Effectiveness of a decentralized, community-related approach to reduce cardiovascular disease risk factor levels in Germany.

AIMS: Conventional community-oriented prevention programmes have been moderately successful in reducing cardiovascular disease risk factor levels in the population. Within the German Cardiovascular Prevention Study, a new decentralized and community-related form of preventive intervention was tested. METHODS AND RESULTS: Interested lay people and general practitioners co-operated in developing activities conducive towards a healthier lifestyle in two towns. Changes in risk factor levels were evaluated by repeated surveys of independent cross-sectional samples in two intervention communities (n=3460, baseline; 2561, final). National survey data (n=4788, baseline; 5311, final) were used to describe secular trends. Six years after the onset of intervention activities the following changes in risk factor prevalence for both sexes combined were observed in the intervention communities (95% CI in brackets): smoking -10.5% (-17.6 to -3.4); hypertension -29.0% (-38.1 to -19. 9); total cholesterol >/=250 mg. dl(-1)-8.1% (-15.4 to -0.9). In contrast to a national increase in the prevalence of obesity, this rate remained stable in the intervention communities. CONCLUSION: Initiating preventive activities developed by community members under the responsibility of local doctors is effective in lowering cardiovascular risk factors at community level. Unlike traditional intervention programmes this new approach does not require external funding and guidance.

[Sex-specific differences in risks and management of coronary heart disease]. / Geschlechtsspezifische Unterschiede in Risiken und Versorgung der koronaren Herzerkrankung.

Reports from several countries indicate that women are disadvantaged in the treatment of coronary heart disease. The aim of the present review is to examine--on the basis of current population-based data (National Health Survey [NHS], hospital diagnosis registry, mortality rates)--whether in the Federal Republic of Germany more recently a change in favor of women could be established. According to NHS results prevalence rates of hypertension, overweight, and smoking in men exceed those of women, whereas hypercholesterolaemia is equally prevalent in both sexes. From 1984/85 to 1990/91 the NHS revealed a marked decline of smoking in men, and a parallel increase in women. The prevalence of chest pain shows no gender difference, but chest pain in men is more predictive for coronary artery disease. In acute myocardial infarction [AMI] thrombolysis and PTCA are applied with equal frequency; the average length of stay in hospital is greater for women. Coronary bypass surgery and rehabilitation in hospitals are less frequently applied in women. Little is known about gender differences in psychosocial adaptation after AMI. AMI mortality rates in all age groups are lower in women, and their mean age of death is higher. However, the decline of AMI mortality since 1980 was less pronounced in women compared to men.

Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention.

The main goal of the preventive intervention study in one community of the German CINDI (Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO) area was to improve cardiovascular health by reducing the risk factors smoking, hypertension, obesity, hypercholesterolaemia, and by changing sedentary lifestyle. The intervention was performed by using the special "Three-Level-Strategy", which is characterised by activities of primary care physicians in the usual consulting hour (1st level), with patient groups in their practices (2nd level), and at community level (3rd level) where a special work group and a co-ordinating general practice are co-operating. To evaluate the occurrence of the risk factors in practice and the local population, four cross-sectional random samples (N(total) = 4881) were carried out in seven practices from 1992 to 1995. On the community level, 23 special exercise-based health groups (N(total) = 600) were established and were investigated by means of a questionnaire, related to behaviour and health beliefs. A "Local Health Information System" facilitated the evaluation, the management of the data, and the organisation of the health programme. The results of the practice samples showed a significant reduction of smoking (-17.8%) and hypertension (-31.5%) (p < 0.01). The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants (83.8%). The participants considerably improved their health behaviour: 82% discussed health in their family, 37.3% stated an increase of healthy nutrition, 52% of relaxation; 86.2% intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings. We conclude that the practice-based "Three-Level-Strategy" provides a strong support for successful long-term prevention of cardiovascular risk, particularly, when exercise-based health training sessions are performed in order to change sedentary lifestyle. When organised on community level, they might have a positive impact on the health behaviour of the whole community. Physical activity can be used as a "prodrug" for health promotion in a holistic way.

Gender differences in the decline of mortality rates of acute myocardial infarction in West Germany.

