[Urban Health (StadtGesundheit): The Wider Perspective Exemplified by the City State of Hamburg]. / StadtGesundheit (Urban Health) - eine Blickfelderweiterung am Beispiel Hamburgs.

Public health and city planning have common roots, and in many places they are now reuniting under the heading of urban health. To organize this field adequately requires a broad, integrative view of medical care, health promotion, and health in all urban policies. Given current crises and developments including climate change and globalization, such a wider perspective should also be useful for Germany. Using the City State of Hamburg as an example and combining historic and systematic approaches, we explore the preconditions for in-depth analyses. Our results show that health is a significant topic of Hamburg urban policy, featuring a broad range of structures, processes and actors, both within the health sector and far beyond. Health promotion over the last 30 years evolved notably from a niche topic into an established field with remarkable cooperative structures. The tradition of comprehensive reporting on urban health in Hamburg that was initiated more than 200 years ago is no longer alive today. However, local health reporting keeps integrating a wide range of diverse topics. Communication among the Hamburg health actors - beyond straightforward medical quality assurance - does not seem to focus on critical evaluations, e. g. concerning social and ecologic sustainability. A prerequisite for in-depth analyses including external comparisons is to secure permanent access to relevant sources. Robust approaches to this end, however, seem to be lacking.

Particulate matter inhalation during hay storing activity induces systemic inflammation and platelet aggregation.

The aim of this study was to investigate possible pathomechanisms behind the cardiovascular morbidity caused by inhalation of particulate matter (PM(10)). For that purpose, healthy volunteers were exposed to high PM(10) concentrations during a 2 h hay storing activity. Blood was drawn in the evening before and after PM(10) exposure and in the morning and evening of the day after exposure. The leukocyte count increased after PM(10) exposure with an initial increase of segmented neutrophils followed by banded forms. C-reactive protein increased over time. Fibrinogen and plasma viscosity became increased in the evening of the day after PM(10) exposure. Platelet aggregation was increased in the evening after PM(10) exposure. At the same time von Willebrand factor and factor VIII were increased, reflecting endothelial activation. These results confirm that acute inhalative exposure to high PM(10) concentrations during hay storage activity leads to a systemic inflammatory reaction, endothelial activation, and platelet aggregation.

Adenosine: an endogenous modulator of hippocampal noradrenaline release.

In slices of hippocampus from the rabbit, preincubated with [3H]noradrenaline and then continuously superfused, the modulation of the release of noradrenaline by adenosine receptors was studied. Electrical field stimulation of the slices elicited a release of [3H]noradrenaline which was inhibited in a concentration-dependent manner by various adenosine receptor agonists. From the order of potency: cyclohexyladenosine greater than (-)phenylisopropyladenosine [(-)PIA] greater than 5'-N-ethylcarboxamide-adenosine (NECA) greater than 2-chloro-adenosine greater than adenosine (+)phenylisopropyladenosine greater than ATP, the inhibitory adenosine receptor was classified as A1- (Ri-) receptor. The effect of the agonist was strongly reduced by adenosine receptor antagonists, the methylxanthines. A role for endogenous adenosine in the modulation of hippocampal noradrenaline release is supported by these findings: (1) that blockade of adenosine receptors by methylxanthines, especially by 8-phenyltheophylline, increased, whereas (2) inhibition of the uptake of adenosine decreased the evoked release of noradrenaline and (3) that deamination of endogenous extracellular adenosine by addition of adenosine deaminase to the medium enhanced the evoked transmitter release. Inhibitors of endogenous adenosine deaminase and 5'-nucleotidase were without effect. It is concluded that release of noradrenaline in the hippocampus is inhibited at the level of the noradrenergic nerve terminals by endogenous adenosine via A1 (or Ri) receptors.

A noxious agents information system with state-wide participation of the public health service.

With environmental health receiving increased attention by Public Health Services, there is a need to access as efficiently as possible detailed, current, and reliable information of physico-chemical, epidemiological, and toxicological as well as regulatory and legal aspects on this subject. Correspondingly, targets 19 and 35 of WHO's "Health for all 2000" strategy all for information systems to meet these demands. On this basis, a Noxious Agents Information System (NIS) was designed with three components: PC-based information workstations allowing access to portable and online databases; a dedicated modular database system providing "immediate answers" as well as support for more comprehensive information retrieval; and a cooperative network for training, information exchange, and consultation. During 1992-93, the system was introduced in Germany in the State of North Rhine-Westphalia, and 54 of 59 eligible institutions (92%) of the Public Health Service decided to participate, proving a virtually state-wide introduction to be feasible. Details are presented of the NIS concept and its realization, and limitations and future perspectives are discussed.

