[Development of the Saxon Health Target "Active aging - aging in health, autonomy, and participation"]. / Entwicklung des Sächsischen Gesundheitsziels "Aktives Altern - Altern in Gesundheit, Autonomie und Mitverantwortlichkeit."

In Saxony, the consequences of demographic aging are observable already today. To manage the implications on the health sector, the Saxon Health Targets Steering Committee decided in March 2008 to develop a health target "Active Aging - Aging in Health, Autonomy, and Participation". Target development was based on a 7-level approach (fields of action, main goals, target areas, targets, strategies, intervention measures, indicators for evaluation). A quantitative content analysis was used to reveal 10 potential relevant fields of action, three of which were selected for target development. Targets were developed by 53 stakeholders in multiprofessional working groups. Criteria-based analyses were performed to assure appropriate scientific evidence and feasibility of targets and intervention measures. Over a period of 9 months, 24 targets were defined referring to the main goals "needs-based health care structures", "multiprofessional qualification", "self-rated health" and "intergenerational solidarity". Thirteen targets were developed into recommendations for specific intervention measures. Most of the proposed interventions aim to modify health-related structures or psychosocial determinants of health in the elderly. The best recommendations for intervention measures shall be implemented in cooperation with interested decision-makers.

[Role of the occupational health service in the control of hypertension]. / Aufgaben des Betriebsgesundheitswesens bei der Hypertoniebekämpfung.

By a representative random sample in an order of magnitude of 5,150 employees the determination of the degree of knowledge of the hypertensives in the factory health service of metal mines showed nearly 100%. In the dispensary of the factory medical officer 64.2% were registered. 36.6% of the hypertensives were stabilised to blood pressure values below 160/95 mm Hg. Forms of therapy, cardiovascular risk factors associated with high blood pressure and effects of the working environment were investigated by means of factor and discriminance analysis with regard to the influence on the quality of the stabilisation of high blood pressure. The compliance resulted as essential limiting factor in the treatment of hypertension. 71% of the hypertensives reported a regular intake of medicaments, in which case 51% admitted to interrupt it without consulting the physician in charge when the constitution is disturbed. 4 features were determined as essential factors which have influence on the compliance: the opinion concerning the duration of the treatment of hypertension, the attitude to the intake of medicaments, the frequency of the intake of the tablets and the observation of the terms of blood pressure control. The investigation of the physician's compliance resulted, apart from an overestimation of the patient's compliance, in distinct deviations from the recommendations for diagnosis and therapy given. The compliance of nurses showed deficiencies in the standardized measurement of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Physician compliance in the treatment of hypertension]. / Die Arzt-Compliance in der Hypertoniebehandlung.

The physician compliance is determined by knowledge, skill and behaviour. In 103 physicians working in the basic medical care investigations of the compliance were performed. Partly clear deviations from the guidelines recommended were found in the habits of diagnostics and therapy. These deviations frequently concerned even the majority of the physicians asked for. While the knowledge can relatively easily be judged according to objective criteria, the behaviour is difficult to be measured. Of 4 physicians with comparable knowledge concerning the clinical picture of hypertension the influence of the behaviour of the physician on the success of therapy was investigated during a psycho-physiologically orientated group therapy and the breath-induced relaxation training. The univariate and discriminance-analytic investigations as well as the factor analyses showed the behaviour of the physician as essentially determinating for the success of the therapy. The determination of the physician compliance gives the possibility to recognize still existing insufficiencies in the treatment of hypertension. It serves for the further optimization of the therapy of hypertension. Measures increasing the compliance among others can be derived also for the training and further training.

[Observations on the course of borderline hypertension in workers in ore mining with variable occupational body burden]. / Beobachtungen zum Verlauf der Grenzwerthypertonie bei Werktätigen im Erzbergbau mit unterschiedlichen professionellen Belastungen.

The blood pressure response of 198 ore miners--working above ground as well as underground--suffering from borderline-hypertension was checked over a period of 5 years. After a period of 5 years 40.9% of the test persons developed a hypertension in 18.7% of the miners the blood pressure returned to normal and with 40.4% it remained within the limits. No statistically significant relationship could be established between the blood pressure response and the various work loads such as the complex work load on face workers, work above ground and underground, shift work, the total time away from home, physically heavy work as well as exposure of the body or part of it to vibrations. Since the individual risk of developing hypertension, particularly with regard to people affected by borderline-hypertension, cannot be predicted the factory doctor has to provide for the adequate health care the group in question.