In Germany in 1994, 86,915 people died from acute myocardial infarction; 56.3% of these cases were male. The corresponding mortality rates per 100,000 were 116.1 in men and 87.9 in women. The male-female mortality ratio in 1994 was most pronounced for males aged 45-54 years with a relative risk of 5.7 (95% CI, 5.2 to 6.2). The mean age of death was 70.5 years in men and 78.6 years in women, reflecting a difference of 8.1 years. In both genders, mortality rates of acute myocardial infarction in the former Federal Republic of Germany (West Germany) started to decline in 1980. This decline summed up to -37.8% (95% CI, -38.9 to -36.8) in men and -25.7% (95% CI, -27.1 to -24.3) in women until 1994. The difference in gender-specific decline was significant. The steepest decline was achieved for men in the 25-44 year age group and for middle-aged women of 45-64 years. An increase could be observed for both genders over 85 years. The mean age of death from myocardial infarction, however, increased in the same time period by 2 years in men and 4 years in women.

[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.

Incidence and risk factors of ischaemic and haemorrhagic stroke in Europe. EUROSTROKE: A collaborative study among research centres in Europe: rationale and design.

EUROSTROKE is a collaborative study among ten European research centres to investigate (1) the variation in incidence of fatal and non-fatal ischaemic and haemorrhagic stroke among populations in different European countries; (2) whether the observed differences in stroke incidence across countries can be explained by differences in prevalence of established cardiovascular risk factors; (3) the relative importance of selected dietary factors (potassium intake, smoking, alcohol consumption), haemostatic disturbances (fibrinogen) and co-morbidity (rheumatic heart disease, atrial fibrillation) compared to established risk factors as determinants of the occurrence of ischaemic and haemorrhagic stroke. The EUROSTROKE database is drawn from ten European population-based prospective follow-up studies (cohorts) and is designed as a case-control study nested within these ten ongoing studies.

[What can family physicians contribute to health promotion in schools?]. / Welchen Beitrag können niedergelassene Arzte zur Gesundheitsförderung an Schulen leisten?

Although several German schools have developed and tested concepts of a goal-directed health education, a stable and continuous implementation is missing. In this field free-practising physicians can support public health efforts. In the area Bruchsal/Ostringen it is demonstrated, that especially those primary care physicians, who work according to the "Three-Level-Concept of Free-Practising Physicians", can successfully use their geographical and social proximity to schools in their neighbourhood for a log-lasting implementation of recurring health-related activities. Within ten years 1389 students in schools, further ca. 500 outside schools, were directly included in interactive learning in the framework of preventive measures, e.g. during school health days. 10 physicians (4 of them continuously) cooperated in these activities, which had been planned in close collaboration with teachers and parents, considering the different age groups. From the very beginning--although sometimes limited in scale--each activity was evaluated. Pupils in the age group 10-12 years generally showed the highest interest in health-related diet, 17-26% were physically more active. Promising are the results with respect to smoking: one fifth of the smoking students intended to quit as a consequence of the health activities in their schools.

[Prevalence of Helicobacter pylori and gastritis in southern Germany. Results of a representative cross-sectional study]. / Prävalenz von Helicobacter pylori und Gastritis in der südlichen Bundesrepublik Deutschland. Ergebnisse einer repräsentativen Querschnittsstudie.

The recent discussions about the relationship between helicobacter-pylori-infection, gastritis and the occurrence of stomach cancer caused us to analyse blood sera of 543 participants randomly selected from the general population in the age of 25 to 34 and of 55 to 64 years from Mosbach (Neckar-Odenwald-Kreis), the county of Deggendorf (Lower-Bavaria) and Augsburg (Upper-Bavaria) regarding IgG-antibodies against helicobacter pylori and the concentrations of the pepsinogens A and C. The latter were used as markers for the presence of chronic gastritis without atrophy and with severe atrophy. The prevalence of helicobacter pylori infection and of forms of gastritis showed no particular differences regarding region or gender. Notable differences in the prevalences were observed with respect to the two age strata. The helicobacter pylori prevalence of the regions being studied ranged for males from 13% to 75% and for females from 22% to 76%. The prevalences of chronic gastritis without atrophy in the investigated areas, derived from the pepsinogen titers, were found to be for males between 24% and 70% and for females between 28% and 61%. Chronic gastritis with severe atrophy appeared mainly in the age group of 55 to 64 years, ranging from 2% to 11% in males and 4% to 10% in females, depending upon region. The helicobacter pylori prevalence and the prevalence of chronic gastritis without atrophy were found to be highly correlated. Chronic gastritis with severe atrophy was also found to be associated with helicobacter pylori prevalence. However, this association did not reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood thiocyanate levels and self-reported smoking habits compared in two large cardiovascular population studies.

