["Healthy Region Lower Rhine ... against Stroke": the concept and implementation of an intersectoral public health programme 2003-2008]. / "Gesunder Niederrhein ... gegen den Schlaganfall": Konzept und Umsetzung eines intersektoralen Public Health Programms 2003-2008.

BACKGROUND AND AIMS: When the Public Health Service Act of North Rhine-Westphalia (OGDG-NRW) came into effect local health conferences (KGK) were established in both rural and urban districts. These conferences are designed to optimize medical and social healthcare at the local level. In 2001 KGK managers from six neighbouring districts founded the Network Healthy Lower Rhine. From 2003 to 2008 this network was able to implement the "Healthy Lower Rhine ... against Stroke" programme. The initiative primarily aims at improving community knowledge of stroke with regard to 1) proper action ("Stroke is a medical emergency, so call the emergency number 112!") and 2) stroke warning signs. Eventually these steps are intended 3) to reduce prehospital delays. METHODS: Before the program started a project plan was developed including evaluation approaches. The central elements of the concept include local health targets, intersectoral collaboration and networking, 5-year programme duration, social marketing and a communication strategy. Initially, a needs assessment was conducted using local expert panels, surveys on community knowledge, and clinical data sampling to assess healthcare quality. Subsequently, a package of measures with a "two-level implementation model" was prepared. Normative evaluation consisted of self-reflection within the network-team. The summative evaluation was based on two approaches: surveys on community knowledge of stroke (city of Düsseldorf and district of Wesel) as well as data sample collection in hospitals on health care quality. RESULTS: The central elements of the concepts were implemented. Community surveys revealed similar deficits in community knowledge of stroke in the city of Dusseldorf (2000 and 2004) and in the district of Wesel (2002 and 2008). Knowledge of proper action (call 112 in case of stroke) significantly improved in the Dusseldorf community from 32.5% of correct statements in 2000 to 50.6% correct answers in 2004 and, finally, in 2008 to 69% correct answers in the Wesel district. Hospitals in the district of Wesel collected three-month samples of data on prehospital times in 2003 (before the initiative was started) and in 2005. There was no significant change: the portion of 28% of patients being hospitalized within a three-hour window after the onset of stroke symptoms remained unchanged. DISCUSSION: Due to medical progress and demographic changes stroke remains a paramount issue of public health in Germany. With its programme "Healthy Lower Rhine ... against Stroke" the Network Healthy Lower Rhine provides a strategy for launching and implementing a complex and intersectoral public health intervention.

[Evaluation of the public-health intervention "Healthy Lower Rhine ... against Stroke" by phone surveys. A comparison of community knowledge of stroke by two surveys in the Lower Rhine Region, district of Wesel, Germany, 2002 and 2008]. / Evaluation der Public-Health-Intervention "Gesunder Niederrhein ... gegen den Schlaganfall" durch Telefonbefragungen: Vergleich des Schlaganfallwissens der Erwachsenenbevölkerung am Niederrhein, Kreis Wesel, 2002 und 2008.