Test of the validity of the Vando R-A Scale.

The purpose of this study was to gather evidence on the validity of the Vando R-A Scale, a paper-and-pencil measure of perceptual reactance. The Vando R-A Scale and Petrie's kinesthetic aftereffect measure of perceptual reactance were administered to 46 participants drawn from university undergraduates. The Vando R-A Scale was not a valid measure of perceptual reactance. The continued use of the Vando R-A Scale as an alternate measure of perceptual reactance is contraindicated.

[Cancer in residents of heavy traffic areas]. / Krebs bei Anwohnern verkehrsreicher Strassen.

A part of the emission of automobiles (exhaust gases, brake-block rubbing-off) is known to be cancerogenic. This study examines the risk of getting cancer, for citizens of Hamburg who are living in streets with high traffic frequency (more than 30,000 automobiles a day). The cancer frequency from 61,636 exposed persons were (standardised to age and specific for sex) related to 11,794 cases of cancer in the years of 1970 to 1972 in the population of Hamburg (1.8 million citizens). 483 cases of all cancer were found within the study group and vs. 455.0 had been expected (SMR = 1.06). 242 of these were men vs. 217 had been expected/SMR = 1.12). 100 cases of death from pulmonary cancer were found and vs. 74.5 expected (SMR = 1.34), 53 cases of colonic cancer vs. 31.5 expected (SMR = 1.68). The presented data cannot explain external variables, such as smoking cigarettes. The risk of getting cancer for citizens, who are living in streets with high automobile frequency and -emissions, should be evaluated further more by specific studies.

Environmental health impact assessment: evaluation of a ten-step model.

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.

[Sinus vein thrombosis. A rare complication of heparin-induced thrombocytopenia type II]. / Sinusvenenthrombose. Eine seltene Komplikation einer Heparin-induzierten Thrombozytopenie Typ II.

In the past 10 years numerous reports of cases referring to complications and their outcome with heparin-induced thrombocytopenia type II (HIT II) have been published. Clinically these symptoms are manifested as a combination of arterial and venous thromboembolisms. Mostly affected are the vessels of the limbs, the abdomen, kidneys and coronary arteries. We present the most rare initial manifestations of cerebral symptoms with headache, nausea, change of character and generalised convulsion, which have found their origin in sinus vein thrombosis and the treatment with the heparinoid danaparoid.

Use of probabilistic methods in exposure assessment in Germany.

Over the last two decades, quantitative risk assessment has received increasing attention in Germany. By now it is also acknowledged that probabilistic techniques in risk assessment seem to be superior to the conventional point estimate approach. An important prerequisite for the use of probabilistic techniques is seen in the provision of 'standard' probability density functions for key exposure factors. For such exposure factors like body weight, time budget, etc., default probability density functions which are representative for Germany need to be developed. Guidance on probabilistic modelling will be needed, too.

[The use of a new renotropic contrast-medium in infants with special reference to magnesium metabolism (author's transl)]. / Die Anwendung eines neuen renotropen Kontrastmittels (Rayvist) im Süglingsalter unter besonderer Berücksichtigung des Magnesiumstoffwechsels.

Rayvist is the meglumine ioglicinate. This contrast medium is compared with Urovist in two groups of 15 infants. Electrolyte and osmolality changes in both groups are equal. In infants receiving Rayvist there were less gastro-intestinal distrubances than in those receiving Urovist. The drop of magnesium level in both groups is similar to the drop of calcium level following contrast medium injection. It is recommended to add calcium to the contrast medium in infants (1 ccm Calcium gluconicum 10% for 10 ccm contrast medium).

[Endoscopic pretherapeutic clipping for gastrointestinal tumors. A method for exact definition of the target volume]. / Endoskopische prätherapeutische Clipmarkierung von Tumoren im Gastrointestinaltrakt. Eine Methode zur exakteren Definition von Zielvolumina.