[Behavior of blood pressure in 3 shift work of workers with level I WHO hypertension]. / Blutdruckverhalten während der Dreischichtarbeit bei Werktätigen mit einer Hypertonie vom Schweregrad In. WHO.

Blood pressure tests were carried out on 40 shift workers with a hypertension level of 1 (according to WHO). Every 5 day period these tests were carried out before, during and after work in the early, late and night shifts. No significant change of both the systolic and the diastolic blood pressure could be found, which could result from shift work, before and after each shift irrespective of the blood pressure stabilization (good, satisfactory, unsatisfactory). The group containing satisfactorily as well as unsatisfactorily stabilized workers suffering from hypertension showed a significant decrease of the systolic blood pressure from the early shift through the late till the night shifts, with the diastolic blood pressure remaining constant. There were no apparent differences in the range of average blood pressure values regarding the various forms of treatment (without medication, monotherapy and combined therapy). The systolic blood pressure is significantly lower only in the group with no medication in the early shift after finishing work and it also decreases from the early shift through the late till the night shifts, while within the other therapy groups no change of both the systolic and the diastolic blood pressure was apparent. Thus shift work does not cause any measurable increase in blood pressure within the test group (suffering from hypertension) that would impair their working capacity. There is no increase of health risk with regard to the blood pressure response during shift work particularly during night work provided the blood pressure is within the normal range.

[Incidence of hypertension and borderline hypertension with reference to complex professional stress in above ground and under ground workers in ore mining]. / Hypertonie-und Grenzwerthypertonieinzidenz unter Berücksichtigung komplexer professioneller Belastung unter und über Tage arbeitender Werktätiger im Erzbergbau.

Comprehensive health care for working people requires a deeper insight into the relationship between work load and biological reactions. This is necessary to be able to adequately influence the field of industrial medicine. The incidence of both hypertension and borderline-hypertension in a group of 200 face workers with complex work load as well as 150 pithead metal workers aged between 25 and 45 was measured over a period of 5 years (1981-1986). The hypertension incidence was 0.90% in the group of face workers and 1.46% with the pithead metal workers, while the incidence of borderline-hypertension was 1.30% for the face workers and 2.12% for the pithead metal workers. A statistically significant difference between those people working above ground and those working underground was not apparent. No relationship was found between age, Broca-index, habit of smoking, shift work, the total time away from home and the development of an increase in blood pressure. Both a hypertension incidence totalling 1.14% and an incidence of borderline-hypertension of 1.66% were found in the test group aged between 25 and 45. This roughly corresponded to the nationally statistical level and was in line with the relevant literature. There was no discernable effect with regard to developing hypertension and borderline-hypertension, respectively, as a result of complex work load in the test group. The incidence rates require regular blood pressure tests on normotensive miners and pithead workers, respectively, as a prerequisite for early detection and registering as well as an adequate therapy of both hypertension and borderline-hypertension.

[The effect of occupational stress on blood pressure of miners in ore mines]. / Einfluss der Arbeitsbelastung auf das Blutdruckverhalten von Bergarbeitern im Erzbergbau.

It was tried to analyse the influence of occupational load on the blood pressure reaction of miners. 200 miners at the age of 25-45 years with a large number of simultaneously affecting loadings at the place of work were examined with regard to the incidence of hypertension within a period of 5 years. The incidence of hypertension was 0.90%. To investigate the blood pressure reactions during an eight-hour shift we chose 2 technologies of mining differing concerning the loading factors, especially the intensity of physical load. In each case 5 miners of the technologies propulsion and mining were examined before the descent, during the eight-hour shift and after having finished the shift and the blood pressure was taken paying attention to standard conditions. The systolic blood pressure taken during an underground mining shift was significantly lower than the systolic blood pressure before the descent and after the shift, while a slight ascent of the diastolic blood pressure was insignificant. In spite of the different physical load we found no signs for a relevant displacement of the blood pressure level. A influence of working on the blood pressure reaction was found neither in the incidence of hypertension nor in the measurements of the blood pressure during an eight-hour miner's shift.

