[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.

[Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level]. / Memorandum--Prävention und Gesundheitsförderung nachhaltig stärken: Herausforderungen auf Bundes-, Landes- und kommunaler Ebene.

Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard prevention and health promotion. The memorandum is intended to stimulate a discourse resulting in structure-building and stabilizing measures designed to ensure the sustainability of prevention and health promotion.

Evaluation of Surinamese medicinal plants for their effects on the contractility of hypoxic guinea pig myocardial tissue

OBJECTIVE: Cardiac stunning occurs after a transient hypoxic or ischemic insult. Preparations from Anona muricata L., Bixa orelana L., Cecropia palmata Willd., Erythrina fusca Lour., Hibiscus esculentus L., Psidium guajava L., and Terminalia catappa L. were evaluated for their possible positive-inotropic effects in a laboratory model of cardiac stunning. DESIGN AND METHOD: Thus, isolated guinea pig atria perfused in oxygenated Ringer-Locke buffer, were exposed to 5-min periods of hypoxic stress and then allowed to recover for 2 x 3 min in oxygenated buffer alone or supplemented with norepinephrine (10-5 M) or a plant extract (0.001 – 1 mg/mL). Atrial contraction force (F) was measured with a force transducer and contractility was derived by calculation of dF/dt. Troponin C - a highly specific marker for heart muscle cell death - was measured in the perfusion solution in the absence or presence of the plant extracts. RESULTS: Reoxygenation led to a gradual recovery of the atria, but they remained in a state of depressed contractility for at least 4 min. However, exposure to the A. muricata, B. orellana, C. palmata, and T. catappa extracts increased the contractility by 50 to 250%. Notably, troponin C release was 3- to 6-fold higher in incubations with the two latter preparations. CONCLUSION: Preparations from A. muricata, B. orellana, C. palmata, and T. catappa may possess positive-inotropic properties that may be useful in cardiac stunning. However, those from C. palmata and T. catappa may cause myocardial damage that may limit their usefulness in this condition.

Memantine benefits functional abilities in moderate to severe Alzheimer's disease.

OBJECTIVE: Functional abilities are severely impacted in Alzheimer's disease (AD). Loss of the ability to perform complex (instrumental) and basic activities of daily living (ADL), leads to decreased independence and increased caregiver burden. This post-hoc analysis investigated the effect of memantine (20 mg/day) on ADLs, as measured by Alzheimer's Disease Cooperative Study-Activities of Daily Living 19-item (ADCS-ADL19) and 23-item (ADCS-ADL23) scales, in patients with moderate-to-severe AD. DESIGN: Data were pooled from six multicenter, randomized, placebo-controlled, double-blind, 6-month studies of memantine 20 mg/day. PARTICIPANTS: Male and female patients aged ≥ 50 years at baseline with a Mini Mental State Examination (MMSE) score < 20. MEASUREMENTS: ADCS-ADL19 and ADCS-ADL23 scales were pooled, and 14 shared items, with a score range of 0-45, were identified and included in the analysis (ADL14). Basic ADLs (BADLs) were defined as: eating, walking, toileting, bathing, and grooming. Instrumental ADLs (IADLs) were defined as: using a telephone, watching television, conversing, clearing a table, finding belongings, obtaining a beverage, disposing of household rubbish, travelling outside the house, and being left alone. Changes from baseline on single-item, BADL (range: 0-15), IADL (range: 0-30), and total ADL14 scores were analysed for observed cases using ANCOVA, with study, center and treatment as categorical explanatory variables and score at baseline as a covariate. RESULTS: 959 patients were treated with memantine and 867 patients received placebo. Memantine-treated patients had less decline from baseline on the ADL14 total score, compared with placebo (p < 0.001) at study end. Memantine also showed lower reductions in BADLs (p < 0.05) and IADLs (p < 0.001), for observed cases, compared with placebo. Memantine-treated patients showed less worsening than placebo recipients for the ADL items: toileting (p < 0.01), grooming (p < 0.01), finding belongings (p < 0.01), and travelling outside the house (p < 0.05). CONCLUSION: Compared with placebo, memantine shows benefits for both basic and instrumental ADLs in patients with moderate-to-severe AD, suggesting that memantine treatment may lead to a more interactive and dignified life for patients with moderate-to-severe AD.

[X-rays in the eye of the general public. A survey of 181 interviews with office personnel (author's transl)]. / Röntgenstrahlen im Urteil der Bevölkerung. Eine Befragung von 181 Verwaltungsangestellten.

For a pilot study, a random sample of 181 office personnel in steel companies were interviewed about their knowledge and feelings on X-rays and other forms of ionizing radiation. The general knowledge about the beneficial and detrimental aspects of X-rays was good, with education at school and news media reports being the main sources of information (70%). In general, the news media are considered to give objective and correct reports on this matter. 85% of the interviewed held ionizing radiation to be at least somewhat dangerous. Those with higher education (college/university) were significantly more vocal on the dangerous aspects. Concerning personal fear of X-rays, 30% were at least somewhat fearful. A significant correlation was found between statements on the dangerous aspects and subjective feelings of fear (anxiety). Interestingly, there was no correlation between general fearfulness (manifest anxiety) and fear of X-rays.