Achieving consensus on assessing health-related quality of life (HRQoL) in people with cognitive impairments (CI)a Delphi study.

BACKGROUND: The prevalence of impairments of cognitive functions is expected to increase. Enhancing the QoL of those affected is important. HRQoL in people with CI can be assessed by self-report, proxy-report or observation but there is uncertainty how to best assess HRQoL in people with CI, and which assessment method is most appropriate. Therefore the aim of our study was to use Delphi methodology in order to achieve consensus on how HRQoL should be assessed in people with CI and which content domains should be assessed. METHODS: The Delphi process consisted of three online survey rounds and a concluding consensus conference. Participants were experts as well as individuals and relatives of people affected by CI. The Delphi survey was developed based on existing literature and included 55 statements at the first round. Consensus was considered to be achieved when a minimum of 75 % of responses fell into the categories 6 (agree) and 7 (strongly agree) (positive consensus) or in categories 1 (strongly disagree) and 2 (disagree) (negative consensus). RESULTS: Consensus was reached for a total of 41 of 56 statements/substatements. In the 1st survey round 102 experts and 11 relatives participated. In the 2nd survey round 68 experts and 11 relatives continued to participate. In the 3rd survey round 41 experts and 9 relatives participated. In the consensus conference 17 experts and 4 relatives of individuals with CI and in the second one-hour online conference session 14 experts and 2 relatives of individuals with CI participated. CONCLUSION: The combination of the three assessment methods self-report, proxy-report and observation across all stages of CI is the preferred method and should be used whenever possible. As domains Physical capacity, Psychological, Level of Independence, Social Relationships, Environment and Spirituality/Relogion/Personal Beliefs should be assessed.

Ativação dos músculos do powerhouse durante os exercícios leg-circle do pilates realizados no solo e em equipamentos / Activación de los músculos de powerhouse durante los ejercicios leg-circle de pilates realizados en el suelo yen máquinas / Powerhouse muscle activation during pilates leg-circle exercises performed on mat and devices

Objetivo: o objetivo do presente estudo foi testar a capacidade dos exercícios leg-circle para ativar os músculos do powerhouse. Método: a amostra foi composta por onze instrutoras de Pilates com pelo menos seis meses de experiência. A eletromiografia (EMG) dos músculos retoabdominal, oblíquo interno, oblíquo externo e multífido foi registrada. Os dados EMG foram coletados durante a realização de 10 repetições do exercício leg-circle bilateralmente no Reformer e no Cadillac, e 10 repetições executadas unilateralmente no Mat com os membros inferiores direito e esquerdo (um total de 40 repetições). Como os dados não eram normais, foi realizada a ANOVA de Friedman. Os testes post-hoc de Wilcoxon foram realizados com a correção de Bonferroni (p 0.008). ˂ 0.008). Resultados: Quando comparados os músculos em um mesmo aparelho, o reto abdominal e o multífido tiverem sempre os menores níveis de ativação, não sendo diferentes entre si em nenhum dos aparelhos. O obliquo externo sempre foi o músculo com maior nível de ativação, independente do aparelho. Quando comparados os aparelhos para um mesmo músculo, houve diferenças significativas no reto abdominal [χ² (3) = 26.89, p <0.001] e no oblíquo ² (3) = 26.89, p <0.001] e no oblíquoχ² (3) = 26.89, p <0.001] e no oblíquo interno [χ² (3) = 26.89, p <0.001] e no oblíquo ² (3) = 27.44, p <0.001], onde a ativação elétrica foi maior nos exercícios realizados no χ² (3) = 26.89, p <0.001] e no oblíquoMat em comparação com aqueles realizados no Cadillac ou Reformer. Em contrapartida, não houve diferença entre os exercícios quanto à ativação dos músculos oblíquos externos ou multífidos. Conclusão: A maior ativação ocorreu no obliquo externo, independente do aparelho analisado. Os exercícios realizados no solo tiveram maior ativação doreto abdominal e do obliquo interno comparativamente aos exercícios realizados nos aparelhos.(AU)

