[Significant reduction of osteoporosis fracture-related hospitalisation rate due to intensified, multimodal treatment - results from the Integrated Health Care Network Osteoporosis North Rhine]. / Signifikante Reduktion von Krankenhauseinweisungen aufgrund osteoporoseassoziierter Frakturen durch intensivierte multimodale Therapie - Ergebnisse der Integrierten Versorgung Osteoporose Nordrhein.

INTRODUCTION: Osteoporosis is known as being undertreated in Germany. The aim of the integrated health care model "osteoporosis" was the improvement of patient care by multimodal treatment within an integrated health care network. This paper shows the results of the accompanying evaluation. METHODS: A retrospective cross-sectional analysis was performed using routine data from the AOK Rheinland/Hamburg for the years 2007-2010. Patients were included if they were 50-89 years old and had a diagnosis of osteoporosis (ICD-10 M80 or M81) and at least three prescriptions of osteoporosis-specific medication. Data were analysed separately for integrated health care and regular health care. RESULTS: 22 040 patients were detected, thereof 3173 patients in the integrated health care group (IV). The hospitalisation rate for hip fractures was significantly lower in the IV group: 5.93/1000 patient years versus 22.96/1000 patient years (- 74 %, p < 0.05). Also the hospitalisation rate of all other osteoporosis-related fractures was reduced by 73 %: 46.92/1000 patient years versus 172.88/1000 patient years (p < 0.05). Osteoporosis-related medication costs were doubled in the IV group, while total medication costs were lower in the IV group (1438 € vs. 1702 €). DISCUSSION: This observational, cross-sectional study shows that an intensified, multimodal treatment of osteoporosis within an integrated health care network of highly qualified physicians can reduce the hospitalisation rate due to osteoporosis-associated fractures and simultaneously reduce direct costs even in the short term.

[BEO'S - physical activity and healthy eating at schools in Oberfranken, Bavaria concept and first results of a resource-oriented, systemic approach in school-based health promotion]. / BEO'S - Bewegung und Ernährung an Oberfrankens Schulen Konzept und Erfahrungen bei der Umsetzung eines ressourcenorientierten, systemischen Ansatzes zur schulischen Gesundheitsförderung.

BACKGROUND: The high prevalence of overweight among children and adolescents has led to an increase in school-based prevention programmes. The aim of the present paper is to present the concept of an initiative called "BEO'S" as well as the experience made with the implementation und acceptance of this programme in the participating schools. METHODS: Different from the majority of school-based projects for healthy eating and physical activity, BEO'S pursues a systemic approach that includes the whole school and is tailored to the school's respective resources. Characteristics are (1) the participation of teachers, students, parents, and caretakers, (2) the motivation and empowerment of schools to plan and implement activities by themselves, (3) the focus on environmental approaches, and (4) addressing and considering the individual school's needs and resources. The university project team supports the schools by individual counselling as well as providing information materials, trainings and workshops for teachers, an internet page, newsletters, and financial support. In the school years 2007/08 and 2008/09, BEO'S was conducted at 14 primary and secondary schools in the district of Oberfranken, Bavaria. It was extended to other schools in 2009/10. The short- and mid-term goals are the improvement of the school's environments as well as the eating behaviour and physical activity of the students. In the long run, it is intended to prevent obesity and improve the students' health and school performance. RESULTS: The implementation processes showed that the teachers for physical education and domestic science as well as the headmasters were especially committed. The participation of the teaching staff, the students and the parents proved to be difficult, however. The schools implemented many activities for healthy eating and physical activity, but the planning process was not very systematic: needs assessment, status quo analysis, identification of successful strategies and definition of aims was difficult for the schools. The provided financial support, training programmes and workshops, and the exchange with other schools were widely used, in contrast to the offered internet-based tools. The acceptance of BEO'S was (very) good by teachers (n=97), students (n=674) and their parents (n=522). The teachers preferred the workshops and trainings to the internet page. The students appreciated the possibilities for physical activity and the emphasis on healthy eating; primary school students and girls more than secondary school students and boys. One third of the parents would like to be involved to a higher degree. CONCLUSION: BEO'S was well received by all the people involved. Yet, there are still deficits concerning the implementation process, especially in the participation of students and parents.

