Identifying the potentials of the Place Standard tool in municipal health promotion in Europe

Background

Municipal health promotion provides the opportunity to promote health equity and to design health-promoting living environments by developing individual strategies. The Place Standard tool is a participatory instrument to identify needs by asking citizens to evaluate their living environment. It is increasingly being implemented and recommended on an international level. The aim of the study was to identify the potential of the Place Standard tool for the development of strategies in a municipal context as well as to identify facilitators and barriers when designing these.

Methods

Within a qualitative study design, nine guided interviews were conducted with international experts who have applied the tool at a municipal level in Europe. The interviews were recorded, subsequently transcribed and analysed using MAXQDA software. The analysis was based on a qualitative content analysis according to Mayring, using a deductively developed category system.

Results

A total of 355 statements were analysed. Some refer to the fact that a comprehensive needs analysis is enabled by the Place Standard tool, empowerment can be promoted and that the development of strategies can only be carried out with follow-up work. Furthermore, some facilitating factors, e.g. participation and intersectoral cooperation, were described. Mentioned inhibiting factors are e.g. lack of support from political decision-makers and the Covid 19 pandemic.

Conclusions

The results of the research indicate that the Place Standard tool can be used to identify priorities for action regarding the needs of the population at a municipal level. They show that a successful strategy development for municipal health promotion strongly relies on the application of the tool in an overall process.

Key messages

The Place Standard tool can be used to analyse needs at a municipal level. In order to develop sustainable strategies for municipal health promotion, it should be applied in an integrated process.

The involvement in health promotion in the setting of daycare centres - Description of access

Background

For health promotion and prevention in childhood, e.g. overweight, the daycare setting enables particularly early access to the target groups. The aim is to address not only children, but more explicitly also their parents and the wider social environment, and to involve them in the planning and implementation of measures. The project is developing participative and demand-oriented offers in different institutions throughout Germany. Scientific monitoring aims to generate recommendations for action for participatory health research from these various experiences.

Methods

Access takes place via day care centres and family centres. The participatory research design starts with the Search Conference method. With this method, institution-specific needs are identified on a local level and goals are defined that determine the further processes. The participatory procedure is accompanied by interviews and focus group discussions which are analysed according to Mayring.

Results

Due to lockdown, access to the target groups via the institution is difficult. Families and network partners are hardly accessible and heavily burdened. Nevertheless, it has been possible to establish digital participation in some institutions. The evaluations show that parents have a great interest in the health of their children. On the one hand, the results indicate that the current conditions lead to a wait-and-see attitude on the part of the institutions, while at the same time the topic of health is gaining in importance among all those involved.

Conclusions

Participatory methods pose a particular challenge during lockdown and must be adapted to the current situation. Especially when moving participation into the digital space, daycare centres (and similar institutions) play a key role as gatekeepers.

Key messages

Covid 19 highlights the central role of families and the immediate social environment for children.

It is essential to involve them in health promotion to enable children to grow up healthily.

Lack of cerebellar tDCS effects on learning of a complex whole body dynamic balance task in middle-aged (50-65 years) adults

Background

Cerebellar transcranial direct current stimulation (tDCS) is widely considered as a promising non-invasive tool to foster motor performance and learning in health and disease. The results of previous studies, however, are inconsistent. Our group failed to provide evidence for an effect of cerebellar tDCS on learning of a complex whole body dynamic balance task in young and healthy participants. Ceiling effects in the young study population are one possible explanation for the negative findings.

Methods

In the present study, we therefore tested 40 middle-aged healthy participants between the ages of 50 to 65 years. Participants received either anodal or sham cerebellar tDCS using a double-blinded study design while performing a balance task on a Lafayette Instrument 16,030 stability platform®. Mean platform angle and mean balance time were assessed as outcome measures.

Results

Significant learning effects were found in all participants. Balancing performance and learning rate was significantly less in the group of middle-aged adults compared to our previous group of young adults. No significant effects of cerebellar tDCS were observed.

Conclusions

Our findings are in line with other studies that have failed to prove robust effects of cerebellar tDCS on motor learning. The present findings, however, do not exclude cerebellar tDCS effects. tDCS effects may be more prominent after repeated stimulation, using other stimulus parameters, in patient populations, or in other motor learning tasks.

Trial registration

Not applicable.

