Long-term evaluation of community health promotion: using capacity building as an intermediate outcome measure.

OBJECTIVES: Between 2001 and 2012, the health authority of Hamburg-Eimsbüttel carried out a health promotion programme for children and their parents in a disadvantaged neighbourhood called Lenzsiedlung. The programme consisted of different action fields aiming at sustainable establishment of community capacities. STUDY DESIGN: The research goal was the long-term assessment of community capacities with a newly developed instrument 'KEQ' (KEQ = Kapazitätsentwicklung im Quartier/capacity building in small areas/neighbourhoods). Practitioners and researchers wanted to know whether community capacities could be increased, which changes occurred during the programme and whether processes of capacity building could be maintained. Research results were also used for the continuous adjustment of the programme to community needs. METHODS: Three surveys on community capacities were conducted (t1: June 2006 [including a retrospective measurement of t0: 2001]; t2: June 2008; and t3: November 2011), each directed to 40-60 stakeholders of the Lenzsiedlung. The instrument consists of five domains (participation, local leadership, available resources, networking and cooperation and health care) with a total of 51 items. RESULTS: For the community capacities, we found a positive trend from 2001 to 2006 supported by data from a documentary analysis over the same period of time. Then, 2006-2011 was a phase of consolidation with only slight improvements (e.g. in the particularly important domain 'health care'). CONCLUSIONS: The results show the feasibility of a community health promotion programme and its maintenance over a period of 10 years. However, Lenzgesund was not the sole programme in the neighbourhood during the period of observation, so that not all improvements in capacities are directly assignable to the interventions. The instrument mainly reflects the possibly one-sided perspective of the interviewed experts from the community.

[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.

[Capacity Building for Prevention and Health Promotion for Children and Parents in a Deprived Urban Quarter: Lenzgesund]. / Strukturbildung für Prävention und Gesundheitsförderung bei Kindern und Eltern in einem benachteiligten Quartier: Lenzgesund.

In 2005 the local health authority Hamburg-Eimsbüttel developed a prevention programme for the disadvantaged quarter "Lenzsiedlung" which has been implemented by the stakeholders committee "Round Table Lenzgesund" and other partners led by the health authority. The Department of Medical Sociology and Health Economics of the University Medical Centre had taken on the accompanying analysis and long-term evaluation with a mixture of qualitative and quantitative methods for health reporting and evaluation and a new instrument for measuring capacity building in the quarter (KEQ).

[Memorandum prevention research - research areas and methods]. / Memorandum zur Präventionsforschung - Themenfelder und Methoden (Langfassung).

From 2004 to 2012, the German Ministry of Education and Research (BMBF) established its first funding programme for the promotion of prevention research. 60 projects on primary prevention and health promotion and the meta-project entitled "Cooperation for Sustainable Prevention Research" (KNP) received BMBF grants under this programme during this period. The experience and knowledge gained and recommendations arising from the research funded under this programme are compiled in memorandum format. The "Memorandum on Prevention Research - Research Areas and Methods" highlights 5 research areas that are considered to be especially relevant from the perspective of the involved scientists and practice partners.The promotion of structural development and sustainability enhancement in disease prevention and health promotion are central areas that should branch out from existing nuclei of crystallization. Improving the health competence of the population and of specific subpopulations is another major area. Research in these areas should contribute to the development of theoretical concepts and to the empirical testing of these concepts. The transfer of knowledge for effective use of developed disease prevention and health promotion programmes and measures is still a scarcely researched area. Among other things, studies of the transfer of programmes from one context to another, analyses of the coop-eration between politics and science, and the continued theoretical and conceptual development of transfer research are needed. Long-term data on the effects of intervention studies are also needed for proper evaluation of sustainability. The latter dem-onstrates the importance of method development in disease prevention and health promotion research as an area that should receive separate funding and support. This research should include, in particular, studies of the efficacy of complex interventions, health economic analyses, and participative health research.

[Integrated sustainability-oriented reporting--key indicators for communities and cities. Results of a research and development project]. / Integrierte nachhaltigkeitsorientierte Berichterstattung -- Kernindikatoren für Kommunen und Städte. Ergebnisse eines Forschungs- und Entwicklungsprojektes.

In our research project -- supported by the German Federal Ministry for Education and Research (BMBF) - 35 key indicators were developed in an ongoing process in co-operation with 10 East German cities, which are all members in the German cities healthy network. With these indicators the cities should take up integrated sustainability - oriented health reporting, from which actions and projects for health promotion and prevention can be derived. The conceptual background for the research project and the reports to be made by the project in co-operation with the cities, are the three policy programmes that to be realised on a county level: Healthy Cities, Local Agenda 21 and the German city development programme "Soziale Stadt (socially oriented city)". The common goal of these programmes is the sustainable improvement of the quality of life in the counties. The project is part of the BMBF-supported research field "problem - oriented regional reporting systems", in which other projects are involved which are mainly being conducted in the newly-formed East German "Lander". In this article we describe the co-operative process of the development of the indicators. A synopsis of already applied or proposed sets of indicators for municipal reporting was the basis for the development of the project's set of 35 key indicators. The set of indicators is presented according to its usefulness for planning and realisation of actions for health promotion on county level. For each of the 35 indicators a meta - data description was made to support the counties and cities in our project for health reporting. These indicator profiles are also helpful and supportive for all counties and citiesaiming at such health reporting. The project started in May 2002 and lasts till Mai 2005, so that most reports should be completed in the spring of 2005.

Charge-exchange-induced two-electron satellite transitions from autoionizing levels in dense plasmas.