[Vibrio infections from food and sea water. Introducing the "VibrioNet"]. / Vibrio-Infektionen durch Lebensmittel und Meerwasser. Das Netzwerk "VibrioNet" stellt sich vor.

Vibrio is a genus of bacteria present in surface and coastal waters as well as in marine organisms worldwide. In many countries, pathogenic Vibrio species are a main cause of bacterial diarrhea, which may result from comsumption of contaminated seafood and fish products or from drinking contaminated water. Vibrio infections may also gain in importance in our regions due to global warming and the increase in the world trade of seafood. The research network "VibrioNet" studies pathogenic Vibrios in the marine environment and in seafood consumed by humans as a potential, new emerging zoonotic agent. An assessment of the risk arising from pathogenic non-cholera-vibrios in central Europe is the target of a multidisciplinary research effort. The research network will be strengthened by cooperations with international partners from countries in which Vibrio infections play a major role (Bangladesh, Chile, India, Thailand, and Vietnam).

Nanosecond photofragment imaging of adiabatic molecular alignment.

Adiabatic alignment of CH(3)I, induced by the anisotropic interaction of this symmetric top molecule with the intense field of a nonresonant infrared laser pulse, has been studied using velocity map imaging. We are using photodissociation imaging with pulsed nanosecond lasers to probe the distribution of the molecular axis in the laboratory space. In contrast to the commonly used probing with femtosecond laser pulses, this technique directly yields the degree of alignment over an extended space-time volume. This will be relevant for future reactive scattering experiments with laser-aligned molecules. The obtained degree of alignment, (cos (2)θ), measured as a function of the infrared laser intensity, agrees well with a quantum calculation for rotationally cold methyl iodide. The strong infrared laser is also found to modify the photofragmentation dynamics and open up pathways to CH(3)I(+) formation and subsequent fragmentation.

[Prevention of overweight and obesity--the role of government, the food industry and the individual]. / Prävention von Ubergewicht und Adipositas - Aufgaben von Staat, Lebensmittelindustrie und Individuum.

Obesity is a growing health problem in Germany and other industrial nations. There is an urgent need for action in order to stop this development. Government and food industry, as well as individuals, have to act. Governmental interventions could consist in direct regulation - as in, e. g., regulations on food offered in schools and restrictions on advertising unwholesome nutrition for children, -, or in economic incentives like taxes on unhealthy food and subsidisation of wholesome school food and information (food education, campaigns, food labelling etc.). The government should provide an environment that makes a healthy life style easy. But, at present, governmental interventions are too much focused on personal behaviour and responsibility. The role of the food industry could, for example, consist in clear food labelling and the production of healthy food. Each individual holds a personal responsibility for his or her health, but there are limits to it, like social, financial, biological, and other environmental factors. Especially social factors ought to be considered more seriously. Hence, personal responsibility should only be demanded in an adequate environment.

[Community analysis serving as a foundation for community-based health promotion programming--results of a citizen survey in Karlshuld, Germany]. / Gemeindeanalyse als Planungsgrundlage für ein gemeindenahes Gesundheitsförderungsprogramm--Ergebnisse einer Bevölkerungsbefragung in Karlshuld.

BACKGROUND: Analysing a community's needs and requirements is useful for planning a community-based health promotion programme. The literature recommends the analysis of existing population-based data, the discussion with a community's key persons, and standardised surveys among the community members. With regagrd to the latter method, German-language literature is scarce. AIM: A community analysis in the Bavarian rural community Karlshuld (5 000 inhabitants) was intended to provide a starting point for tailored health promotion activities in the community. As a part of the community analysis, a survey among the Karlshuld citizens was intended to inform about (1) health-related knowledge and behaviour of the community members, (2) their utilization and acceptance of existing health-related offers and activities, (3) their possibilities for active participation, their state of empowerment and (4) community-related aspects influencing quality of life. METHODS: A standardised telephone survey was performed with a random sample of Karlshuld community members aged 15 years and older. The questions covered health-related living conditions and activities in Karlshuld, quality of life and participation of community members. In addition, data were collected on knowledge, attitude and behaviour with regard to the issues nutrition, physical activity and tobacco consumption. The sample comprised 314 community members (f=68.8%; age 43.9+/-13.8 years). RESULTS: Shortcomings in knowledge on healthy nutrition were evident, especially among male participants. Whereas the general attitude towards a healthy diet was favourable in the majority of respondents, only 45.9%/58.6% stated that they daily consumed vegetables/fruit. One third of the 27.4% smokers among the respondents had intended but failed to quit smoking in the previous year; 80% stated they were willing to quit. The participants named infrastructure, nature and health-related activities as positive aspects in Karlshuld. Only 50% knew where to get information on health-related issues. 42.9% of respondents felt they could influence decisions on health-related issues in the community. There was no correlation between school education and knowledge or participation. DISCUSSION: The survey among Karlshuld community members identified potential approaches to improving the community environment and to tailor health education activities to the special needs of Karlshuld. A follow-up survey in 2008/2009 will be carried out in order to evaluate whether or not the Karlshuld health promotion programme was successful in building on Karlshuld's strengths and influencing its weaknesses.

