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Results from cross-sectional and longitudinal studies such as Alimentacion y Valoracion del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Spanish Adolescents (AVENA) and the European Youth Heart Study (EYHS) respectively, highlight physical fitness as a key health marker in childhood and adolescence. Moderate and vigourous levels of physical activity stimulate functional adaptation of all tissues and organs in the body (i.e. improve fitness), thereby also making them less vulnerable to lifestyle-related degenerative and chronic diseases. To identify children and adolescents at risk for these major public health diseases and to be able to evaluate the effects of alternative intervention strategies in European countries and internationally, comparable testing methodology across Europe has to be developed, tested, agreed upon and included in the health monitoring systems currently under development by the European Commission (EC): the Directorate General for Health and Consumer Affairs (DG SANCO); the Statistical Office of the European Communities (EUROSTAT), etc. The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study group plans, among other things, to describe the health-related fitness of adolescents in a number of European countries. Experiences from AVENA and EYHS will be taken advantage of. This review summarises results and experiences from the developmental work so far and suggests a set of health-related fitness tests for possible use in future health information systems.

The European Youth Heart Study (EYHS) addresses cardiovascular disease risk factors and their determinants in European children and adolescents. The Swedish part of the study began with cross-sectional data collection in 9- and 15-year-old schoolchildren in 1998–1999 (EYHS-I). Repeated observations of the key indicators were performed in 2004–2005 (EYHS-II). The purpose of this study was to assess potential dropout effects in EYHS-II. Participants in both EYHS-I and EYHS-II (n=459) were compared with dropouts who participated only in the EYHS-I (n=678) in relation to baseline physical activity, cardiorespiratory fitness and socioeconomic and anthropometric characteristics. Bivariate comparisons were performed using chi-square tests and gamma tests for nominal and ordinal data, respectively. Continuous data were compared by t tests and Mann−Whitney tests depending on the distribution. The Bonferroni correction was used to control for multiple hypothesis testing. Multiple logistic regression with backward elimination of variables was applied to study independent effects of variables on the probability of becoming a dropout. Analyses were performed separately for the younger and older age groups. The dropout proportion in EYHS-II was 60%. Subjects from the older age group were less likely to participate in the follow-up study (32% vs. 50%, p

There has been a world-wide increase in scientific interest in health-enhancing physical activity (HEPA). The importance of a physically active lifestyle has now been well established both on the individual and on the population level. At the same time, physical inactivity has become a global problem. While sports for all has a long history, only a few examples of long-term integrated physical activity promotion strategies have been in place in Europe until recently, namely in Finland, the Netherlands and England. A number of countries have now begun to develop their own activities. However, there has been a noticeable lack of a platform for sharing the development and implementation of evidence-based policies and strategies. In order to fill this gap, HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity, was founded in May 2005 in Gerlev, Denmark. The goal of the network is to strengthen and support efforts and actions that increase participation in physical activity and improve the conditions favourable to a healthy lifestyle, in particular with respect to HEPA. The Network is working closely with the WHO Regional Office for Europe (http://www.euro.who.int/hepa). The network focuses on population-based approaches for the promotion of HEPA, using the best-available scientific evidence, and is currently implementing its first projects. HEPA Europe has established collaboration with EU Commission projects and Agita Mundo. Priorities for future work have been defined, and interested organisations and institutions have the opportunity to join the network and participate in the process.

The question as to whether fitness should be assessed in a European health monitoring system, perhaps from the early stages of life onwards, remains to be answered. We aimed to examine the associations between cardiorespiratory fitness and metabolic risk factors in children. A total of 873 healthy children from Sweden and Estonia aged 9–10 years (444 girls and 429 boys) were randomly selected. A maximal ergometer bike test was used to estimate cardiorespiratory fitness. Additional cardiovascular risk factors were assessed. Significant differences among cardiorespiratory fitness quartiles for the sum of five skinfolds, insulin resistance, triglycerides, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDLc) ratio were shown in girls whereas in boys, the sum of five skinfolds and insulin resistance were significantly different. The lowest sum of five skinfolds and insulin resistance was shown in the highest cardiorespiratory fitness quartile in girls and boys, and the lowest values of triglyceride and TC/HDLc values in the highest cardiorespiratory fitness quartile was observed only in girls. Cardiorespiratory fitness was negatively associated with a clustering of metabolic risk factors in girls and boys. The results add supportive evidence to the body of knowledge suggesting that cardiorespiratory fitness in children is an important health marker and thus should be considered to be included in a pan-European health monitoring system.