In two representative population surveys (n1 = 1712, n2 = 3757, age-range: 25-64 years) from six towns in Northern Badenia (FRG) self-reported smoking habits and blood thiocyanate levels were compared. In Survey 1 the smoking prevalence was 44.1% in males and 32.9% in females, in Survey 2 45.0% in males and 26.5% in females. In agreement with previous studies it was proved that thiocyanate measurements allow to distinguish groups of non-smokers from smokers, whilst not being specific enough to reflect precisely the quantity of tobacco consumption of the individual. A quadratic regression of thiocyanate levels on cigarette consumption provided a better fit and a higher correlation coefficient than linear regression, indicating a saturation effect, i.e., there is no further increase of thiocyanate levels when more than about 30 cigarettes daily are consumed.

First results from the MONICA stroke register in Heidelberg.

The Stroke Register was established in 1984 in Heidelberg, as a part of the MONICA Project, covering the same population (approximately 601,000) as the Acute Myocardial Infarction Register. In the present analysis, the data for men and women (aged 25-64) for 1985 and 1986 are presented. During the two years, 303 men and 143 women were registered. The overall age-standardized attack rate was 127.2/100,000 for men and 52.8/100,000 for women, and the age-standardized incidence was 97.4/100,000 in men and 42.9/100,000 in women. The proportion of first stroke was 76.5% in men and 81% in women. The 28-days mortality was 12% for men and 19% for women. Hypertension, diabetes mellitus, smoking and heart disease (coronary heart disease, rhythm disturbances) were identified as risk factors for stroke. Among the registered victims of stroke, 61% of the men and 67% of the women had a history of hypertension. In men, a high prevalence of smokers, 54% was found (33.9% in the total population in the same age range). In women, the prevalence of smokers is nearly the same as in the total population. Diabetes mellitus was present in 23% of men and in 40% of women, and hyperlipidaemia in 30% of men and in 18% of women.

[Calcium antagonists for the treatment of Raynaud's phenomenon]. / Calciumantagonisten zur Behandlung des Raynaud-Phänomens.

The effectiveness of a new, nifedipine-like calcium antagonist (Bay K 9320) on the severity and frequency of episodic digital vasospasms was studied in a randomized double-blind trial of 24 patients (10 women, 14 men) with Raynaud's phenomenon. During the winter months the patients took one tablet three times daily for three weeks, each tablet either containing 20 mg of the calcium antagonist or a placebo. Three patients had collagen disease, 21 a primary form of Raynaud's phenomenon. Subjective improvement was reported by nine of twelve patients receiving the drug, while no improvement occurred in nine patients on the placebo. Light-plethysmography demonstrated under calcium antagonist treatment a reduction in the cold-provoked acral blood flow decrease more than four-fold compared with the unchanged value in the placebo group.

The Biostack experiment on Apollo 16.

The object of the Biostack experiment is to study the biological effects of high ZE particles of cosmic radiation in order to obtain information on the mechanism of these particles in biological matter. For this purpose individual local evaluation methods have been developed which allow one to identify each biologically effective particle and to correlate the individual hitting particle with the biological effect produced. The Biostack experimental package contains a series of monolayers of selected biological objects (Bacillus subtilis spores, Arabidopsis thaliana seeds, Vicia faba radiculae, Artemia salina eggs) with each layer sandwiched between several different cosmic ion track detectors (nuclear emulsions, cellulose nitrate, polycarbonate). By this arrangement a variety of biological effects due to a single penetrating particle can be analysed. Influence on cellular and tissue development, nuclear damages, and mutation induction are the main investigated effects. These space flight findings will be completed by results of balloon flight and accelerator experiments.