[Health protection during heat waves: European recommendations and experience in Hesse]. / Gesundheitsschutz bei Hitzewellen: Europäische Empfehlungen und hessische Erfahrungen.

BACKGROUND: In the course of climate change periods of extreme heat will probably happen more frequently. The aim of heat health action plans is to prevent the health consequences of heat. OBJECTIVES: The purpose of the present work is to develop a proposal for a heat health action plan for Hesse, Germany. MATERIALS AND METHODS: In 34 interviews with experts the existing heat health warning system was evaluated. Heat health action plans of 8 European countries were analysed. On this basis a concept for a heat health action plan for Hesse was developed. RESULTS: In Hesse only nursing homes take preventative measures reliably, other health care sectors act along varying individual criteria. Heat health action plans include a heat health warning system and measures. They arrange competences and risk communication. Local authorities are responsible for implementation. Some plans include a surveillance system of mortality or morbidity. In a heat health action plan for Hesse measures should be specified and adapted to specific needs on the local level. Physicians in outpatient clinics are in a key position having contact with the vulnerable group of the elderly. CONCLUSION: A heat health action plan offers opportunities for effective prevention if responsibilities are defined and evaluated, and monitoring of mortality and morbidity is integrated. In the structures of the German health care system efforts to prevent heat-related illness cannot succeed without reliable participation of the outpatient medical system.

[Competence centre for victims of violence as part of the public health services--a consecutive case series of the "Schutzambulanz Fulda"]. / Kompetenzzentrum für Gewaltopfer im ÖGD--Analyse des Fallaufkommens der Schutzambulanz Fulda.

Health-care services often fail to address violence sufficiently and to provide adequate forensic medical examination and documentation, especially in cases of intimate partner violence and violence against people in need of care. The "Schutzambulanz Fulda", hosted by the public health department of Fulda county, aims to close this gap in the east Hessian region. We have evaluated the first year of service. Between November 26(th) 2010 and November 26(th) 2011 a total of 154 persons called for support. Data concerning personal characteristics of the victims and the suspected perpetrators, the time and place of the incidents, and their impacts were analysed. 76.6% of th subjects were female, 23.4% male and 18.8% were less than 18 years old. In 60 cases a documentation of the injuries suitable for use in court was made. The majority of clients were women who reported having been assaulted by their partner or ex-partner. Community violence was less frequently stated. Contact to people in need of care suffering from violence was very rare. Currently, the "Schutzambulanz" as part of a public health department meets the goals to some degree. A comparative evaluation could help to identify the benefits and disadvantages of various trusteeships within the health-care system.

[Community-based prevention of climate-associated health risks]. / Prävention klimabedingter Gesundheitsrisiken in der Kommune.

BACKGROUND: Climate changes and their impact on public health services are presenting officials with new challenges. The Klimzug Nordhessen project provides a framework for the development of suitable adaptation strategies to deal with climate changes. PROJECT: The demographic and climatic circumstances in the region in and surrounding Kassel require a focus on the prevention of heat-caused morbidity and mortality among adults 75 or more years old. The Klimzug Nordhessen project assesses the feasibility of heat monitoring for city and county regions and collects data about the temperature-related comfort of older people. The main focus of the project is the development of prevention strategies for older people who live at home in climatic and demographic high-risk regions. CONCLUSIONS: In the face of inadequate data, the current cooperation between science and practice seems to be an appropriate base for the development of verifiable empirical methods and instruments as well as evidence-based prevention strategies at the communal level.

[Identifying residential areas with heat-related health risks. Sociodemographic and climate data mapping as a planning tool for targeted prevention strategies]. / Wohngebiete mit hitzeabhängigen Gesundheitsrisiken ermitteln. Soziodemografische und klimatische Kartierung als Planungsinstrument gezielter Prävention.

Prognosticated heat waves in the context of climate change require appropriate strategies to prevent harmful health effects in the population. In a model project within the public health department of the Kassel region, elderly living in areas at risk of over-heating will be identified and advised. The localization of high-risk residential areas was part of the planning process. Through mapping of demographic and microclimate data and the characteristics of the material of the residential buildings, high-risk areas that require preventive measures as a top priority were identified. The prevention of heat-related mortality and morbidity by communal health authorities requires close cooperation with other administrative bodies, especially with town planning departments. Mapping demographic and microclimate data and the characteristics of the material of the residential buildings can facilitate the planning of preventive measures.

[Doppler ultrasound monitoring during vascular interventions]. / Dopplerultraschallmonitoring während Gefässintervention.

Doppler ultrasound examination as diagnostic device in angiology yields only discontinuous information on flow velocities in vessels during insonation with hand-held probes. Continuous insonation and therefore determination of flow velocities in arteries are necessary to evaluate flow disturbances and changes of flow velocities during radiologic invasive interventions, i.e. implantation of stents, during percutaneous transluminal angioplasty therapy or local lysis. This modification of Doppler ultrasound examination is already used in neurosurgery for permanent monitoring of flow velocities in large brain vessels in one or both hemispheres during therapy. In our institute we developed a probe holder device to fix a miniature Doppler ultrasound probe (8-MHZ pulsed-wave probe) on the skin surface. Therefore continuous insonation during the manipulations is easy to realize. Information about complications such as occlusions, thrombi, emboli and changes in flow velocity is immediately present on the screen. We have monitored 40 patients during radiologic interventional therapy in arteries of the lower limb. Complications during the interventions were detected immediately and could be corrected.