid output. The degree of inhibition evoked by 300 mg and 600 mg ranitidine against pentagastrin was not statistically different during the 16-days treatment period; i.e. no significant tolerance did occur within 16 days. Our data suggest that, in contrast to intragastric acidity measurements, no significant decline of inhibitory effectiveness of ranitidine against i.v. pentagastrin could be observed in healthy male volunteers.

[75 mg roxatidine nocte protects human gastric mucosa against 300 mg acetylsalicylic acid nocte]. / 75 mg Roxatidin nocte schützen die menschliche Magenschleimhaut gegenüber 300 mg Acetylsalizylsäure nocte.

In a randomized double-blind parallel study the gastroduodenal tolerability of 300 mg ASS nocte (8 p.m.) has been evaluated in the presence of 75 mg roxatidine nocte (8 p.m.) or placebo in 20 healthy volunteers using upper GI-endoscopy. The treatment periods lasted 14 days. Endoscopic controls were performed at entry, and repeated at day 7 and day 14. At entry the mean endoscopic score averaged 0.9 +/- 0.1 in the ASS/placebo-group and 0.9 +/- 0.1 in the ASS/roxatidine-group. The median values were 1.0 and 1.0. 300 mg ASS nocte induced in the placebo-experiments marked gastroduodenal lesions both at day 7 and day 14 (6.5 +/- 1.2 and 7.9 +/- 0.7, respectively). The median values were 8.0 and 9.0, respectively. Concomitant administration of 75 mg roxatidine nocte afforded significant protection against 300 mg ASS nocte both on day 7 and day 14 (3.3 +/- 1.0 and 3.1 +/- 0.9, respectively) (p less than 0.05). The corresponding median values were 1.0 and 1.0. Our data suggest that coadministration of roxatidine nocte reduces significantly gastroduodenal lesions evoked by acetylsalicylic acid 300 mg nocte.

[The effect of glycine on the gastroduodenal tolerability of acetylsalicylic acid. An endoscopic, controlled double-blind study in healthy subjects]. / Einfluss von Glycin auf die gastroduodenale Verträglichkeit von Acetylsalicylsäure. Eine endoskopisch kontrollierte Doppelblindstudie an gesunden Probanden.

In a randomized double-blind study the gastroduodenal tolerability of daily 500 mg acetylsalicylic acid (ASA, CAS 50-78-2) in combination with 250 mg glycine (CAS 56-40-6) (Godamed) and 500 mg ASA without addition of glycine were evaluated in 20 healthy volunteers giving upper GI-endoscopy. Both ASA-preparations have been taken over a period of 4 weeks. Endoscopic controls were performed at entry, and repeated after 7, 14 and 28 days of treatment. Both ASA-preparations induced comparable gastroduodenal damages during the whole test period: The lesions score of both groups on day 7, 14 and day 28 was almost identical. In contrast to plain ASA, where 9 of 10 volunteers reported gastrointestinal side effects, all subjects receiving ASA in combination with glycine did not complain from any dyspeptic symptoms, i.e. epigastric pain etc. The reasons for the apparent better tolerability of ASA in combination with glycine are discussed.

[Protection from gastroduodenal adverse effects of acetylsalicylic acid with ranitidine. An endoscopic controlled double-blind study of healthy subjects]. / Verbesserung der gastroduodenalen Verträglichkeit von Azetylsalizylsäure durch Ranitidin. Eine endoskopische kontrollierte Doppelblindstudie an gesunden Probanden.

Ranitidine protects against gastroduodenal mucosal damage associated with low-dose ASA therapy/Endoscopically evaluated double-blind study in healthy volunteers In a randomized double-blind crossover study the gastroduodenal tolerability of 300 mg ASA mane (8 a.m.) has been evaluated in the presence of 300 mg ranitidine nocte (8 p.m.) or placebo in 10 healthy volunteers using upper GI-endoscopy. The treatment periods lasted 14 d. Endoscopic controls were performed at entry, and repeated at day 7 and day 14. At entry the mean endoscopic score averaged 0.9 +/- 0.1 in the ASA/placebo-group and 0.8 +/- 0.1 in the ASA/ranitidine-group. 300 mg ASA mane induced in the placebo-experiments marked gastroduodenal ulcerations both at day 7 and day 14 (7.3 +/- 1.3 and 8.2 +/- 2.1, respectively). Concommittant administration of 300 mg ranitidine nocte afforded almost full protection against 300 mg ASA mane both on day 7 and day 14 (1.6 +/- 0.4 and 1.7 +/- 0.5, respectively) (p less than 0.05). These data suggest that nocturnal coadministration of ranitidine 300 mg reduces almost completely gastroduodenal lesions evoked by acetylsalicylic acid 300 mg mane.