Health problems in childhood, which can be altered by basic preventive measures, are dramatically increasing. Therefore, effective primary prevention programmes beginning in early childhood are increasingly regarded as important. In this field a great deal of action, activities and interventions exist. The kindergarten setting is a particular field for integrated intervention. The special public health focus is to involve not only the children but also their parents, siblings, and teachers. The aim of the project was to establish an inventory of health promotion measures as well as prevention programmes in kindergartens in Germany. The objective was a stock-taking and a critical assessment of evaluated programmes for preschool children with a main focus on obesity prevention, promotion of physical activity and nutrition education. This complete overview involved extensive literature research, internet research and interviews with experts. Regarding obesity prevention intervention programmes, only 13 evaluated measures were identified. Concerning promotion of physical activity and nutrition education, 41 measures were listed. A programme evaluation has been carried out very rarely. Only nine projects have had a documented qualified evaluation. With regard to cooperation with a research institution, the evaluation were competent. Nevertheless, the proportion of integrated projects with a sustainable character was quite small. For the most part, interventions are aimed at prevention at the behavioural level; activities at the conditional level are uncommon. The results show an enormous demand on evaluated intervention programmes for kindergarten children, their relatives, and teachers. For future intervention programmes an evaluation is obligatory. Standardized measures are justified, because only such evaluated interventions were proved effective and successful. It is necessary to link existing projects, and not to create new programmes. A scientific analysis has shown that success is possible.

Beratungsdienste fur Arzte und Patienten tragen zur Verbesserung der Arzt-Patient-Kommunikation bei und konnen die aktuelle Versorgungslage beschreiben. Die Daten des seit 1995 etablierten Arzneimittelberatungsdienstes fur Arzte (ABDA) und des seit 2001 bestehenden Patienteninformationsdienstes (ABDP) am Institut fur Klinische Pharmakologie der TU Dresden wurden deskriptiv ausgewertet. Beide Beratungsdienste wurden haufig in Anspruch genommen (2004: 129 arztliche Anfragen vs. 1 358 Patientenanfragen). Die Anfragen in beiden Beratungsdiensten bezogen sich in der Hauptsache auf hochpravalente Arzneimittelgruppen, am haufigsten wurde zu kardiovaskularen Therapeutika (ABDA: 20%; ABDP: 30%) und Psychopharmaka (ABDA: 22%; ABDP: 17%) Auskunft gegeben. Die Ergebnisse legen nahe, dass aus Patientensicht von den Angehorigen der Heilberufe nicht ausreichend uber die verordnete Medikation aufgeklart wird. Auch wenn in beiden Beratungsdiensten inhaltlich ahnliche Arzneimittelgruppen Gegenstand der Anfrage waren, durfte ein Zeitproblem eher fur mangelnde Aufklarung verantwortlich zu machen sein als arztliche Wissensdefizite.

To investigate changes in long-term medication during the transfer between surgical hospital and primary care. To examine differences in defined daily doses (DDDs) versus real prescribed daily doses (PDDs).During a 15-month period, patients from three surgical wards in a university-based teaching hospital were asked about their medication at admission (T1), at discharge (T2), and 3 months after discharge (T3). Complete data were obtained for 299 patients (169 women, 130 men; mean age 69.5 years). Both DDD and PDD were calculated for each drug. Analysis of data was performed using a relational database.Patients took 3.6 drugs (+/-2.2) at T1, 5 (+/-2.4) at T2, and 3.8 (+/-3.1) at T3. After surgical intervention, a discontinuation of analgesic, anti-rheumatic, and thyroid medication was observed frequently (35% of discontinued drugs at T2). We found more drug alterations at T3 than at T2 (263 versus 87). Family doctors mostly changed medications prescribed for the cardiovascular system (22% of all cardiovascular agents were discontinued and/or started at T3). We could not determine those changes to be methodical. The total of PDDs and DDDs did not differ, but the mean PDDs of statins and beta-blocking agents were significantly below the DDDs (P0.005).The observed changes in medication after hospitalization can be only partially attributed to a successful surgical intervention and to the hospital stay. Those alterations seemed not to be initiated by the intention of saving costs.

