[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.

Brain water and electrolyte distribution during the inhalation of halothane.

The brain concentration of Na+, K+ and Cl-, water content and total brain osmolality were measured in six normocapnic dogs under pentobarbitone narcosis (30 mg kg-1). These studies were repeated in six additional dogs after exposure for 1 h to the inhalation of halothane 1% (end-tidal); there was an increase (P less than 0.05) in Na+, Cl- and water content but no change in K+ content in the grey matter, but in the white matter only Cl- increased (P less than 0.05). These findings were associated with a decrease in total brain osmolality (P less than 0.05) and a negative brain-cisternal c.s.f. osmotic gradient. The changes in the grey cortical matter were interpreted as a pattern of metabolic brain oedema related to interference with water-ion transport mechanisms across cell membranes. The observed brain-c.s.f. osmolality deficit could be related to a time-lag in the intracellular water-solute adjustment or to a deficit in osmotically active brain amino acids induced by the anaesthetic agent, or both.

On measurement of brain elastic response in vivo.

The elastic response behavior of brain tissue in vivo has been shown to be sensitive to the physiological environment of the brain and thus represents a useful parameter for identifying effects of controlled changes on the system. Here we describe a method for measuring brain elastic response using an epidural pressure-depth transducer and a minimum number of insertions. The method also serves to identify the nonlinear response of brain tissue.

Dynamic response of the intracranial system in the conscious dog to papaverine hydrochloride.

The influence of papaverine on the intracranial system of the dog was studied by measuring the pressure-depth-time response for the intact intracranial system, i.e., for the subarachnoid and subpial compartments. This was accomplished by a measurement system which provided an accurate pressure-depth determination and a uniform rate of transducer insertion. Distinct regions of the intracranial system (subarachnoid, transitional, and subpial) were identified from inflections in the pressure response curve. The test parameter, brain relative stiffness (BRS), was obtained by determining the slope of the pressure response values within the subpial region. This parameter is a measure of the "stiffness" or elasticity of bring tissue within the test configuration. A bolus injection of papaverine (1 mg per kilogram, i.v.) caused an increase in the transitional region, a compensatory reduction in the subarachnoid space, and an increase in BRS. It is postulated that at normotensive arterial blood pressure, cerebrovascular expansion caused by papaverine resulted in increased brain tissue elasticity, i.e., an increase in the pressure-depth response for the subpial region. Possible implications for this increase are discussed. Experiments should be conducted in which local blood flow studies are coupled with measurements of brain elastic response.