Guideline on multimodal rehabilitation for patients with post-intensive care syndrome.

BACKGROUND: Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS. METHODS: A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as "strong recommendation", "recommendation" or "therapy option", based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified. RESULTS: The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS. RECOMMENDATIONS: early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS. CONCLUSIONS: PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments.

[Neighbourhood deprivation and community nutrition environment: associations between the social and built environment and food availability]. / Stadtteildeprivation und Lebensmittelumwelt: Zusammenhänge von sozialen und baulichen Merkmalen der Wohnumgebung und Lebensmittelverfügbarkeit.

OBJECTIVE: Eating habits are influenced by individual socioeconomic status (SES). As the association between neighbourhood characteristics and food availability is still unclear, we investigated the community nutrition environment in different neighbourhoods. METHODS: Using official data of the city of Leipzig, we selected three neighbourhoods which differed in terms of their social (2 deprived vs. 1 affluent) and built (1 large housing estates vs. 2 historic buildings) environment. Data on food outlets were assessed via direct observation (ground truthing). RESULTS: Social and residential environment characteristics are associated with food availability. The proportion of fast food outlets is higher in deprived neighbourhoods compared to the affluent one (25%, 30.4% vs. 13.5%). Neighbourhoods with historic buildings offer a greater variety of food outlets. CONCLUSION: The greater availability of unhealthy food may contribute to the development of obesity. Preventive measures should consider the physical and social environment.

Challenges in doing multi-disciplinary health promotion research in Germany.

Health problems such as obesity are increasingly addressed by complex intervention programmes which operate at multiple levels of influence (e.g. families, schools, neighbourhoods) involving partners from various academic, professional and cultural backgrounds. Following a complex participatory health promotion approach is challenging, because conflicting interests as well as contextual constraints may occur which are rarely discussed empirically. Process evaluations of some programmes investigate factors influencing the implementation process. However, researchers' perspectives on inter- and transdisciplinary work are mostly neglected. This paper aims at illustrating and critically analysing challenges that arose in the planning and implementation of a health promotion project in a socially deprived neighbourhood in Germany. Drawing on minutes, email conversations, and research diary entries we reflect on discrepancies and difficult interactions within the research team, with collaborating (academic) institutions (interdisciplinary work) and with the community partners (transdisciplinary work) respectively. Differences in language, interests, success criteria, professional preferences and habits as well as contextual factors are worked out and coping strategies or solutions are proposed. According to our experiences, bringing to light researchers' positions, preferences and interactions with the community is necessary to find a balance between research and practice, to develop adequate solutions for challenging situations and to evaluate the process, effectiveness and transferability of a programme. Health promotion research should report not only on the effectiveness of interventions but also on struggles, unsuccessful attempts and useful (or useless) strategies to fuel discourse on opportunities in and the efficacy and transferability of health promotion projects.

[Community-based prevention of obesity in children]. / Gemeinwesen-basierte Prävention und kindliche Adipositas.

Besides individual determinants, obesity is also caused by obesogenic environmental conditions. Thus, prevention of obesity in children should aim at creating health-promoting environments. This is especially important for children of socially disadvantaged families and communities who are hardly reached and often profit less by behavior-oriented interventions. The main question is which environmental conditions should be changed and how in order to be accepted and sustainable? According to our experiences from the project "Grünau moves" (Grünau bewegt sich), the consideration of environmental and social conditions in the intervention field as well as the inclusion of the professional expertise of local agents and the lifeworld perspective (subjective meanings and realities) of families and children are crucial. Based on the fact that the understanding and weighting of health varies between individuals, the starting points for interventions and environmental change must be sought according to the interests and resources of the local community. Combining a medical and social work perspective and focusing on the community work approach can help to link and bundle different perspectives and interests in order to create appropriate and context-specific health-promoting environments.

[Primordial prevention in childhood to avoid chronic diseases]. / Primordiale Prävention im Kindesalter zur Vermeidung chronischer Erkrankungen.

Primordial prevention targets the healthy population. It aims at supporting people in developing and maintaining a healthy lifestyle to minimize the development of risk factors for noncommunicable diseases. Childhood offers special starting points and opportunities for this. Essentially for this is the creation of health-promoting conditions. This requires the participation of medical and non-medical professionals. Community organizing can significantly foster this process of interdisciplinary and setting-related work. Primordial prevention in childhood cannot be achieved without the active participation of pediatricians.

"Movement-enhancing footpaths" - A natural experiment on street design and physical activity in children in a deprived district of Leipzig, Germany.

Despite the beneficial effects of physical activity (PA), only 26% of children in Germany meet the WHO's recommendations. Because active play contributes to PA and is accepted by families, the creation of "playable" environments could promote PA. This study is a natural experiment that was conducted to investigate whether slight changes in the physical environment can increase PA in children. In autumn 2016, 140 students from two primary schools located in a deprived district of Leipzig (Germany) gathered ideas on PA-promoting street designs. After protracted negotiations with the city administration, two footpaths were decorated with colored markings (hopscotch grids, labyrinths, "mirror me") in September 2019. 48 observations were made before (August 2019) and after (September/October 2019) the implementation using the System for Observing Play and Recreation in Communities (SOPARC). Age, gender, activity level, bike use, and interactions with the colored markings were recorded. A total of 5455 individuals (including 1099 cyclists) were observed. Almost one fifth of the observed children (0 to 12 years) interacted with the markings. There was a slight increase in vigorous activity in all observed individuals after the implementation (2.9% vs. 6.4%, p < 0.001). The chance for vigorous activity was higher on decorated footpaths (OR 2.45, CI 1.54-3.89, p < 0.001), for children (OR 19.32, CI 13.07-28.56, p < 0.001), and on Sundays (OR 3.39, CI 2.33-4.94, p < 0.001). The participatory development and design of footpaths that support spontaneous active play "on the way" might be one component that can be used to support changes in children's PA behaviors and social interactions.