Recent scientific literature reveals a tremendous change in the health status of children and adolescents caused by malnutrition and changes in general lifestyle. Thus, the crucial value of a sustainable nutrition education has long been recognised as a major component of public health nutrition strategies. This paper describes a study that took several requirements for nutrition education programmes into account by developing and evaluating a new age-adapted version of an existing nutrition education programme. The objective of the evaluation was to draw conclusions about the effects of the intervention’s success. A quasi-experimental field study design was utilised, arranging subjects into intervention, comparison and control groups. For each group, a pre- and post-test was assessed. Between the pre-test and post-test, a period of 4 months elapsed. In total, data from 616 children, 474 parents and 47 teachers were included in the evaluation. In general, all children in the intervention group (IG) across all ages showed a statistically significant improvement of general nutrition-related knowledge between the pre-test and post-test, which was measured in one section of the questionnaire. The comparison between intervention group (IG) and control group (CG) revealed significantly stronger improvement for the intervention group (IG). In comparison with the control group, the intervention group did not show any meaningful improvement in any of the five age groups. Parents, kindergarten-teachers and school teachers of all intervention groups reported serious changes for the health-conscious attitudes in children. In summarising, the presented age-adapted nutrition education programme and its evaluation could show a clear improvement of nutrition-related knowledge and less clear improvements in nutrition-related attitudes and behavioural intentions. A sustainable prolongation of the programme could lead to even higher improvement.

In the last decade, the WHO European Region has been struck by various extreme weather events. The dramatic political, social, environmental and health consequences have stimulated debate on whether appropriate action can prevent the health effects of such extreme weather events. Based on our knowledge of climate change, more extreme weather and climate events will occur in the coming years, and they are likely to be more severe. International collaboration is needed to evaluate and target actions better. Many lessons have been learned from early warning and information systems. In preparation for the Fourth Ministerial Conference on Environment and Health in Budapest in 2004, the WHO European Centre for Environment and Health of the WHO Regional Office for Europe and the European Environment Agency (EEA) organized a meeting entitled “Extreme weather events and public health responses” in Bratislava, Slovakia, on 9–10 February 2004 to exchange information regarding the 2002 floodings and the 2003 heat waves as well as to develop recommendations on public health and environmental responses to climate extremes. This paper reviews the contributions from the Bratislava meeting and summarizes the policy recommendations that were developed in a working document for the Fourth Ministerial Conference. Climate variability and extremes are discussed, as are country case studies and experience with floods, heat and cold waves in various European countries; some of the lessons learned are summarized in response to extreme events.

The purpose of this study was to improve the understanding of the relationship between cardiorespiratory fitness (CRF) and the early aetiology of cardiovascular disease. We examined if the levels of traditional and novel cardiovascular disease risk factors were influenced by the levels of CRF in children. A total of 339 randomly selected children aged 9–10 years participated in the Swedish part of the European Youth Heart Study (EYHS). CRF was estimated by a maximal ergometer bike test and dichotomized into low and high categories. Additional measured outcomes included fasting triglycerides, high density lipoprotein cholesterol (HDLc), C-reactive protein, homocysteine, blood pressure, body mass index, sum of five skinfolds and waist circumference. Homeostasis model assessment (HOMA) was computed from insulin and glucose measurements. Body mass index, skinfold thickness, waist circumference and insulin resistance (HOMA) levels were lower both in girls and boys with high CRF compared to those with low CRF. In girls, the levels of C-reactive protein were significantly lower in those with high CRF compared with those with low CRF, while HDLc levels showed the opposite pattern. The levels of triglycerides and homocysteine showed a tendency to be lower in girls having low CRF compared to those with high CRF. The results indicate that the levels of several traditional and novel cardiovascular disease risk factors are positively influenced by the levels of CRF in school-aged children. The data call for the development, testing and implementation of preventive strategies with stronger emphasis on CRF, especially for those children with low CRF. They also reinforce the need to include CRF testing in pan-European Health Monitoring Systems, also among younger individuals.