BACKGROUND AND PURPOSE: From 2003 to 2008, the program "Healthy Lower Rhine ... against Stroke" was carried out by the Healthy Lower Rhine Network consisting of Health-Conference agencies of six neighboring districts and municipalities. The initiative aims primarily at improving public knowledge on stroke with regard to proper action - "A stroke is a medical emergency, so phone the emergency number 112 immediately!" - and stroke warning signs and symptoms. The campaign is designed to eventually reduce prehospital time, i.e., delays from onset of symptoms to hospital delivery. In the Wesel district (North Rhine-Westphalia [NRW]) the local Health Conference commissioned two representative telephone surveys with a T(0) survey before the start of the program in 2003 and T(1) in 2008 prior to the end of the 5 years' runtime. METHODS: The telephone survey was carried out by the CATI Laboratory (Computer-Assisted Telephone Interviews) of the Survey Center for Social Science (SUZ) in Duisburg in collaboration with the Institute of Health and Work NRW (LIGA.NRW) and the Health-Conference agency of the Wesel district. The study population was the adult community with about 385,000 inhabitants. The random sample comprised 1,089 persons for the T(0) survey (02/18/02-03/28/02) and 1,104 persons were interviewed for the T(1) poll (03/18/08-04/05/08). RESULTS: While in 2002 a proportion of 31.9% of the interviewed persons knew not a single correct stroke symptom, in 2008 this portion amounted to 27.3%. Three or more correct signs were mentioned by 18.6% in the T0 survey versus 25.5% in 2008 (T(1) survey). Symptoms which were mentioned significantly more frequently in 2008 than in 2002 were hemiplegia and dropping corner of the mouth (+5.3%), respectively, numbness/paresthesia (+17.9%), trouble speaking or understanding (+6.1%), and trouble seeing/visual impairment (+4.3%). When being asked: "What would you do in case of stroke?", 69% of the answers in 2008 were correct (call emergency number 112). There were no significant differences in knowledge of risk factors. About 25% of participants in 2008 stated, that they remembered the stroke awareness campaign or related events. CONCLUSION: The present study shows a moderate improvement of community knowledge about stroke with respect to symptoms and proper action in the course of the 5 years' public-health intervention. In comparison to similar surveys performed in 2000 and 2004, especially knowledge of correct action in case of emergency (stroke = medical emergency = call 112) improved. Still, there are persisting gaps in knowledge about stroke in the community, which make further efforts of improving this knowledge recommendable.

[Evaluation of the public-health intervention "Healthy Lower Rhine...against Stroke" by means of clinic data in the district of Wesel, Germany. Comparative study with clinic data samples in 2003 and in 2005]. / Evaluation des Public-Health-Programms "Gesunder Niederrhein ... gegen den Schlaganfall" durch Primärdaten aus Kliniken im Kreis Wesel: Vergleichende Studie von Stichprobendaten aus den Jahren 2003 und 2005.

BACKGROUND AND PURPOSE: The initiative "Healthy Lower Rhine ... against Stroke" aims at improving stroke knowledge in the community, i.e., knowledge of stroke symptoms and proper action when stroke signs occur (call emergency number 112) in order to reduce prehospital times/delay. An expert group in the district of Wesel decided to raise an inventory of stroke-care quality in the whole district. Samples of patient data were drawn in all hospitals in the district of Wesel, in order to gain a database for evaluation of possible effects on prehospital time due to the intervention. MATERIAL AND METHODS: All hospitals in the Wesel district collected data from patients presenting with stroke signs. Data collection was performed for a time span of 3 months before (T0 in 2003) and during (T1 in 2005) the public-health intervention. Standardized data collection was performed with a short version of the questionnaire issued by the German Stroke Registers Study Group (ADSR). Influential factors on prehospital time and means of transportation were analyzed by multivariate logistic regression. RESULTS: The portion of patients hospitalized within a <3-h window after onset of stroke symptoms did no vary between 2003 and 2005 (27.3% vs. 27.5%). In 2005, acute care of stroke patients was performed more frequently in the emergency department (33% in 2003 vs. 84% in 2005). Before the start of the stroke intervention, seven clinics collected data on 326 patients, and in 2005, 375 patients were registered by all eight hospitals in the district of Wesel. Mean age of patients rose from 72 to 74 years. The portion of men dropped from 50% to 43%. CONCLUSION AND PERSPECTIVE: Obviously, prehospital delay was not reduced after a 2-year run of a stroke campaign. It is recommended to carry out a second survey into community stroke knowledge in the district of Wesel. If a significant trend of improved knowledge should be detected, a new evaluation through clinic data sampling would make sense.

["Medical Emergency Services as Seen by Consumers". Health services research by CATI survey of the community]. / "Medizinische Notfalldienste aus Nutzersicht" Ein Beitrag zur Versorgungsforschung durch CATI-Befragung der Bevölkerung.