Subcutaneous Immunization of Dogs With Bordetella bronchiseptica Bacterial Ghost Vaccine

The Bordetella species are Gram-negative bacterial pathogens that colonizes mammalian respiratory tract causing respiratory diseases in humans and animals. B. bronchiseptica causes clinical conditions in many mammals including immunocompromised humans. Using the dog model of respiratory infection, it has been shown in this study that a newly developed B. bronchiseptica Bacterial Ghost (BbBG) vaccine exhibited significant protection in the face of a severe pathogenic bacterial challenge in seronegative dogs. The protein E-specific lysis mechanism was used to produce BbBGs. Bacterial Ghosts (BGs) are the empty cell envelope of Gram-negative bacterium. They are genetically processed to form a microscopic hole in their membrane, through which all the cytoplasmic contents are expelled leaving behind intact empty bacterial shells. Due to the intact surface structures of BGs, they offer the safety of inactivated but efficacy of live attenuated vaccines. In this study, seronegative dogs were vaccinated subcutaneously (s/c) with two different doses of a newly developed BbBG vaccine [lower 10^∧5 (BbBG – 5) and higher 10^∧7 (BbBG – 7)] on day 0 and 21. The animals were challenged (by aerosol) with virulent live B. bronchiseptica strains 41 days after first vaccination. The dogs vaccinated s/c with BbBG – 7 vaccine had significantly lower spontaneous coughing scores (P = 0.0001) than dogs in negative control group. Furthermore, the tested BbBG – 7 vaccine was equivalent to the positive control vaccine Bronchicine CAe in terms of safety and efficacy. For the first time, we report the successful use of liquid formulated BGs vaccines in animal studies. Earlier reported studies using BGs vaccines were performed with resuspended freeze-dried BGs preparations.

Functional display of ice nucleation protein InaZ on the surface of bacterial ghosts

In a concept study the ability to induce heterogeneous ice formation by Bacterial Ghosts (BGs) from Escherichia coli carrying ice nucleation protein InaZ from Pseudomonas syringae in their outer membrane was investigated by a droplet-freezing assay of ultra-pure water. As determined by the median freezing temperature and cumulative ice nucleation spectra it could be demonstrated that both the living recombinant E. coli and their corresponding BGs functionally display InaZ on their surface. Under the production conditions chosen both samples belong to type II ice-nucleation particles inducing ice formation at a temperature range of between -5.6 °C and -6.7 °C, respectively. One advantage for the application of such BGs over their living recombinant mother bacteria is that they are non-living native cell envelopes retaining the biophysical properties of ice nucleation and do no longer represent genetically modified organisms (GMOs).

Advanced Techniques of Micro-Analysis and Confocal Microscopy: Perspectives for Studying Chemical and Structural Changes at the Interface Between Restorative Materials and the Cavity Wall

Migration of trace amounts of elements and structural changes characterize the interface between immiscible substances. The contact zone among filling materials, saliva, and the cavity wall has the additional function of preventing the progress of leakage and subsequent caries. Difficulties in chemically and structurally analyzing the gradients of composition in an interface of microscopic dimensions characterize the experimental situation. The use of advanced techniques of instrumental micro-analysis and techniques of micro-visualization is our approach to the problem. With confocal laser scanning microscopy (CLSM), effects of the components of the filling material on the structure of the cavity wall can be visualized non-destructively. Surface analysis with electron spectroscopy (XPS) and micro-spot analysis with laser mass analysis (LASMA) give the information on changes of the elemental composition of the cavity wall. The effects of the filling materials on the structure of enamel are correlated with the pre-treatment of the cavity wall. XPS and LASMA give evidence that fluoride does not migrate into the enamel of the cavity wall.

Micro-rheology on (polymer-grafted) colloids using optical tweezers

Optical tweezers are experimental tools with extraordinary resolution in positioning (± 1 nm) a micron-sized colloid and in the measurement of forces (± 50 fN) acting on it-without any mechanical contact. This enables one to carry out a multitude of novel experiments in nano- and microfluidics, of which the following will be presented in this review: (i) forces within single pairs of colloids in media of varying concentration and valency of the surrounding ionic solution, (ii) measurements of the electrophoretic mobility of single colloids in different solvents (concentration, valency of the ionic solution and pH), (iii) similar experiments as in (i) with DNA-grafted colloids, (iv) the nonlinear response of single DNA-grafted colloids in shear flow and (v) the drag force on single colloids pulled through a polymer solution. The experiments will be described in detail and their analysis discussed.