Objetivo: el objetivo del presente estudio es probar la capacidad de los ejercicios leg-circle para activar los músculos de powerhouse. Método: la muestra está formada por once instructores de Pilates con al menos seis meses de experiencia. Se registró la electromiografía (EMG) de los músculos recto del abdomen, oblicuo interno, oblicuo externo y multífidos. Los datos de EMG se recopilaron durante 10 repeticiones del ejercicio de leg-circle bilateralmente en el Reformer y en el Cadillac, y 10 repeticiones realizadas unilateralmente en el Mat con las extremidades inferiores derecha e izquierda (un total de 40 repeticiones). Como los datos no eran normales, se realizó el ANOVA de Friedman. Las pruebas post-hoc de Wilcoxon se realizaron con la corrección de Bonferroni (p ˂ 0.05). Resultados: Los resultados revelaron diferencias significativas en el recto abdominal [χ² (3) = 26.89, p <0.001] y en el oblicuo interno [χ² (3) = 27.44, p <0.001], donde la activación eléctrica fue mayor en ejercicios realizados en el Mat en comparación con los realizados en el Cadillac o Reformer. Por otro lado, no hubo diferencia entre los ejercicios en cuanto a la activación de los músculos oblicuos externos o multífidos. Conclusión: los instructores de Pilates pueden usar esta información sobre las características EMG de los ejercicios leg-circle realizados en diferentes dispositivos para calificar el nivel de ejercicio.(AU)

Objective: The goal of the present study was to test the capacity of leg-circle exercises to activate core muscles. Method: The sample comprised eleven female Pilates instructors with at least six months experience. The electromyography (EMG) of the rectus abdominis, internal oblique, external oblique, and multifidus muscles was recorded. EMG data were collected during the performance of 10 repetitions ofthe leg-circle exercise bilaterally on the Reformer and on the Cadillac, as well as 10 single leg-circle repetitions performed unilaterally on the Mat with both the right and left lower limbs (a total of 40 repetitions). Since the data were not normal, Friedman ANOVA was conducted. Post-hoc Wilcoxon testswere carried out using the Bonferroni correction (p 0.008). ˂ 0.008). Results: When comparing the muscles in the same device, the rectus abdominis and the multifidus always have the lowest levels of activation and are not different from each other in any of the devices. The external oblique was always the muscle with the highest level of activation, regardless of the device.When comparing the devices in the same muscle, the results revealed significant differences in the rectus abdominis [χ² (3) = 26.89, p <0.001] e no oblíquo ²(3) = 26.89, p < 0.001] and in the χ² (3) = 26.89, p <0.001] e no oblíquointernal oblique [χ² (3) = 26.89, p <0.001] e no oblíquo ²(3) = 27.44, p < 0.001], where the electrical activation was higher in the Mat-based exercises compared to those performed on theχ² (3) = 26.89, p <0.001] e no oblíquo Cadillac or Reformer. By contrast, there was no difference between the exercises regarding activation of the external oblique or multifidus muscles. Conclusion: The greatest activation occurred in the external oblique, regardless of the device analyzed.(AU)

Evaluation of community readiness for change prior to a participatory physical activity intervention in Germany.

A lack of communities' readiness for change is reported as a major barrier toward an effective implementation of health promoting interventions in community settings. Adding an alternative readiness assessment approach to existing research practice, this study aimed to investigate how a selected community could be evaluated in-depth regarding its readiness for change based on multiple key informant perspectives, with the intention of using this knowledge for the preparation of improved local physical activity (PA) interventions for men above 50 years of age. We conducted semi-structured face-to-face key informant interviews with stakeholders and relevant persons from a local German community (N = 15). The interview guide was based on a comprehensive summary of community readiness dimensions. After verbatim transcription, we conducted thematic analysis to synthesize the complex results regarding community readiness related to PA. The data supported that the community disposed of a variety of resources regarding PA and showed signs of readiness for change. However, a certain degree of saturation regarding PA programs existed. The need for health enhancing PA interventions for men was only partly recognized. The local authority considered PA to be particularly important in the context of mobility and traffic safety. Including multiple stakeholders contributed to a balanced and in-depth assessment of community readiness and was helpful for determining starting points for tailored PA interventions due to the detection of complex relationships and structures. The study delivers preliminary evidence that a qualitative multi-perspective community readiness assessment adds value to quantified single-perspective readiness assessment research practice.

[Reasons for delayed and discontinued therapy in age-related macular degeneration]. / Gründe für Therapieverzögerung und -abbruch bei altersabhängiger Makuladegeneration.

