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Background: Internationally, a variety of definitions for public health interventions (PHI) exist. In the German-speaking countries, however, a definition is still outstanding. Therefore, the aim of this study was to derive consensus criteria for the definition of PHI from the expert perspective of science and practice., Methods: A Delphi survey with two online rounds was conducted from December 2022 to February 2023. Six criteria were formulated by a working group and posed for consensus: 1) the intention of the intervention, 2) potential conflicts of interest of the initiators of the intervention, 3) primary vs. secondary/tertiary prevention, 4) costs, 5) targeting, and 6) the reach of the intervention. In both Delphi rounds, experts from academia and practice were recruited through relevant networks and associations throughout the German-speaking world. The judgments were asked about standardized rating scales with the possibility of open justification., Results: In the first Delphi round, n = 52 and in the second round n = 43 experts from research, care and administration/management in health care participated. Consensus was reached on four of the six criteria after the second Delphi round: the intention of the intervention, possible conflicts of interest of the initiators of the intervention, primary vs. secondary/tertiary prevention, and the scope of the intervention. From the perspective of the experts interviewed, these are the criteria that distinguish PHI., Discussion and Conclusion: Based on the consensus criteria, PHI can be defined more concretely. Thus, the results contribute to a better inter- and transdisciplinary understanding. Ideally, the criteria will make it easier to assign interventions to the public health sector in the future, even if a precise examination will be necessary in individual cases, among other things because the experts disagreed on the criteria of costs and how to address the target group., (Copyright © 2023. Published by Elsevier GmbH.)

In the field of medicine and health sciences, Delphi methods are applied mainly in the exploratory or evaluative phases of a research process. Explicit and implicit knowledge of respected experts from research and practice is systematically synthesized. Originally developed as a method for structuring a group communication process, Delphi techniques have been established in the health sector as a consensus method. The findings are used to improve the evidence and acceptance of planned interventions or necessary standards or guidelines and to increase the probability of successful implementation in practice. However, different variants of Delphi methods have been developed in recent years, which are systematically contrasted and reflected in this paper with regard to key epistemological and methodological research activities. Based on this overview, researchers should be enabled to select the most suitable Delphi technique for their own research questions and research endeavors., (Copyright © 2022. Published by Elsevier GmbH.)

Research in the field of health promotion generates evidence-based knowledge and has the potential to increase the acceptance, impact and long-term effectiveness of interventions. Typically, a distinction is made between qualitative and quantitative approaches. Yet, with complex and multidimensional re-search questions in the field of health promotion a combination of the two approaches has proven useful. Using mixed-methods designs promises, among other things, to compensate for weaknesses of the individual methods, to improve the scope of the results, and to provide a comprehensive insight into the topic. In this systematic review of two German journals we examine the role of the mixed-methods approach in the field of health promotion and how it can be translated into specific research projects. The review's results show that mixed-methods designs are implemented in various contexts. In most studies, the quantitative research strand plays the central role. The use of the mixed-methods designs in health promotion can be further discussed, especially taking into account technical innovations in the field of data collection or with regard to the interpretative potential of qualitative research. The presentation of the review is based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) by the Equator Network., (Copyright © 2020. Published by Elsevier GmbH.)

Mixed methods studies (MMS) play an increasingly important role in the health sciences. Its potential lies in the acquisition of causal conditions and in the intersubjective understanding of diverse and new phenomena. The holistic and multi-perspective analysis strategy of MMS also allows a subject-oriented and an evidence-based approach to clinical practice. The article reviews the use of MMS in the health sciences on the basis of various reviews, and it highlights current methodological developments and research gaps., (Copyright © 2018. Published by Elsevier GmbH.)

The clinical signs, pathological and laboratory findings of cattle suffering from a tremorgenic syndrome are described. Animals on a farm with a total of 22 cows, 18 heifers and 9 calves were fed mouldy grass and spent malt-grain silage. Five heifers were affected with muscular tremor, hyperexcitability and hypersensitivity. They were ataxic or in sternal recumbency, while their appetite remained normal. Haematology and blood chemistry in two heifers as well as cerebrospinal fluid from one sick animal were unremarkable. The pathological examination of one animal brought no macroscopic changes to light. Histological examination, however, revealed the degeneration of motor neurones in the midbrain, brain stem and spinal cord. Analysis of a silage sample provided evidence of the presence of Aspergillus clavatus, a mould capable of producing neurotoxic tremorgenic mycotoxins. Epidemiology, clinical findings, pathology and microbiological examination suggest that the five cattle were suffering from neuromycotoxicosis.

