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.

[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.

[Drug therapy of shock]. / Medikamentöse Schock-Therapie.

Shock is to define by clinical symptoms, measurable haemodynamic and metabolic changes, clotting failure and disorders of fluid, electrolyte and acid-base balance. It is essential to remove hypovolemia, acidosis, cardiovascular failure, pulmonary and renal insufficiency. Quite a lot of proved and controversial pharmacological substances are placed at physician's disposal. However, the mortality of cardiogenic shock and gram-negative septic shock is more than 80% respectively 30%, often caused by shock lung or irreversible injury to the kidneys. Shock due to depletion of extracellular fluid, poisoning and acute pancreatitis require specific treatment.

HB-antigen in serum and synovialis in acute hepatitis with and without polyarthritis.

In 27 patients suffering from acute hepatitis serum and synovial-fluid were tested for HB-Ag. It was detected in the serum in 19 cases, in the synovial fluid in 2 cases, but never in both serum and synovial-fluid. HB-Ag was not found in 6 patients. Polyarthritis was seen in 10 cases; 5 of them carried HB-Ag in the serum, 2 in the synovial-fluid. A hepatitis B however, was also suspected in the 3 cases with polyarthritis lacking HB-Ag. The results suggest that virus B may persist in joints too and that polyarthritis associated with acute hepatitis is coupled to an infection with virus B.