BACKGROUND: Critical prerequisites for successful therapy of neovascular age-related macular degeneration (nvAMD) are an early initiation and continuous monitoring; however, delays in starting therapy and non-medically indicated discontinuation of therapy are frequent, which limits therapy efficacy and, thus, visual outcomes. OBJECTIVE: To identify the reasons for delay in therapy and non-medically indicated termination of therapy. MATERIAL AND METHODS: Patients who had started a new therapy (starters) and those who independently terminated therapy (dropouts) were interviewed by telephone with a specific, standardized questionnaire. Results were summarized descriptively. RESULTS: A total of 100 starters and 55 dropouts were interviewed. The mean therapy delay was 22 (±28 SD) days. This was mainly due to the time until the decision to see an ophthalmologist was made. Main reasons for dropping out were: transportation issues (27%), poor general health (25%) and the assumption that there is no benefit from therapy (11%). Of the patients who dropped out 63% would have liked to continue therapy. CONCLUSION: There is potential for improvement in nvAMD management regarding therapy start as well as therapy maintenance. Sensitizing for initial nvAMD symptoms is important as is reduction of barriers to therapy maintenance, since most therapy dropouts would like to continue the therapy.

[Patient-centredness in health services research]. / Patientenorientierung in der Versorgungsforschung.

This paper provides a sketch of key research areas within health services research focusing on patient-centredness. The evaluation of patient-reported outcomes (PROs) is increasingly required for evaluating interventions in clinical trials and in routine health care. Often, however, it is un-clear which PROs are best suited for a particular research question. One of the most commonly used PRO is the construct of quality of life (QoL), which has become an established outcome in clinical trials and is also named as a health goal in the German Social Code of Law. The concept of patient empowerment implies that autonomy and room for manoeuver of the individual patient should be strengthened. However, it is un-clear how the concept is best operationalised. One prerequisite for patient empowerment in routine health care is the development and implementation of evidence-based patient information. Another prominent research area focuses on the role of self-help and patient organisations in health services. Topics of interest are aims and activities of self-help organisations, potentials and challenges of integrating self-help into professional health services, effects of organised self-help support on patients and barriers of use.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

[Complementary and alternative medicine in the German outpatient setting: extent, structure and reasons for provision]. / Komplementäre und alternative Heilverfahren im vertragsärztlichen Bereich: Ausmaß, Struktur und Gründe des ärztlichen Angebots.

BACKGROUND: Research on complementary and alternative medicine (CAM) has mainly focused on CAM utilisation by patients. Fewer studies have analysed extent and structure of CAM provision or the reasons why physicians offer CAM as a therapeutic option in the outpatient setting. METHODS: A standardised questionnaire was developed addressing reasons and patterns of CAM provision. The questionnaire was sent by post to 2,396 general practitioners and specialists in 9 selected German districts. 553 physicians participated in the survey (23%). RESULTS: 63% of the respondents (n=350) answered that they had provided some sort of CAM to their patients within a period of 12 months preceding the study. The most frequently provided methods were acupuncture/traditional Chinese medicine, herbal remedies and homeopathy. In the sample, 90% of the orthopaedists were CAM providers, the highest rate among the participating disciplines. Several reasons for offering CAM were identified: conviction of therapeutic effectiveness regarding the patient's situation (68%), aspects of therapeutic freedom (47%) or less harmful side effects than conventional therapies (34%). 6% provide CAM for monetary reasons. CONCLUSION: Findings suggest that the provision of CAM is widespread in the German outpatient setting. However, it has to be taken into account that a selection bias may apply which may lead to an overestimation of CAM provision. Doctors' reasons to offer CAM are manifold; therapeutic reasons seem to outweigh economic motives.

[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.

[Environmental approaches in the prevention of obesity in children and adolescents]. / Ansätze zur verhältnisorientierten Adipositasprävention bei Kindern und Jugendlichen.

This article aims to provide a structured review of how to create settings and environments that prevent the development of childhood overweight and obesity. It also describes which institutions and levels are responsible for environmental (global) approaches in obesity prevention and which evidence exists in terms of process and outcomes of different preventive measures. Environmental approaches in disease prevention deal with social and technical-material conditions of daily living, as those conditions significantly influence health behavior. Strategies that focus on the obesogenic environment are considered increasingly important in the prevention of obesity in children and adolescents. They can be applied at different levels (e.g., schools, communities). These interventions should aim to improve the availability of healthy foods and physical activity facilities, e.g., by provision of healthy meals and foods in schools, restaurants, and stores and by price reductions of healthy foods. Physical activity can be supported by creating attractive green spaces and playgrounds in schools and cities, improving sidewalk networks and a supportive pedestrian environment, and implementing walk-to-school projects. On a national level, policies and legislation can support changes in the social and situational environments, e.g., relating to catering in schools or TV advertisement. The practice of environmental approaches is complex, because many stakeholders from different sectors have to be involved. This may account for the observation that environmental approaches are currently underrepresented in obesity prevention.

