Dirk Meusel

Health-related fitness assessment in childhood and adolescence: a European approach based on the AVENA, EYHS and HELENA studies

Results from cross-sectional and longitudinal studies such as Alimentación y Valoración 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.

Cardiorespiratory fitness is associated with features of metabolic risk factors in children. Should cardiorespiratory fitness be assessed in a European health monitoring system? The European Youth Heart Study

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.

Evidence-based physical activity promotion - HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity

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.

Nutrition education for children—results and perspectives

AimRecent 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.MethodsThe 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.ResultsIn 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.ConclusionIn 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.

Public health responses to extreme weather and climate events—a brief summary of the WHO meeting on this topic in Bratislava on 9–10 February 2004

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.

A dropout analysis of the second phase of the Swedish part of the European Youth Heart Study

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<0.001). In bivariate analyses, only maternal education was associated with dropout rates in the younger age group after Bonferroni correction. Males were more likely to drop out in both younger [odds ratio (OR)=1.72; 95% confidence interval (CI): 1.10, 2.96] and older (OR=1.96; 95% CI: 1.09, 3.54) age groups while basic maternal education was associated with outcome only in the younger group (OR=4.31; 95% CI: 1.78, 2.95) in regression analysis. The Swedish EYHS-II had high dropout rate after EYHS-I, but the dropouts did not differ from the participants in relation to physical activity, physical fitness, and anthropometric indices. Males were more likely to drop out than were females in both age groups. Differential dropout in relation to maternal education was observed in the younger age group.

Arzneimittelberatungsdienste als Instrumente der Versorgungsforschung

ZusammenfassungHintergrund:Beratungsdienste für Ärzte und Patienten tragen zur Verbesserung der Arzt-Patient-Kommunikation bei und können die aktuelle Versorgungslage beschreiben.Methodik:Die Daten des seit 1995 etablierten Arzneimittelberatungsdienstes für Ärzte (ABDÄ) und des seit 2001 bestehenden Patienteninformationsdienstes (ABDP) am Institut für Klinische Pharmakologie der TU Dresden wurden deskriptiv ausgewertet.Ergebnisse:Beide Beratungsdienste wurden häufig in Anspruch genommen (2004: 129 ärztliche Anfragen vs. 1 358 Patientenanfragen). Die Anfragen in beiden Beratungsdiensten bezogen sich in der Hauptsache auf hochprävalente Arzneimittelgruppen, am häufigsten wurde zu kardiovaskulären Therapeutika (ABDÄ: 20%; ABDP: 30%) und Psychopharmaka (ABDÄ: 22%; ABDP: 17%) Auskunft gegeben.Schlussfolgerung:Die Ergebnisse legen nahe, dass aus Patientensicht von den Angehörigen der Heilberufe nicht ausreichend über die verordnete Medikation aufgeklärt wird. Auch wenn in beiden Beratungsdiensten inhaltlich ähnliche Arzneimittelgruppen Gegenstand der Anfrage waren, dürfte ein Zeitproblem eher für mangelnde Aufklärung verantwortlich zu machen sein als ärztliche Wissensdefizite.AbstractBackground: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.Methods: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.Results: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.Conclusion: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.

Health promotion in kindergarten children: an assessment of evaluated projects in Germany

AimHealth 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.MethodsThe 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.ResultsRegarding 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.ConclusionThe 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.

Assessment of lifestyle in Europe (EU): a variety of topics

The worrying tendency across Europe towards early and more pronounced symptoms and signs of chronic disease among adolescents, and even among children, gave rise to organisation of the workshop “Assessment of Lifestyle among Young Individuals in Europe (EU)”. The workshop was initiated by the Scientific Platform of the Working Party “Lifestyle” within the Health Information Strand of the Public Health Programme 2003–2008 of the European Commission (EC) (Directorate General Health and Consumer Safety) in Luxembourg. The Scientific Platform is carried out by the Research Association Public Health at Technische Universität Dresden (Germany) and the workshop’s organisation supported by the Unit for Preventive Nutrition at Karolinska Institute in Stockholm (Sweden). The workshop was held at the European Union Public Health Association (EUPHA) Annual Meeting in Montreux between 16 and 18 November 2006. Along the present work of the Working Party “Lifestyle”, this special issue extends the focus of the special issue “Physical Activity in Public Health Nutrition” (see February 2006) introducing European, bilateral and national studies on the populationbased assessment of lifestyle factors influencing health.

New public health programme

Within the workplan of 2003, the European Commission, Directorate General ‘Health and Consumer Protection’ in Luxembourg, launched the new Public Health Programme 2003–2008. This programme includes three major parts: (1) Health Information, (2) Health Threats and (3) Health Determinants. In general, one of the programme’s most important aims is to build upon the work done by previous projects that had been supported by the European Commission. One aspect is relevant for health monitoring in the European region. Compared with other regions of similar geographical size such as North America or Australia, Europe’s population is much more heterogeneous in terms of culture, historic background, language, day-to-day habits and lifestyle. On the one hand, this heterogeneity poses many problems for health monitoring. Health-related data might not be available in every member country and also might be measured using different instruments, such as questionnaires. On the other hand, this heterogeneity may provide a valuable potential for public health in the European region. As an example, health monitoring may find a positive association between a certain culturally determined lifestyle and its positive effects on health in one country. Thus, the adoption of this effect may be used for other member countries’ national health policies, whereby the pool of available cultural habits to be monitored is huge. The previous health monitoring programme was carried out between 1 January 1997 and 31 December 2002 and helped to establish a system to monitor the health status in the community, facilitate the planning of healthrelated issues and provide member states with comparable health information, which should, in turn, support their national policies. Numerous expert networks have been initiated under the umbrella of this programme, comprising a wide thematic field. A selection of these projects is being published in a supplement of the European Journal of Public Health [1]. In the section called Health Information, the new Public Health Programme is organised into six independent Working Parties that are supported by the European Commission and include: a (1) Working Party on Lifestyle and other health determinants; (2) Working Party on Morbidity and Mortality; (3) Working Party on Mental Health; (4) Working Party on Health and Environment; (5) Working Party on Health Systems; (6) Working Party on Accidents and Injuries; (7) Working Party on European Community Health Indicators. Each of these working parties includes projects and experts in the respective field. The Coordinating Secretariat of the Working Party on Lifestyle was contracted by the European Commission in April 2004 and is run by the Research Association Public Health Saxony and Saxony-Anhalt, Institute of Clinical Pharmacology at the Medical Faculty of Dresden University of Technology. According to the mandate of the Working Party, the secretariat’s objective is to be the focus point for better co-ordination between the Lifestyle Working Party members and internal and external stakeholders such as the European Commission and International Organisations. Two new projects were contracted by the European Commission in 2004 to monitor specific aspects of the nutritional status with emphasis on the newly joining member states. Firstly, the project Data Food Networking (DAFNE) V continues a long tradition in monitoring the nutritional habits based on information collected in the context of household budget surveys (HBS) of most European countries. Secondly, the project Comparative analysis of existing data on nutrition and lifestyle of the ageing population in Europe (AGEING NUTRITION) focuses on describing the nutritional habits of the elderly, Hanc ergo sanam ac salubrem formam vitae tenete, ut corpori tantum indulgeatis quantum bonae valetudini satis est. L.A. Seneca, Epistula VIII