[Knowledge about UV-radiation and sun protection: survey of adolescents and young adults in Bavaria]. / Kenntnisstand zum Thema UV-Strahlung und Sonnenschutz : Befragung von bayerischen Jugendlichen und jungen Erwachsenen.

BACKGROUND: Identifying deficits in sun protection knowledge and behavior can serve as a starting point for primary prevention interventions. The aim of this study was to investigate knowledge and behavior related to ultraviolet radiation in the population between 14 and 45 years of age in Bavaria, as well as effects of the awareness campaign "Sensible in the Sun". METHODS: In two Bavarian districts, 545 individuals of the target population completed a telephone survey about risks of UV-radiation, sun protection knowledge and behavior, and effects of the campaign. RESULTS: Sunburn and skin cancer as adverse effects of ultraviolet radiation were named by almost every participant. When asked about protective interventions, 91% mentioned sunscreen and 45-54% clothing, limited stay in the sun and seeking shade at noon. Women were better informed than men, adults better than adolescents. 10.6% were aware of the campaign. In this group, 37.9% had been motivated to consider their sun protective behavior; 13.8% (especially women >30 years) stated they had changed their behavior because of the campaign. CONCLUSION: There were deficits in knowledge, especially about eye damage and the importance of getting slowly used to UV radiation. Physician advice, but also broadcast and print media, has an effect on UV-related knowledge.

Inverse temperature dependent lifetimes of transient S(N)2 ion-dipole complexes.

The association and collisional stabilization of the S(N)2 entrance channel complex [Cl(-)...CH3Cl]* is studied in a low-temperature radiofrequency ion trap. The temperature dependence of the ternary rate coefficient is measured and a much stronger inverse temperature dependence than expected from a simple statistical calculation is found. From these data the lifetime of the transient S(N)2 complex has been derived as a function of temperature. It is suggested that the inverse temperature dependent rates of nonsymmetric S(N)2 reactions are related to the observed inverse temperature dependence of the transient ion-dipole complexes.

Imaging nucleophilic substitution dynamics.

Anion-molecule nucleophilic substitution (S(N)2) reactions are known for their rich reaction dynamics, caused by a complex potential energy surface with a submerged barrier and by weak coupling of the relevant rotational-vibrational quantum states. The dynamics of the S(N)2 reaction of Cl- + CH3I were uncovered in detail by using crossed molecular beam imaging. As a function of the collision energy, the transition from a complex-mediated reaction mechanism to direct backward scattering of the I- product was observed experimentally. Chemical dynamics calculations were performed that explain the observed energy transfer and reveal an indirect roundabout reaction mechanism involving CH3 rotation.

[Do German nutrition interventions for children and adolescents meet quality criteria for program planning and evaluation? - Results of a survey of institutions at state and regional levels]. / Erfüllen Ernährungsinterventionen für Kinder und Jugendliche in Deutschland Qualitätskriterien für Projektdesign und Evaluation? Ergebnisse einer Befragung von Institutionen auf Landes- und regionaler Ebene.