[Social marketing--seduction with the aim of healthy behavior?]. / Social Marketing - Verführung zum gesundheitsbewussten Verhalten?

SOCIAL MARKETING - SEDUCTION WITH THE AIM OF HEALTHY BEHAVIOR? Social marketing is the use of marketing principles to design and implement programs that promote socially beneficial behaviour change. Contrary to the marketing of consumption goods, social marketing does not deal with material products, but with behaviour, e. g. not smoking. This 'product' has a basic benefit (i. e. reduction of health risks in the long run), which is, however, difficult to convey. Therefore, the intended change in behaviour has to be related to a further reward which consists of symbolic goods, e. g. social appreciation or a better body feeling. The communication policy is essential for information on and motivation for the preventive issue. Social marketing campaigns whose development and management follow the principles of classical marketing can render preventive efforts more effective. In addition, social marketing can lead to a better quality management as compared to conventional preventive activities. These advantages can be explained by a) tailoring the campaign more specifically to the target group's needs and motives, b) presenting health risks more convincingly, and c) continuously analysing and evaluating the campaign and its effects. On the other hand, the marketing of preventive aims through mass media can bear several risks, as exemplified by different national and international public health campaigns. The necessity to communicate briefly and succinctly can lead to misleading simplifications and, in case of cancer screening, to the trivialization of a behaviour's consequences and adverse effects. Also, many campaigns do not intend to educate and inform, but try to persuade target persons of a certain behaviour, using emotions such as fear. This has led to social marketing being criticized as manipulation. Sometimes, social marketing campaigns cause stigma and discrimination of certain population subgroups, e. g. obese or HIV-positive people. Health promoters who plan mass media campaigns can be recommended to follow marketing principles in order to improve the campaign's impact. However, they should also consider possible adverse effects of the communication strategy on the social perception of health behavior, health risks and the responsibility of certain subgroups.

[Problems and ethical challenges in public health communication]. / Probleme und ethische Herausforderungen bei der bevölkerungsbezogenen Gesundheitskommunikation.

Health communication, e.g., mass media campaigns, patient information leaflets or websites, plays an important role in public health. It contributes to citizen empowerment and helps them make informed decisions in health matters. However, public health communication can lead to adverse effects on both individual and societal level, e.g., by inaccurate or partial information, discriminatory messages, scandalizing coverage or inadequate tailoring to relevant target groups. It seems important to suggest ethical criteria for health information, e.g., (1) accuracy, completeness and balance, (2) transparency, (3) participation of the target group, (4) respect for human dignity, (5) social justice and equity, (6) appropriateness. Thoughtfulness is important in order not to stigmatize population subgroups. In addition, it is laborious to comprehensively and correctly present benefits and risks of a certain health behavior. Marketing principles guide how to 'sell' a certain health behavior, but health campaigns should not manipulate target persons for the sake of a population health aim. It remains unclear, however, how the different providers of health information can be held ethically responsible.

Use of electromyography to assess pain in the upper trapezius and lower back muscles within a fatigue protocol / Uso da eletromiografia na análise de dor dos músculos trapézio superior e lombares durante protocolo de fadiga

OBJECTIVE: The aim of this study was to investigate whether muscle fatigue indices obtained using surface electromyography and calculated in the time and frequency domains would be capable of objectively diagnosing pain and discriminating between subjects with and without pain in the upper trapezius muscle and the lower back muscles. METHODS: Forty-seven individuals underwent a muscle fatigue test for thirty-five seconds at 80% of the maximal voluntary contraction (MVC), while EMG and muscle force data were recorded. The RMS value and the median frequency (MF) were calculated within consecutive one-second windows. Linear regression analysis was used to obtain the slope coefficients and the respective y-axis intercept values, which were considered to be localized muscle fatigue indices. RESULTS: In the frequency domain, the slope coefficients were negative for both muscles, while in the time domain, the coefficient for the upper trapezius was positive and the coefficient for the lower back muscles was negative (p<0.01). Significant differences were also found in the frequency domain between subjects with and without pain in the upper trapezius (p<0.01). The subjects with pain had significantly lower force values than the subjects without pain (p<0.05), in both the upper trapezius and the lower back muscles. CONCLUSION: The force values associated with the fatigue indices (MF slope and y-axis intercept) were able to predict the presence of pain in the upper trapezius (p<0.05), but not in the lower back muscles.