[Ranitidine in the therapy and prevention of NSAR-induced (non-steroidal anti-rheumatic agents) gastroduodenal lesions in patients with rheumatism]. / Ranitidin in der Therapie und Prophylaxe NSAR-induzierter gastroduodenaler Läsionen bei Rheumapatienten.

178 patients with various rheumatic disorders who had been treated with non-steroidal anti-inflammatory drugs (NSAID) for at least 32 months, were enrolled in this open trial. Entry criteria were both the presence of endoscopic lesions in gastric and/or duodenal mucosa as well as dyspeptic symptoms. All patients were treated with ranitidine 150 mg bid for 4 weeks; 127 of them continued to take their original medication. Only in a small subgroup of 21 patients the NSAIDs were withdrawn. Mean gastric lesions scores averaged at entry in both treatment groups 2.2 and 2.0; the corresponding duodenal values were 2.2 and 2.6. After 4 weeks therapy a significant reduction of the mean gastric and duodenal damaging scores was observed (p less than 0.05). In addition, a marked symptomatic relief occurred. In the subsequent prophylactic trial 98 patients could be followed for 3 months and 59 patients for at least 6 months. 44 patients (3 months) and 36 patients (6 months) received in addition to their antirheumatic medication ranitidine 150 mg bid, whereas 54 patients (3 months) and 23 patients (6 months) were without any antiulcer therapy. The calculated relapse rates within 6 months were in the presence of ranitidine only 12% and without ranitidine 63% (p less than 0.05). Our data emphasize the efficacy of H2-receptor antagonist both in the therapy as well as in the prophylaxis of NSAID-induced lesions in the upper GI-tract.

[Modification of the risk profile of obese essential hypertensive patients by the group "hypertension discussion" program]. / Beeinflussung des Risikoprofils von adipösen essentiellen Hypertonikern durch das Gruppenprogramm "Hypertonie im Gespräch".

The programme "Discussions on Hypertension" is a programme for group treatment of obese essential hypertensives in medical practices on the basis of behavioural therapy. A co-operation model was developed between the Department for General Medicine of the "Medizinische Hochschule Hannover", the Institute for Medical Psychology of the "Philipps-Universität Marburg" and the company Galenus Mannheim and was offered to doctors in general practice. The effects of the programme on the modifying of the risk profile for coronary heart disease was investigated in a controlled study in 137 patients by nine general practitioners. 81 patients were enrolled in the experimental group and 56 patients were assigned to a control group that was not using the programme. The experimental and control groups were comparable with respect to sociodemographic, psychological and medical parameters. Three months after completing the programme, the results of the study was shown in specific effect both on the psychological criteria of success (well-being, health knowledge, healthy behaviour, salt use and compliance) and in a reduction of the diastolic blood pressure in spite of a reduction of the antihypertensive drug treatment. The blood lipid levels (cholesterol and triglycerides) and the blood glucose level were also favourably affected. Patients in the experimental group had reduced their weight by an average of 5.6 kg. The patients in the control group only by 0.8 kg. Overall, there was a marked reduction in the proportion of patients with several risk factors in the experimental group, so that the programme can be attributed a preventive effect.

[The "Wiesloch model". Sports therapy and intervening prevention]. / Das "Wieslocher Modell". Sporttherapie und intervenierende Prävention.

For more than 4 years independent practitioners in the area of Wiesloch have led an intervening prophylactic treatment. Based on the recognition of heart and circulatory diseases, the program consists of sport with medical participation, a series of lectures and a course an dietary cooking. The results of 4 years show that there is success in normalising pathological risk factors.