BACKGROUND: In the Wesel district (North Rhine-Westphalia), emergency ambulances have been called out with increasing frequency and hospitals report that their emergency departments (ED) are more and more being used outside consultation hours of panel doctors. Therefore, the district health conference put this issue on its agenda. PURPOSE: The aim was to obtain data on the following questions: * What do people do when they need medical help outside consultation hours of panel doctors? * Do people know that there is an on-call duty by panel doctors? Do they know how to contact this service? Do people know the Emergency Medical Service and phone number 112 and the new phone number 19222 for Patient Transport Ambulances? MATERIAL AND METHODS: The study population was defined as comprising all residents in the district of Wesel between 18 and 87 years of age (approximately 385,000 people). The sample contained 1,089 persons drawn in accordance with the Gabler-Häder method and in a second step the "birthday method" was used. The survey was carried out by the CATI Laboratory (Computer-Assisted Telephone Interviews) at the Institute of Public Health (lögd, Bielefeld, Germany) between February 18 and March 28, 2002. RESULTS: (1) Being asked: "How would you act in case of a non-life-threatening disease outside consultation hours of panel doctors?", 52.6% of the respondents gave at least one correct answer; 48.6 % of all given answers were "correct" (i. e., on-call duty of Statutory Health Insurance [SHI]-accredited physicians), the others were "incorrect", i. e., "I go to the hospital/emergency department" (24.3%) or "I call the phone number 112" (13%). (2) About 80% of respondents said they heard about the on-call duty of SHI physicians. (3) 95.6% of respondents stated they knew the emergency call of the fire department; 86% of these participants were able to name the correct phone number 112. (4) About 4% of the respondents said they knew the nationwide telephone number for patient transports, and 58% of these respondents mentioned the correct number 19222. CONCLUSION: A) The tiered medical emergency system should be used adequately; this aim could be attained by (1) information of the public about the "24-h" on-call service of panel doctors; information about the fact that the majority of medical conditions can be treated by panel doctors and that in severe cases a professional and quick referral will be done; information about the fact that self-referral to hospitals may reduce or even obstruct professional resources for the treatment of "real" emergency patients. Target groups are men, younger age groups and people with a higher level of education. (2) information of target groups (elderly people) about the emergency call number 112. (3) information of the public about the national phone number 19222 for patient transports. B) Structural measures such as (1) specific on-call services, (2) improvement of the transparency and reach-ability of panel doctors' on-call services.

Influence of choking and arm lock technique in judo on the acoustic reflex threshold (art) in healthy well-trained male and female judoka.

The objective of this controlled parallel group study was to assess the effects of standardized choke holds (test) and arm lock techniques (controls) in on the acoustic hearing threshold. 104 (test group, 32 female subjects and 72 male subjects, mean age = 28.0 years, SD = 7.9 years) and 51 experienced judoka (controls. 21 female subjects, 30 male subjects; mean age = 26.8 years; SD = 13.2 years) participated. Acoustic reflex thresholds (ART [dB]) were measured separately before and after each manoeuvre both for air and bone conduction of the right and left side. The difference Dart of the ART before and after a manoeuvre (Dart = ARTbefore - ARTafter) was calculated. Data were presented descriptively and nonparametric statistics was applied for nonrelated (Kruskal Wallis ANOVA) or related samples (Friedman ANOVA). Wilcoxon tests were used for pre/post comparisons of original ART values. The effect of choking on Dart was significantly different from the effect of the arm lock technique on Dart independent of the experimental condition. A significant influence of applied frequencies on Dart was ascertained if a choking technique was used. For all frequency ranges applied a highly significant improvement of the ART after choking was found. With regard to bone conduction thresholds increased by an average of 6.1 dB and for air conduction the average increase was 4.9 dB. On the contrary, arm locks induced a slight mean deterioration of the ART for bone conduction of 1.8 dB. The ART for bone conduction also showed a trend towards a reduction after arm locks with a mean decrease of about 1.2 dB. In conclusion, standardized choking manoeuvres reduced the ART corresponding to an improved hearing both with regard to air and bone conduction. Such an effect on hearing ability was not found for arm lock techniques.