OBJETIVO: A proposta do estudo foi investigar se índices de fadiga, obtidos a partir de eletromiografia de superfície, calculados no domínio do tempo e da frequência, são capazes de diagnosticar a dor objetivamente, discriminando entre sujeitos com e sem dor no trapézio superior e nos músculos lombares. MÉTODOS: Quarenta e sete indivíduos foram submetidos a um teste de fadiga muscular por 35s a 80% da contração voluntária máxima (CVM), enquanto EMG e força muscular foram registradas. O valor RMS e a mediana da frequência (MF) foram calculados em janelas consecutivas de 1s. Análise de regressão linear foi utilizada para obter os coeficientes de inclinação e seus respectivos valores de interseção no eixo y, os quais foram considerados índices de fadiga muscular localizada. RESULTADOS: Os coeficientes de inclinação analisados no domínio da frequência apresentaram comportamento similar, sendo negativos para ambos os músculos, enquanto que, no domínio tempo, o trapézio superior apresentou coeficientes positivos, e músculos lombares, coeficientes negativos (p<0,01). Diferenças significativas também foram identificadas no domínio da frequência entre os sujeitos com e sem dor no trapézio superior (p<0,01). Os indivíduos com dor apresentaram valores de força significativamente menores que os sujeitos sem dor (p<0,05), tanto nos músculos lombares quanto no trapézio superior. CONCLUSÃO: Os valores de força associados aos índices de fadiga (inclinação da MF e intersecção do eixo y) foram hábeis para predizer a presença de dor no trapézio superior (p<0,05), mas não nos músculos lombares.

[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.

[Evaluation of empowerment: health promotion practitioners' perceptions and concepts. Results of a qualitative study in Australia]. / Evaluation von Empowerment--Perspektiven und Konzepte von Gesundheitsförderern. Ergebnisse einer qualitativen Studie in Australien.

BACKGROUND: Although the concepts of participation and empowerment are hallmarks of the WHO vision of health promotion, it is acknowledged that they are difficult to evaluate. Devising adequate study designs, indicators and methods for the assessment of participation and empowerment should take into account the experiences, concerns, working conditions and constraints of health promotion practitioners. METHODS: Semi-structured interviews were conducted with 17 experienced practitioners in community-based health promotion in New South Wales, Australia. The interviews covered benefits of and barriers to the evaluation of empowerment, key indicators and methodological aspects. Interview transcripts were examined using thematic content analysis. RESULTS AND DISCUSSION: The idea of evaluating empowerment is supported by health promotion practitioners, provided that empowerment is part of the programme logic and/or programme theory. The interviews highlighted the importance of a receptive environment for evaluation of empowerment and participation to take root. The resistence of health authorities towards empowerment indicators is a great challenge for funding of evaluations. Community members are to be included in the evaluation process, al-though it is not always easy to do so in a representative way and empowering approach. The best methods to capture whether empowerment has occurred in a programme are qualitative ones. The positive experiences that the interview partners made with innovative qualitative methods encourage further investment in developing new research designs.

Comparative study between two elbow flexion exercises using the estimated resultant muscle force / Estudo comparativo entre dois exercícios de flexão do cotovelo utilizando a estimativa da força muscular resultante

OBJECTIVE: The present study sought to compare the estimated resultant muscle force required throughout the range of motion in two variations of elbow flexion exercise: the Scott exercise, performed with the aid of a Scott bench, and the unsupported exercise, performed with the upper arm simply resting on the leg. METHOD: Eight healthy individuals performed each exercise eight times, with the same 4kg load. The biceps brachii and triceps brachii muscles were monitored using surface electromyography and the elbow joint movement was measured using an electrogoniometer. A mechanical model of the situation was proposed to evaluate the resultant muscle force acting throughout the range of motion of the exercise. RESULTS: Comparisons between the two exercise variations presented significant differences (p<0.01) in practically all of the angles. CONCLUSION: Analysis of the model suggests that greater muscle demand is not necessarily associated with higher resistance torque values in the exercise as it is fundamental to take into consideration the moment arm of the muscles involved.