PURPOSE: The international literature describes comprehensive nutrition interventions for children and adolescents, and gives recommendations for successful program planning. For Germany, only few studies on these issues are available, and there is a particular scarcity of data on implementation, acceptance and effectiveness of nutrition interventions. Thus the aim of this study was to record nutrition interventions at state and regional levels in Germany, and to assess their project design and evaluation quality. On the basis of these data, conclusions about implementation, acceptance and effectiveness of interventions are made. METHODS: Quality indicators for project design, process and outcome evaluation were developed according to international literature and related quality assurance models. State ministries, public health departments, non-governmental institutions for health at state level and "Healthy Cities" (n=105) were surveyed about their nutrition interventions for children and adolescents including evaluation with a standardised questionnaire. The interventions were assessed using the developed quality criteria. RESULTS: The response rate was 70.5%. 42 primary preventive nutrition interventions were recorded. The quality criteria for program planning were only partly fulfilled. Encouraging results were, among others, that 54.8% of the projects combined behaviourally focused and environment focused criterions, 90.5% started in kindergarten or primary school, 88.1% involved parents, 85.7% cooperated with other institutions and 73.8% integrated nutrition specialists. 77.8% of the projects conducted a process evaluation (n=28), 60.7% of those had a good evaluation quality. Changing the environmental context proved to be the greatest challenge. The projects were well accepted by the target group. An outcome evaluation was conducted by 61.1% of the projects (n=22), 27.2% of those evaluations had a (very) good quality. Among these projects, 3 could improve nutrition knowledge, 3 environmental context and 3 nutrition behaviour. Improvements of medical parameters have not been recorded. CONCLUSION: In Germany, a high number of nutrition interventions for children and adolescents is being conducted. However, only five quality indicators were fulfilled by more than 75% of the projects. Because of inadequate evaluation quality, only little evidence for implementation, acceptance, and effectiveness could be found. More evaluation studies are needed to more successfully plan, implement and assess future interventions.

[Community-based health promotion--a challenge for the evaluation]. / Gemeindenahe Gesundheitsförderung--Herausforderung an die Evaluation.

PURPOSE: Community-based health promotion (CBHP) aims at mobilising citizens for health-related issues in their environment, and at implementing health-promoting projects on the community level. Whereas recent political decisions support this approach, scientific studies dealing with theories and consequences of CBHP are scarce in Germany. Evaluation of CBHP could help identify (in)effective factors and elements of community programmes and thus improve future planning. In Germany, however, there is a deficit in systematic concepts and recommendations for the evaluation of CBHP. This work outlines basic ideas and core principles of CBHP and deduces implications for the assessment of health-promoting community projects. METHODS: Based on different international models and studies and on discussions with health promotion professionals, we developed a framework for the evaluation of CBHP. RESULTS: The proposed framework includes a guideline for CBHP programme planning. Its strategic and operational criteria can serve as a basis for a strategy evaluation. In terms of process evaluation, indicators for the dimensions (1) programme implementation and service delivery, (2) capacity building, and (3) reach of and acceptability in the target group were developed. In addition, we present different areas of OUTCOME EVALUATION; it is advisable to distinguish between measurement on the individual and on the community level. The framework further proposes strategies for the evaluation of the core principles empowerment and participation. CONCLUSION: The presented framework can serve as a basis for the development of flexible and individual instruments for the evaluation of CBHP, which should not ignore the perspective of the citizens, or complex aspects like changes on the community level. Some aspects, e.g., the potential evaluation of further targets of CBHP (improvement of quality of life, reduction of social and health inequalities), the responsibility of evaluation or the effects of financial constraints, are important questions to be addressed in the future.

The effects of promoting colorectal cancer screening on screening utilisation: evaluation of the German Campaign "Aktiv gegen Darmkrebs" (Action against Colorectal Cancer).

BACKGROUND: Although colorectal cancer is the second leading cause of cancer death in Germany, screening rates remain low. It is unknown whether local approaches to promoting colorectal cancer screening are effective. This study evaluates the effectiveness of a regional awareness campaign consisting of public information sessions and leaflet distribution, upon the use of colorectal cancer screening by faecal occult blood test (FOBT) and colonoscopy. METHODS: Data on FOBT and colonoscopy were collected by doctors for 12 months following the campaign, including reason for and result of the testing. 37 % (n = 43) of all physicians and practitioners in two administrative districts (249 632 inhabitants) that were exposed to the campaign participated in the study. It was recorded whether the individuals requesting colorectal cancer screening had been prompted by the campaign, so the number and outcome of campaign-related tests was determined. RESULTS: 3398 individuals (male: 54.6 %, female: 45.4 %, age: 64.3 +/- 8.3 years) underwent 3551 screening tests (2446 FOBT, 819 colonoscopy, 133 both). 141 additional diagnostic colonoscopies were performed because of a positive result in the FOBT. Adenomas were detected in 279 individuals, malignancies in 11 individuals. 225 FOBT (8.7 %) and 176 colonoscopies (18.5 %) were performed due to the campaign; among these individuals, 49 had adenoma(s), 1 had carcinoma. The effect could be attributed both to leaflets and to information sessions. The proportion of campaign-related screening tests declined over time. CONCLUSION: The regional information campaign could reach target individuals and motivate them to utilise colorectal cancer screening. The combination of mass media and personal communicative elements seems useful.