BACKGROUND: In many cases it is not possible to exactly define the extension of carcinoma of the gastrointestinal tract with the help of computertomography scans made for 3-D-radiation treatment planning. Consequently, the planning of external beam radiotherapy is made more difficult for the gross tumor volume as well as, in some cases, also for the clinical target volume. PATIENTS AND METHODS: Eleven patients with macroscopic tumors (rectal cancer n = 5, cardiac cancer n = 6) were included. Just before 3-D planning, the oral and aboral border of the tumor was marked endoscopically with hemoclips. Subsequently, CT scans for radiotherapy planning were made and the clinical target volume was defined. Five to 6 weeks thereafter, new CT scans were done to define the gross tumor volume for boost planning. Two investigators independently assessed the influence of the hemoclips on the different planning volumes, and whether the number of clips was sufficient to define the gross tumor volume. RESULTS: In all patients, the implantation of the clips was done without complications. Start of radiotherapy was not delayed. With the help of the clips it was possible to exactly define the position and the extension of the primary tumor. The clinical target volume was modified according to the position of the clips in 5/11 patients; the gross tumor volume was modified in 7/11 patients. The use of the clips made the documentation and verification of the treatment portals by the simulator easier. Moreover, the clips helped the surgeon to define the primary tumor region following marked regression after neoadjuvant therapy in 3 patients. CONCLUSIONS: Endoscopic clipping of gastrointestinal tumors helps to define the tumor volumes more precisely in radiation therapy. The clips are easily recognized on the portal films and, thus, contribute to quality control.

[Evaluation of impact on health--a central responsibility of the public health service]. / Gesundheitsverträglichkeitsprüfung--eine Schwerpunktaufgabe des öffentlichen Gesundheitsdienstes.

Health impact assessment (HIA) is defined in this paper as the adequate coverage of health aspects within the context of environmental impact assessment. HIA is a typical task for the public health service. A project on HIA undertaken by the North Rhine-Westphalian Research Compound for Public Health found out that presently the opportunity to use HIA for preventive health purposes is still largely neglected. However, in a survey local health departments expressed great interest in receiving HIA-training. A workable concept and supporting tools are both necessary prerequisites for the practice of HIA becoming routine. This paper presents a ten step HIA-conceptl. Supporting tools are presently under development and testing.

Treatment of childhood epilepsy with dipropylacetic acid (DPA).

Dipropylacetate (DPA) was used in the treatment of different types of epilepsy in 112 children aged 1--20 years, with a mean age of 9.2 years, for a period of 19.8 months, ranging from 1 to 49 months. Of this group, 64 children were therapy-resistant to other antiepileptic medications prior to the introduction of DPA; 31 were treated for the first time with an antiepileptic drug, which was DPA; 44 were treated with DPA alone; and 68 had one or more additional antiepileptic medication. The following results were found while DPA was administered in a relatively high dosage with a mean of 48 mg/kg body weight/day and ranging from 7 to 125 mg/kg/day. 1. Statistically, the results are significantly better in primary generalized epilepsy than in partial or in secondary generalized epilepsy. 2. Ninety-two percent of 51 patients who had absences were treated successfully. The same applies to 87% of 30 patients with primary generalized grand mal with spike wave, to all four patients who had impulsive petit mal, and to 47% of the 15 patients who had centrencephalic myoclonic-astatic petit mal. 3. Positive effect of DPA in partial epilepsy and secondary generalized epilepsy was seen only if the EEG pattern was 'centrencephalic' besides focal changes. During therapy with DPA, five patients with pure focal EEG showed an increase in seizure frequency, which demonstrated complete therapeutic failure. 4. Centrencephalic seizure activity (irregular spike wave, 3/s spike wave, and more than 3.5/s spike wave) were treated successfully (P less than 0.001). Focal changes or focal sharp wave with tendency to spread or generalization were treated unsucessfully.

[The treatment of primary generalized epilepsies with dipropyl acetate (DPA)]. / Die Behandlung primär generalisierter Epilepsien mit Dipropylazetat (DPA)

79 patients with primary generalized epilepsies have been treated with DPA in a medium dosage of 51 mg/kg bodyweight/day, range 14 to 125 mg/kg/day, for a medium time of 22 months, range 2 to 49 months. 51 children out of this group had been treated previously and were therapy resistant to other medications. 27 children got DPA for their first medication. 34 patients were treated with DPA as a single drug, 45 were treated in combination with other medications. Therapeutic success was found to be remarkable good in impulsive petit mal (n = 4, all patients without any more seizures), in absences (n = 52, complete success in 84%), and in primary generalized grand mal seizures with spike-waves in the EEG alone or in combination with petit mal (n = 30, 87% success). However, centrencephalic myoclonic-astatic seizures (n = 17, no more seizures in 35%) were influenced significantly less. Side effects were rarely seen, mostly they could be observed in those patients treated with DPA and another medication. Side effects never induced interruption of treatment with DPA.