OBJETIVO: O presente estudo objetivou comparar a força muscular resultante estimada necessária durante toda a amplitude do exercício de flexão de cotovelo, executado em duas variações: exercício Scott, realizado com auxílio do banco Scott, e exercício sem suporte, realizado com o braço apenas apoiado na perna. MÉTODO: Oito indivíduos saudáveis realizaram oito execuções de cada exercício, com uma carga fixa de 4kg. Os músculos bíceps braquial e tríceps braquial foram monitorados com eletromiografia de superfície e o movimento da articulação do cotovelo acompanhado com eletrogoniometria. Um modelo mecânico da situação foi proposto para avaliar a força muscular resultante atuante durante toda a amplitude do exercício. RESULTADOS: Comparações entre os exercícios apresentaram diferenças significativas em praticamente todas as angulações (p<0,01). CONCLUSÃO: A análise do modelo sugere que a maior exigência muscular não necessariamente está associada aos maiores valores do torque de resistência do exercício, sendo fundamental levar em consideração a distância perpendicular da musculatura envolvida.

[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.

[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.

Efeito da posição da articulação do cotovelo no controle de torque de supinação do antebraço em jovens adultos / Effects of elbow joint position on forearm supination torque control among young adults

INTRODUÇÃO: Inúmeros casos de patologias em antebraço e cotovelo reportados na literatura estão associados com tarefas que envolvem esforço e movimentos repetitivos do braço e mão. A posição do cotovelo é conhecida por afetar a produção de torque máximo de supinação do antebraço, assim como é um fator crítico na determinação de exercícios terapêuticos apropriados. No entanto, baseado no que se conhece, não existem evidências sobre os efeitos da posição do cotovelo em tarefas que requerem controle de níveis submáximos de torque. OBJETIVO: Este estudo investigou o efeito da posição do cotovelo na produção de torque isométrico máximo de supinação do antebraço e no controle constante e contínuo de torque em diferentes níveis submáximos de torque. MÉTODOS: Dezesseis jovens adultos (24,7 ± 2,2 anos de idade) foram solicitados a realizar duas tarefas: produção de torque máximo em pinça lateral (polegar e indicador) e controle constante de torque em pinça lateral. Ambas as tarefas foram avaliadas em quatro posições do cotovelo (livre, 0º, 45º e 90º de flexão) e três níveis submáximos de produção de torque em pinça lateral (20 por cento, 40 por cento e 60 por cento). Torque máximo, variabilidade, irregularidade e precisão da resposta motora foram usados como variáveis dependentes. RESULTADOS: Maiores valores de torque foram encontrados quando a articulação do cotovelo não foi restringida. O controle de torque não foi influenciado pela posição da articulação do cotovelo. Maior variabilidade, irregularidade e menor precisão na resposta de torque foram registradas com o aumento progressivo dos níveis submáximos de torque. CONCLUSÃO: Os resultados sugerem que a posição do cotovelo não é um fator determinante para exercícios de reabilitação que incluam torque em supinação do antebraço.

BACKGROUND: Large numbers of cases of pathological conditions in the forearm and elbow that have been reported in the literature are associated with tasks involving effort and repetitive movements of the arms and hands. Elbow position is known to affect the production of maximum forearm supination torque, and is a critical factor in designing appropriate therapeutic exercises. However, to our knowledge, there are no data on the effects of elbow position on tasks requiring control over submaximal torque levels. OBJECTIVE: This study investigated the effects of elbow position on the production of maximum isometric forearm supination torque, and on constant and continuous torque control at different submaximal torque levels. METHOD: Sixteen young adults (24.7 ± 2.2 years old) were asked to perform two tasks: production of maximum lateral pinch torque (thumb and index finger) and controlled lateral pinch constant torque. Both tasks were evaluated at four different elbow positions (free position, 0º, 45º and 90º of elbow flexion) and three submaximal levels of lateral pinch torque production (20 percent, 40 percent and 60 percent). Maximal torque, variability, irregularity and accuracy of the motor response were used as dependent variables. RESULTS: Greater torque values were found when the elbow joint was not restricted. The torque control tasks were not affected by the elbow position. However, greater variability and irregularity and lower accuracy in torque response were recorded with progressively increased submaximal torque levels. CONCLUSION: The results suggest that elbow position is not a determining factor for rehabilitation exercises that include torque control, in relation to forearm supination.