Order-of-magnitude anomalously high intensities for two-electron (dielectronic) satellite transitions, originating from the He-like 2s(2) 1S0 and Li-like 1s2s(2) (2)S(1/2) autoionizing states of silicon, have been observed in dense laser-produced plasmas at different laboratories. Spatially resolved, high-resolution spectra and plasma images show that these effects are correlated with an intense emission of the He-like 1s3p 1P-1s(2) 1S lines, as well as the K(alpha) lines. A time-dependent, collisional-radiative model, allowing for non-Maxwellian electron-energy distributions, has been developed for the determination of the relevant nonequilibrium level populations of the silicon ions, and a detailed analysis of the experimental data has been carried out. Taking into account electron density and temperature variations, plasma optical-depth effects, and hot-electron distributions, the spectral simulations are found to be not in agreement with the observations. We propose that highly stripped target ions (e.g., bare nuclei or H-like 1s ground-state ions) are transported into the dense, cold plasma (predominantly consisting of L- and M-shell ions) near the target surface and undergo single- and double-electron charge-transfer processes. The spectral simulations indicate that, in dense and optically thick plasmas, these charge-transfer processes may lead to an enhancement of the intensities of the two-electron transitions by up to a factor of 10 relative to those of the other emission lines, in agreement with the spectral observations.

[Health promotion and prevention by urban renewal?]. / Gesundheitsförderung und Prävention durch Stadtteilsanierung?

This article is based on a study using different approaches to examine the links between urban development on the one hand and health promotion on the other. The background and basic concepts underlying this study are briefly explained. Programmatic papers from both spheres of approach result in the basic thesis that both urban development and health promotion are aiming at improving the quality of life in city districts (objective conditions of living and subjective feeling tone, i.e. subjective well-being) in the overall sense of a health-promoting general policy. Because of these common goals cooperation between both spheres is hypothesised. However, the study as a whole shows (especially an analysis of the documents of the files of the sanitation committee) that this is not so. To understand this finding better the freedom of both parties concerned to act as they should, is analysed, namely, that of the sanitation committee and of the regional health and environmental office. It becomes evident that in both these spheres the requisite monitoring capacities, such as legal support, finances, information service and counselling activities, are fundamentally lacking or indeed limited. Hence, there are limited chances of success in the spheres of health promotion and preventive care by means of sanitation of city districts. Finally, the authors point to long-term trends and developments that would make a future approach between the two spheres mandatory and (at least partially) possible.

[Role of the public health (and environmental) office in urban development--current status and perspectives]. / Zur Rolle des Gesundheits-(und Umwelt-)amtes in der Stadtentwicklung--Situation und Perspektiven.

Our central question is how the local public health services can influence urban development and urban renewal policies. The need for a three-way cooperation between departments of urban planning and development, environmental affairs and health is now being widely acknowledged. In practice, however, it has to face manifold and serious problems. We suggest that there are basically three essential "instruments" which could lead to a new and defined role of health departments in urban development: environmental and health audits, local health profiles and "health promotion committees" or similar bodies for closer cooperation at the local level. These three "instruments" are described in terms of the present state of development and dissemination by analysing empirical studies from public health research. The results indicate that the "new role" of local health services in urban planning and development is presently fulfilled only in a few pilot cases. The lack of basic requirements particularly in terms of resources, motivation and qualifications is the main cause for the inability to implement the three "instruments" on a broader level in local health services.

[The content of Hb in the blood and of different constituents in the plasma of lambs with low and normal increase in body mass]. / Untersuchungen über den Gehalt an Hb im Blut sowie an verschiedenen Bestandteilen im Plasma von Lämmern mit niedriger sowie mit normaler Zunahme an Körpermasse.

In lambs with a very restricted intake of nutrients and an increase of the body mass of less than 60 g per day (group A) and in those with an increase of more than 220 g/day (group B), analyses of components of the blood and the plasma were performed at certain intervals. In the lambs of group A an anemia developed in the course of 77 days. The concentrations of alpha-amino-N, non-protein-N, urea, glucose and insulin as well as the activity of the alkaline phosphatase of the plasma of the lambs of group A were always lower than those of group B. The beta-hydroxybutyrate concentration of the lambs of group A on the 7th and 21st day of the experiment was higher than that of group B. The concentrations of inorganic phosphate and iron in the plasma of group A at most points during the study were lower than that in group B.

[Preparations of acetylsalicylic acid sustained-release tablets on hydrophilic matrix forms]. / Herstellung von Acetylsalicylsäuretabletten mit verzögerter Wirkstoffliberation auf der Basis hydrophiler Matrixformen.

The aim of this study was to prepare a tablet with acetylsalicylic acid based on hydrophilic matrix form by means of polyvinyl alcohol. The liberation was carried out with the column dissolution-rate method. In contrast to other studies, the percentage of the cumulative liberation is decreased by increasing the drug concentration. Acetylsalicylic acid caused a decrease of the wetting and the rate of swelling.

A case of Sjögren's syndrome with severe anemia due to myelitis.

An unusual case of Sjögren's syndrome presenting with severe anemia as the predominant clinical feature is described. Histological examination of a bone marrow biopsy specimen demonstrated that the patient's anemia was caused by myelitis and vasculitis of the small intraosseous vessels. Our report might stimulate a more thorough investigation of bone marrow in patients with connective tissue diseases and anemia.

[Bacterial meningitis as a late complication of persistent traumatic cerebrospinal fluid fistulas]. / Bakterielle Meningitiden als Spätkomplikation persistierender traumatischer Liquorfisteln.

Report on two patients who suffered from bacterial meningitis 26 and 27 years after a severe headtrauma with consecutive cerebrospinal fluid fistulas. This is a rare cause, but must be considered if a bacterial meningitis of unknown origin is diagnosed.