[Drug compliance behavior of hypertensive patients in 3-shift work with a prescription for 3 or more single doses daily]. / Medikamenten-Einnahmeverhalten der Hypertoniker während der Dreischichtarbeit mit einer Medikamentenverordnung von drei und mehr Einzeldosen täglich.

82 hypertensive patients with a prescription of medicaments of three and more individual doses a day who worked in the three-shift system were anonymously asked about their behaviour concerning the intake of tablets. 78% said not to have obtained any recommendations for the intake of tablets during the nightwork. 20.7% of them took antihypertensive drugs at night during the shift. 51.3% in the day-time and 28.0% did not take any tablets during the night-work. The compliance was approximately 60%, similarly as in hypertensive patients working in the one-shift system. With 3.7% the non-compliance was lowest during the night-shift. It was 22.0% during the early shift and 12.1% during the late shift. Side-effects and disturbances of the good health, respectively, during the antihypertensive treatment were stated with 14.0% and with 7.3% they appeared most frequently during the night-work. There was a statistically ascertained connection between the intake of tablets at night during work and the side-effects. They altogether appeared more infrequently, when a concrete advice was given by the physician. From this is concluded that on principle in shift-workers a treatment of the hypertension is to be aspired to with one or two individual doses a day, otherwise in a prescription of three individual doses the tablets should not be taken at night during work, but in the day-time. The temporary intake of tablets during shift-work as well as possible side-effects and corresponding behaviour patterns when disturbances of good health are appearing are to be discussed in detail particularly with the three-shift workers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence, degree of recognition and detection of hypertension and the quality of blood pressure control at the Wismut industrial branch]. / Prävalenz, Bekanntheits- und Erfassungsgrad der Hypertonie und Qualität der Bluthochdruckeinstellung im Industriezweig Wismut.

On account of the active and passive selection conditioned by demands of fitness the prevalence of hypertension is 8.0% in the branch of industry Wismut. It shows a clear increase in the 4th decennium, in these cases there is a higher prevalence of hypertension in males younger than 40 years than in females of the same age, after the 40th year of age the relation inverts itself. The mild hypertension prevails (degree of severity I of hypertension according to WHO) with 87.8%. By a representative chance control in a proportion of 5,150 employees the determination of the degree of knowledge of hypertensive patients was nearly 100% and the degree of recognition in the dispensary of the works medical officer was 64.2%. The quality of the control of high blood pressure was investigated according to the random principle in 1,714 workers with hypertension. 36.6% of the patients with hypertension had values of blood pressure lower than 160/95 Hg, in 40.5% the blood pressure values were systolically in the region from 160 to 180 mm Hg and/or diastolically 95 to 105 mm Hg, in 22.9% systolically more than 180 mm Hg and diastolically more than 105 mm Hg, respectively. Forms of therapy, cardiovascular risk factors and influences of the working environment were by means of the factor analysis and the discrimination analysis investigated as to their influence on the quality of the control of high blood pressure and adequate conclusions were drawn.

[Drug-taking behavior of workers with hypertension in the health service of the Wismut public health district]. / Untersuchungen des Medikamenten-Einnahmeverhaltens bei Werktätigen mit Bluthochdruck im Betreuungsbereich des Gesundheitswesens Wismut.

In 353 workers with a medicamentously stabilized high blood pressure following an educational lecture on hypertension the compliance was determined by means of a patients' questionnaire. Circa 70% of the hypertensives reported to take regularly the medicaments prescribed, in which cases approximately 50% admitted to discontinue the taking of medicaments without having conferred with the attending physician when the well-being was disturbed. As essential factors influencing the compliance 4 features were determined: the opinion concerning the duration of the treatment of hypertension, the attitude to the prescription of medicaments, the frequency of taking the tablets and the observation of the terms of control of blood pressure, whereas, for instance, age, working place, professional activity and shift work had no remarkable influence. Before long an improvement of the compliance can be achieved by the decrease of the information deficit proved and by an improved motivation in form of the group therapy. A necessary prerequisite is the complete registration and comprehensive treatment in the dispensary of the works medical officer with established control terms, short times of waiting and sufficient time for a talk between physician and patient.