Data of 253 patients with acute myocardial infarction (data collected from primary hospital, from the rehabilitation center-- R.C.-- and from a questionnaire dealing with the individual problems of the rehabilitation period; response rate 77%) were correlated in order to derive criteria for the estimation of the success of rehabilitation. It could be shown that the increase in physical performance and the clinical judgement in the R.C. are well paralleled by the further course of the rehabilitation period (return to work etc.). On the other hand it seemed difficult to predict rehabilitative results from the hospital data alone. It was only shown that the severity of the disease had a major influence upon rate of and interval, before return to work.

12 patients with the diagnosis of coronary heart disease and angina pectoris underwent evaluation of heart rate as an indicator of tolerance of a given work load. A floating catheter in a pulmonary artery and a peripheral arterial catheter permitted measurement of blood pressures. Oxygen uptake per minute (VO2) was measured by Douglas bags and oxygen content of arterial and mixed-venous blood was determined at rest and during each minute of submaximal and symptom-limited maximal exercise on a treadmill. In the minute of exercise, in which 60-80% (mean 71.3%) of maximal heart rate (HF max) were attained, VO2 averaged 60.3% VO2 max, cardiac output (Q) 72.5% Q max and mean pulmonary arterial pressure (PAP) 26.6 mm Hg. With one exception, Q leveled off or dropped in the last minutes of exercise beyond 85% HF max. Heart rate (HF), oxygen difference between arterial and mixed venous blood (DavO2) and PAP reached their highest values in the last minute. It is suggested that heart rates up to 70% HF max, as individually determined in a symptom-limited maximal exercise test, are the tolerable limit during occupational activities. 85% HF max should not be exceeded during exercise training. Left ventricular function may be impaired beyond that limit because of acute coronary or myocardial insufficiency, and the regulation of cardiac output becomes uneconomical.

The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.

Correlations between scales and items of the "MPFH", and physical performance of MI-patients, lead us to conclude that the self-perception of decreased physical performance after MI is often generalized and thus leads to a decrease in self-esteem, often connected with feelings of social isolation. This pattern of reaction can in itself be a new risk factor during rehabilitation. Psychological rehabilitation must therefore focus on both: 1. trying to find a meaningful balance between moderate increase in physical performance and psychological adaptation to the reduction in performance, and 2. trying to reduce the feeling of social isolation which comes along with decreased physical performance.

The antihypertensive effect of atenolol, a cardioselective beta-blocker, was examined in 8 patients with essential hypertension. The most important haemodynamic changes observed were a significant reduction in heart rate (reduction in maximum heart rate at the end of symptom-limited exercise by 23% p less than 0.01) and a moderate fall in systolic blood pressure (reduction at submaximum level of exercise by 22%, p less than 0.01). The antihypertensive effect was attributable in half the patients to a drop in peripheral vascular resistance and in the other half evenly to a predominant reduction in cardiac output or to a reduction in both parameters. In view of the compensatory rise in stroke volume a significant reduction in cardiac output was not found. Symptom-limited exercise tolerance was increased in all patients. These results lead to the conclusion that the antihypertensive action of the cardioselective beta-blocker, atenolol is based on a lowering of the increased peripheral vascular resistance and a reduction in cardiac output; the latter mechanism is predominantly found in patients with hyperkinetic features.

9 patients with diagnosis of coronary heart disease (CHD) and typical angina pectoris (AP) were studied by means of a multistage, symptom-limited treadmill test and a similar bicycle ergometer (bike)-test. The sequence of tests was determined by chance. Between the tests, the patients rested one hour. Oxygen uptake (vo2) was determined by the Douglas-bag-method, blood pressures were measured via catheters placed in a pulmonary and a brachial or radial artery, respectively. Cardiac output (Q) was calculated by the direct Fick principle. In all tests, with the exception of one bike-test, all patients were limited by AP. They attained high VO2 (mean 1316 ml/min) on the treadmill (TM) while on the TM their mean arterial blood pressure (BP) was significantly (P greater than 0.05), namely 10 mm Hg as an average, lower. Comparing the final minute -3 of the TM-test with the final minute -1 of the bike-test in 5 patients, we found heart rate (HR), BP and pressure rate product (HR times BP) lower on the TM (P greater than 0.05), whereas VO2 was the same. Patients, whose exercise performance is limited by angina pectoris on bike and TM, achieve higher VO2 on the treadmill, together with lower BP. This may be of clinical importance in exercise-testing and -training of patients with CHD.