[The concept of social marketing--potential and limitations for health promotion and prevention in Germany]. / Das Konzept des Social Marketing--Chancen und Grenzen für die Gesundheitsförderung und Prävention in Deutschland.

"Social marketing" is the use of marketing principles to design and implement programmes to promote socially beneficial behaviour changes. In the field of health promotion and prevention, the systematic planning process of social marketing can offer new ideas and perspectives to the traditions of social science. Major characteristics of social marketing encompass continuous market research focussing on attitudes, motives and behavioural patterns of the target group, an integrated mix of strategic key elements, and the perpetual evaluation of all procedures. So far, however, it is unclear in how far social marketing is actually more effective than other concepts of programme planning. Furthermore, it has to be discussed whether the underlying philosophy of social marketing and its implicit understanding of relationships to the public are reconcilable with health promotion principles. In Anglo-Saxon countries, the social marketing concept has achieved widespread application and is subject to controversial scientific discussions, whereas this approach is hardly considered in German health promotion research and practice. Given the increasing call for quality management and evaluation of health promotion interventions, the social marketing concept may contribute useful insights at an operational level and thus add to a discussion on effective approaches for programme planning.

[Knowledge of colorectal cancer prevention in the Bavarian population above 50 years--survey in two districts]. / Der Kenntnisstand der bayerischen Bevölkerung ab 50 Jahre über Darmkrebsprävention--Untersuchung in zwei Landkreisen.

PURPOSE: Colorectal cancer is the second main cause of cancer death in Germany, although several measures related to primary prevention are described, and the utilisation of existing diagnostic tools (faecal occult blood test = FOBT, colonoscopy) is known to significantly decrease incidence and mortality. However, screening rates remain low in Germany, and insufficient knowledge of prevention possibilities is assumed to be responsible. The aim of this study was to investigate the knowledge related to colorectal cancer prevention in a Bavarian population, in the context of a regional public awareness campaign ("Active against Colorectal Cancer"). METHODS: 618 individuals between 50 and 90 ys of age participated in a telephone survey (m: 219, f: 399, 63.2 +/- 9.17 ys); the participants were inhabitants of two Bavarian districts. The questionnaire consisted of open-ended questions concerning preventive behaviour, colorectal cancer screening, risk factors, early warning signs and knowledge of colorectal cancer information. RESULTS: More than 80% of participants recalled healthy diet as a possible protective factor against colorectal cancer; a distinctly smaller percentage, however, could correctly define concrete dietary factors: e. g., fruit and vegetables were named by 54.5%. 66% of participants knew that unusual rectal bleeding might be a warning sign of cancer. Colonoscopy was the screening test that was most frequently recalled (61.5%); fewer participants named FOBT (32.8%) and rectal examination (11.5%). The results demonstrate that for many knowledge items, females proved to be significantly better informed than males. The most frequent sources of colorectal cancer information were newspapers, magazines, television and/or radio (named by 76.7%), as well as physicians and pharmacies (45.1%). 11.5% of participants attended the regional public awareness campaign "Action against colorectal cancer"; this subgroup had a better knowledge of some aspects related to colorectal cancer prevention. CONCLUSION: Evidently, the interviewed Bavarian population of 50 years or older lack knowledge of risk or protection factors for colorectal cancer. Knowledge of existing screening tests was also poor. These findings can serve as starting point for information campaigns tailored for target groups.

Validation of air-displacement plethysmography for estimation of body fat mass in healthy elderly subjects.