Der vorliegende Beitrag stellt Praventionsprogramme mit Bezug zu Ernahrung und korperlicher Bewegung vor, welche durch die Generaldirektion „Gesundheit und Verbraucherschutz“ (DG SANCO) in Luxemburg gefo rdert wurden und werden. Die Liste der vorgestellten Praventionsprogramme erhebt dabei keinen Anspruch auf Vollstandigkeit, sondern soll dem interessierten Leser vielmehr ein Bild von der Komplexitat der Themen sowie der Fulle von Problemstellungen eines einzelnen europaweiten Forderprogramms geben, welches wiederum eines unter zahlreichen ist. Pro Praventionsprojekt werden Ziele, Partner und die verfolgte Strategie des Projektes dargestellt, Quellen zu weiterfuhrenden Reports angegeben sowie das Projekt in den jeweiligen Kontext des beschriebenen Forderprogramms gestellt. Der interessierte Leser soll diese Aufstellung als Leitfaden fur einen Einstieg in die komplexe Materie Europaischer Praventionsprojekte und -netzwerke verstehen.

Patient- and physician-centered drug information services (DICs) can contribute to a better communication between doctors and patients and health care research. Furthermore, gaps within health care can be identified.Data of two DICs (the physician-centered service is in operation for almost 10 years, the patient-centered service since 2001), both established in the Institute of Clinical Pharmacology of the TU Dresden, Germany, were analyzed using descriptive statistics.The consultation frequency in both DICs was high (2004: 129 enquiries by physicians; 1,358 by patients). Questions concerning highly prevalent drug groups, i. e., cardiovascular drugs (physicians: 20%; patients: 30%) and drugs targeting the central nervous system (physicians: 22%; patients: 17%) were asked most frequently.The results indicate that patient's drug information in primary care needs improvement. Although in both DICs similar drug groups were asked, the authors suggest that the time factor is the core obstacle to sufficient information rather than knowledge deficits of physicians.

(1999) compare the general scientific practice with the Open Source movement in computer science. Counterpart to the commercial software model that created software giants like Microsoft, the Open Source movement has been matured to considerable importance since the advent of the Internet. In the here used sense, an open source describes a software development process, where all resources including the so called source code is shared and distributed for free within the framework of a GPL (General Public Licence). Nothing that contributed to a final software will be handled as a secret. The authors state: Science, after all, is ultimately an Open Source enterprise. The scientific method rests on a process of discovery, and a process of justification. For scientific results to be justified, they must be replicable. Replication is not possible unless the source is shared: the hypothesis, the test conditions, and the results. The process of discovery can follow many paths, and at times scientific discoveries do occur in isolation. But ultimately the process of discovery must be served by sharing information: enabling other scientists to go forward where one cannot: pollinating the ideas of others so that something new may grow that otherwise would not have been born (Dibona, Stone, & Ockman 1999: 2).

EDITOR—Public health outcomes in East Germany have substantially improved since unification with West Germany.1 2 This process should be two way,3 and neglected aspects of the east's former healthcare system have indeed resurfaced in Germany's healthcare reform. State owned health centres (policlinics) were one …

Die Forderung nach offentlicher Berichterstattung uber Forschungsaktivitaten wird durch die deutsche Public Health Forschung unter anderem durch die Erstellung von so genannten Public Use Files und Public Documentation Files realisiert. Da Forschungsdesigns und die daraus resultierenden Datensets sehr heterogen sind sowie sensible Patientendaten enthalten konnen, stellt die Dissemination dieser Files uber das Internet besondere Anforderungen an die Rechnerarchitektur und die Software Entwicklung. Die Arbeitsgruppe Public Use Files hat eine Pilot- Webanwendung zum Test der Dissemination von Public Use Files bzw. Public Documentation Files uber das Internet entwickelt. Diese Applikation ist unter der URL http://www.public-health.tu-dresden.de aufrufbar und wird in diesem Artikel vorgestellt.