Because exercise testing is of value not only for "qualitative" but even more for "quantitative" diagnostic purposes, the exercise ECG is often of minor importance in relation to the other exercise responses. 1. Exercise capacity. Maximal aerobic power or aerobic capacity as a measure of physical and cardiovascular performance can not be calculated from measurements during submaximal exercise (with the exception of young healthy persons), but correlates well with the maximal workload attained in a (symptom-limited) maximal test when sex, age and the state of health as well as of physical training are taken into account. Therefore, exercise capacity as measured in such a test is of diagnostic and prognostic significance. 2. Heart rate. Changes in heart rate at a given submaximal workload correlate well with qualitative changes of exercise capacity in the individual. The peak heart rate that is attained in a (symptom-limited) maximal exercise test (HR max) varies greatly interindividually. It declines with age and because heart rate is one of the major determinants of myocardial oxygen uptake it is a measure of "coronary reserve" in the patient with coronary heart disease. Limits for professional activities or other physical exercise may be expressed as a certain percentage of HR max (% HR max). 3. Blood pressure. An inadequate rise of systolic blood pressure or a fall despite increasing workloads indicate inadequacy of cardiac output. In coronary heart disease, it is often a sign of acute left ventricular dysfunction due to reversible ischemia and is of therapeutic and prognostic consequence. 4. ECG. Electrocardiographic changes should always be related to other exercise responses. Sensitivity and specificity of the ST-segment changes depend on sex, age, resting ECG, type of exercise, lead system and medical treatment. In coronary heart disease, "Bayes' theorem" should be regarded. The predictive value of a test result should be calculated, based on the prevalence and the pretest likelihood of the disease. Other than ST-segment changes are or relatively minor significance or need further evaluation.

Maximal work endurance of heart and circulation measured by submaximal work load on an ergometer can be estimated with reasonable accuracy by means of the physical working capacity 170 (PWC 170) only in healthy individuals aged 30 years or below. Limitation of exercise by pulmonary factors does not appear to bias the results essentially. In healthy people aged 40 or over, the risk of miscalculating maximal working ability based on PWC 170 increases considerably despite maintenance of high statistical correlation to maximal work load. In patients with coronary heart disease, there is no statistical correlation between PWC 170 and maximal work load; therefore, symptom-limited ergometry is required in these patients. For the assessment of quality in follow-up tests, the watt-pulse at submaximal work load appears to be the most adequate parameter. It is recommended that submaximal tests be also carried out in a rectangular-triangular manner, for the purpose of comparison with symptom-limited tests and for evaluation of changes in the dynamics of pulse and blood pressure regulation.

A special swimming programme was initiated during the course of rehabilitation of patients after myocardial infarction with additional disturbances of the musculoskeletal system. Allowance was made for aspects of individual training requirements. Patients were divided in two groups according initial values of physical working capacity: One group contained patients with less than 80% of the normal work capacity, the other those with borderline normal values. The first group showed an average increase of 35% in the initial values during a one-year period of swimming training once a week. The other group with practically normal initial values showed only a slight or negligible increase. Serum lipid levels were unchanged in both groups. No serious side effects were encountered in more than 3000 patients hours. However, no prediction of the risks of this type of training as compared to other forms of physical exercise in patients recovering from myocardial infarction can be made from this study.

The relationship between coronary disease and psychological factors is generally accepted. Numerous psychiatric studies have shown that there are typical basic personality features which predispose to heart disease. A personality inventory - the Freiburger Persönlichkeitsinventar (FPI) - was applied to a group of patients attending the Cardiology Clinic of the University of Vienna for a follow-up control examination after a heart attack. The results were compared with those of a control group (taken from the control population of the FPI). With respect to one personality dimension of the FPI, the so-called,,Nervositätsskala" (nervousness scale), significant differences were observed between the two groups. This scale includes so-called ,,psychosomatic" distrubances and disorders. According to these results,patients with coronary disease were more likely to experience such ,,psychosomatic distrubances" (as far as could be measured by this dimension of the FPI) than members of the control group. A comparison of patients graded according to the physical stamina level showed that those with a greatly-reduced work capacity as a consequence of myocardial infarction had a significantly higher score than patients whose work capacity was impaired to a lesser extent. This study introduces a new aspect in the relationship between coronary disease and personality dimensions.

Treatment of 12 hypertensive patients with a new imidazoline derivative, St 600 (1.5 to 12.0 mg daily over at least 7 days) resulted in a significant lowering of the blood pressure, mostly to normal values, parallelled by a reduced heart heart rate. A significant decrease in arterial resistance was observed at rest and during exercise in 6 of the patients, whereas a slight increase or no change was recorded in the remaining 6 patients. The changes in resistance in the pulmonary circulation were analogous to those in the systematic circulation for the 2 groups, respectively. The latter half of the patients displayed a decrease in stroke volume, cardiac index and oxygen consumption. No negative inotropic effect was observed.