BACKGROUND: Air-displacement plethysmography (ADP) is a non-invasive method for body composition analysis that divides the body into fat-free mass (FFM) and fat mass (FM) (= 2 compartment model, 2C). It places low demands on subject performance and is therefore most convenient in the elderly. OBJECTIVE: To validate ADP against dual energy X-ray absorptiometry (DEXA) and to compare it to a four-compartment model of body composition (4C; fat mass, total body water, bone mineral content and residual mass) in the elderly. METHODS: Body composition was assessed by ADP, DEXA and bioelectrical impedance analysis (BIA) in 26 healthy elderly subjects (15 women, 11 men) aged 60-82 years. RESULTS: Despite a high correlation of %FM assessed by ADP and DEXA we observed significant differences between the results of these methods for both sexes (2.5 +/-3.4%; bias +/- SD). Deviations of %FM(ADP) from %FM(DEXA) were dependent on bone mineral content (BMC(DEXA)) fraction of FFM. A low BMC(DEXA) was related to an overestimation of DEXA-derived %FM by ADP. There was a systematic bias between results from ADP and the 4C model. 76% of its variance was explained by the assumption of a fixed density of FFM. 96% of the variance in the density of FFM was explained by water content and only 4% by BMC(DEXA) of FFM. When compared to a 4C model, overestimation of %FM(ADP) increases with increasing water fraction of FFM. CONCLUSION: Although there is a tendency for overestimation of %FM(ADP),ADP is a valid method for body composition measurement in the elderly. The bias in %FM(ADP) is mainly related to water content of FFM and indicates that a correction factor for TBW may improve the accuracy of the ADP measurements in the elderly.

A polymorphism in the endothelin-A receptor gene predicts survival in patients with idiopathic dilated cardiomyopathy.

AIMS: The endothelin system plays a role in the complex pathophysiology of idiopathic dilated cardiomyopathy. We investigated whether genetic polymorphisms of the endothelin system might be associated with dilated cardiomyopathy-related cardiac phenotypes and differences in disease outcome. METHODS: One hundred and twenty-five unrelated dilated cardiomyopathy patients of a well characterized dilated cardiomyopathy cohort were genotyped for six common polymorphisms of the endothelin-1, endothelin-A (ETA) and endothelin-B (ETB) receptor genes using hybridization with allele-specific oligonucleotides. RESULTS: The H323H (C/T) polymorphism in exon 6 of the ETA receptor gene was significantly associated with a shorter survival time after diagnosis. The odds ratio for carriers of the less frequent ET(A)T allele to die within 2 years after diagnosis was 5.5 (95% confidence interval, 1.4 to 21.0, P=0.013) compared to non-carriers. Kaplan-Meier analysis revealed a significantly different survival time for T allele carriers as compared to non-carriers as tested by logrank (P=0.0196), Breslow (P=0.0195), and Tarone tests (P=0.020). The influence of the ETA H323H polymorphism on survival remained significant when known predictors of prognosis such as left ventricular ejection fraction, left ventricular end-diastolic diameter, age and NYHA functional classification were entered in a Cox proportional hazards analysis. In this model, end-diastolic diameter showed a trend to influence survival (P=0.07) but only the ETA H323H polymorphism (P=0.0029) was a significant independent predictor of survival. CONCLUSIONS: Our results suggest that genetic variation in the ETA receptor predicts survival in dilated cardiomyopathy patients, which might have important consequences for the identification of high-risk individuals.

Baroreflex sensitivity and cardiovascular mortality in patients with mild to moderate heart failure.

OBJECTIVE: To assess the influence of both sympathetic (plasma noradrenaline concentrations) and parasympathetic (baroreflex activation) tone on survival in patients with congestive heart failure. DESIGN: Invasive study with determination of parasympathetic activity and follow up for at least 4.5 years. SUBJECTS: 35 patients with sinus rhythm and mild to moderate heart failure (New York Heart Association grades II-III) (mean age 53 (SD 3)). RESULTS: 20 patients whose hearts survived were compared with 15 patients whose hearts did not (12 died and three received transplants). The two groups differed significantly in terms of mean arterial blood pressure (98 (3) v 90 (3) mm Hg), heart rate (82 (2) v 93 (4) beats/min), and mean pulmonary artery pressure (24 (3) v 35 (2) mm Hg) (all P < 0.05), while cardiac index, stroke volume index, and right atrial pressures were not different. The survivors had significantly lower plasma renin activities (3.6 (0.8) v 9.0 (3.6) angiotensin I/ml/h; P < 0.05) and tended to have lower noradrenaline values than non-survivors (170 (23) v 286 (74) pg/ml) at baseline. Baroreflex sensitivity was significantly lower in non- survivors than in survivors (1.3 (0.2) v 2.3 (0.3) ms/mm/Hg); P < 0.02). As the time of cardiac transplantation is dependent on complex logistical factors the three patients who received a transplant were excluded from the analysis of survival time. The risk of death in relation to baroreflex sensitivity at the median sensitivity of 1.48 ms/mm Hg was calculated. Survival was significantly different (P < 0.04) between the resulting two groups; three of the 16 subjects with high baroreflex sensitivity died compared with nine of the 16 with a baroreflex sensitivity < 1.48 ms/mm Hg. When systemic blood pressure, pulmonary artery pressure, stroke volume index, plasma noradrenaline concentrations, and baroreflex sensitivity were entered into a Cox proportional hazards regression, only systolic blood pressure and plasma noradrenaline values predicted survival (P < 0.001). CONCLUSIONS: Low vagal tone is correlated with a poor prognosis in patients with heart failure. Sympathetic tone measured as plasma noradrenaline concentration also contributed to survival. An additional contribution of vagal tone to survival could not be shown when sympathetic tone was considered simultaneously. This may be due to the inverse relation of sympathetic and parasympathetic tone and to the insensitivity of the multiple regression method to identify additional risk factors in small numbers of patients.

Effect of noise stress and ethanol intake on hearts of spontaneously hypertensive rats.

The pathogenesis and progression of hypertensive heart disease are unclear; however, both involve a genetic predisposition and environmental influences. To test the role of exogenous factors, we examined the hearts of spontaneously hypertensive rats (SHR) exposed to noise stress and ethanol intake. Twenty-two SHR and nine normotensive Wistar rats (NWR) were continuously exposed to a 65 db, 4 and 250 Hz tone for 52 weeks. Twelve of these SHR aged 20-22 weeks were concomitantly given 20% ethanol in their drinking water up to week 52. Eight SHR and 12 NWR served as controls. We examined hemodynamic parameters, the cardiac configuration, the cardiac microvasculature, interstitial tissue, and ischemic myocardial lesions. We found that noise stress significantly increased the microvessel wall area, the number of microvessels with an outer diameter > 19 microns, the degree of cardiac fibrosis, and the extent of ischemic myocardial lesions in SHR, but not in NWR. These effects were all ameliorated and the diastolic blood pressure was lowered by the ingestion of ethanol. Cardiac weights and dimensions, heart rate and dp/dtmax were not influenced by either noise or ethanol intake. These results suggest that hypertensive heart disease in SHR can be aggravated by noise stress. Ethanol ameliorates these changes by mechanisms which remain to be explored.

A complex experimental assessment for objective description of hierarchical psychophysiological behavior as human regulatory phenotype.

For the objective and valid identification of different human regulatory phenotypes it should be useful to analyze the behavior of different regulatory subsystems (Anochin 1976) in one multivariate design. Therefore in a DARA supported project a fully computerized and reliable laboratory assessment was developed and tested. We used a set of electrophysiological parameters that should indicate the activity of different functional regulation systems on different "behavioral levels". Skin conductance, skin temperature and voice pitch were used as indicators of sympathico-parasympathical activity. Breathing, heart rate variability and bloodpressure should indicate cardiovascular activity and electromyogram and mimic variablity were thought as indicators of locomotional external behavioral activity. To identify physiological reactions which are influenced by emotional stress we used voice stress measures. Even in the field of aviation and space medicine there exist data about the correlation of voice pitch with emotional excitation (Hecker et. al. 1968, Williams et.al. 1969, Friedrich, Vaic 1978, Vaic et.al. 1981,1982, Griffin, Williams 1987). In our former study (MOSAIC-study, Johannes 1990) the voice pitch and its variation range correlated with perceived emotional excitation but were independent of real bloodpressure variations. Two different types of pitch reaction to this experimental design were correlated to psychological personality scales and assigned subjects to "sensitizers" and "suppressors".