8 healthy women and 4 men, examined by a clinical check-up, mean age 71.1 years, took part in a bicycle ergometer training, 3 times a week, for 12 weeks. Symptom limited ergometric bicycle tests were done before and after the training period. The training work load was continuously controlled by maintaining the training heart rate according to 60% of the maximum work load of the first test. In order to hold the training heart rate (HR) on a constant level the work load had to be increased systematically during the whole training period up to 180% of the level at the beginning. The working time in each training session was increased from 2 X 10 minutes in the beginning up to 2 X 20 minutes from the 7. week on. The maximum work load (+ 15%) and the maximum oxygen uptake (+ 14%) increased significantly. The submaximal HR decreased significantly. In maximum HR and maximum decrease of the base excess were no significant changes, indicating a real endurance training effect and not only an increase in the degree of exhaustion. We conclude that also in healthy people between 67-76 years a significant endurance effect is possible when the training is systematically increased in work load and working time, according to the rules of training science.

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

This report concerns a model for multifactorial rehabilitation after myocardial infarction (MI), with minimum requirements of personnel, space and equipment. Groups of patients are treated twice weekly, in a gymnasium of a school. Survivors of MI increased their exercise capacity from 77% to 93% of sex- and age adjusted normal within 3 to 6 months of therapy (mean values, P less than 0.001). A similar improvement was observed regardless of whether exercise training was started soon (less than 6 months) or late (greater than 12 months) after MI, indicating that exercise capacity increased with training, but was not dependent on time alone. The majority of 87 patients who answered a questionnaire, indicated that in their opinion a strictly organized program requiring a regular attendance was important for the rehabilitation and 89% thought that their participation had resulted in physical and psychological benefits. Two groups of survivors of MI were compared by use of the "Freiburger personality inventory" (FPI). Patients who were more physically impaired, showed a greater degree of a sort of psychosomatic disorder as indicated by the ratings of scale 1 of the FPI. The described program has proved successful, as it resulted in an increase of exercise capacity. This may have a favorable influence on a sort of psychosomatic disorder encountered in patients with healed MI. Beneficial physical and psychological effects were reported by the participants.

The effects of high altitude (3000 m, low-pressure chamber) on maximum exercise and maximum oxygen uptake were studied in four normal subjects. In order to separate the effects of hypobaria and of hypoxia, exercise testing was performed under normoxic, hypobaric conditions and compared with the results under normoxic, normobaric conditions. There was no significant difference in performance, nor in the effects of exercise on the measured cardiovascular parameters.

In order to evaluate effects of aortocoronary bypass grafting on exercise tolerance, we analyzed the data of 109 patients who performed exercise tests before and one month or one year after surgery. Subgroups of patients were formed on the basis of preoperative exercise tolerance. Previously severely impaired patients benefited from surgery by an improvement of exercise capacity, whether preoperative left ventricular enddiastolic pressure at rest exceeded 16 mm Hg and left ventricular ejection fraction was below 50% or not. On the other hand, exercise capacity of patients who were comparable in respect to the numbers of coronary lesions and bypass grafts but whose exercise tolerance was less impaired preoperatively did not improve after surgery. Because in such patients, independent of coronary anatomy, surgery has been reported to be ineffective for prolongation of life, indication for aortocoronary bypass grafting in the presence of "good" exercise capacity must be questioned for symptomatic as well as for prognostic reasons.

Results of physical rehabilitation were studied in 2 groups of patients. Group A consisted of 16 men and at least 24 (mean 51.5) months had elapsed after myocardial infarction before they were entered into a training programme with supervised once-weekly classes in a school gymnasium. By contrast, the interval between infarction and onset of training was less than 12 (mean 7.0 months in the 21 patients of group B, who had exercise classes twice a week. Group A achieved an average increase in estimated aerobic capacity of 32% (p less than 0.001) in 10 months of training, group B of 33% (p less than 0.001) in 4.7 months. Further participation of group A for 26 more months resulted in an additional improvement of 11% (p less than 0.05). Differences between the groups in aerobic power and different methods of exercise testing and training are discussed. The results indicate that early physical training of groups of patients helps them to obtain a normal exercise capacity with a year after myocardial fixation. Without such intervention patients often remain restricted, but with supervised training their physical power may be improved significantly even if years have passed after the heart attack.