Dynamics of colloids in confined geometries

We discuss the Brownian dynamics of colloids in confinement with special emphasis on the influence of the solvent dynamics. We review the derivation of a dynamic density functional theory (DDFT) including some aspects of hydrodynamic interactions and its application to the micro-rheology of suspensions. In particular we discuss the failure of Stokes' law in suspensions and non-equilibrium solvent structure mediated interactions. With regard to hydrodynamic chromatography we also discuss the stationary transport of particles in narrow channels, and the reasons for the failure of DDFT in this situation.

DDFT for Brownian particles and hydrodynamics

Classical dynamic density functional theory (DDFT) has developed into a versatile tool for describing the dynamics of overdamped Brownian particles. The underlying equilibrium density functional is a quantitative model for colloidal suspensions. Non-equilibrium properties of these systems are strongly influenced by the solvent hydrodynamics. In this paper we discuss ways to introduce certain aspects of solvent hydrodynamics into the DDFT, in particular advection by a flowing solvent and hydrodynamic interactions among suspended particles as well as with container walls.

Dynamics of nanodroplets on topographically structured substrates

Mesoscopic hydrodynamic equations are solved to investigate the dynamics of nanodroplets positioned near a topographic step of the supporting substrate. Our results show that the dynamics depends on the characteristic length scales of the system given by the height of the step and the size of the nanodroplets as well as on the constituting substances of both the nanodroplets and the substrate. The lateral motion of nanodroplets far from the step can be described well in terms of a power law of the distance from the step. In general the direction of motion depends on the details of the effective laterally varying intermolecular forces. But for nanodroplets positioned far from the step it is solely given by the sign of the Hamaker constant of the system. Moreover, our study reveals that the steps always act as a barrier for transporting liquid droplets from one side of the step to the other.

Stability of liquid ridges on chemical micro- and nanostripes

We analyze the stability of sessile filaments (ridges) of nonvolatile liquids versus pearling in the case of externally driven flow along a chemical stripe within the framework of the thin-film approximation. The ridges can be stable with respect to pearling even if the contact line is not completely pinned. A generalized stability criterion for moving contact lines is provided. For large wavelengths and no driving force, within perturbation theory, an analytical expression of the growth rate of pearling instabilities is derived. A numerical analysis shows that a body force along the ridge further stabilizes the ridge by reducing the growth rate of unstable perturbations, even though there is no complete stabilization. Hence the stability criteria established in the absence of driven flow ensure overall stability.

Motion of nanodroplets near chemical heterogeneities

We investigate the dynamics of nanoscale droplets in the vicinity of chemical steps which separate parts of a substrate with different wettabilities. Due to long-ranged dispersion forces, nanodroplets positioned on one side of the step perceive the different character of the other side even at a finite distance from the step, leading to a dynamic response. The direction of the ensuing motion of such droplets depends not only on the difference between the equilibrium contact angles on these two parts but in particular on the difference between the corresponding Hamaker constants. Therefore, the motion is not necessarily directed toward the more wettable side and can also be different from that of droplets which span the step.

Quantifying hydrodynamic slip: a comprehensive analysis of dewetting profiles

To characterize nontrivial boundary conditions of a liquid flowing past a solid, the slip length is commonly used as a measure. From the profile of a retracting liquid front (e.g., measured with atomic force microscopy), the slip length can be extracted with the help of a Stokes model for a thin liquid film dewetting from a solid substrate. Specifically, we use a lubrication model derived from the Stokes model for strong slippage and linearize the film profile around the flat, unperturbed film. For small slip lengths, we expand the linearized full Stokes model for small slopes up to third order. Using the respective model, we obtain, in addition to the slip length, the capillary number, from which we can estimate the viscosity of the fluid film. We compare numerical and experimental results, test the consistency and the validity of the models/approximations, and give an easy-to-follow guide of how they can be used to analyze experiments.

Thermal noise influences fluid flow in thin films during spinodal dewetting

Experiments on dewetting thin polymer films confirm the theoretical prediction that thermal noise can strongly influence characteristic time scales of fluid flow and cause coarsening of typical length scales. Comparing the experiments with deterministic simulations, we show that the Navier-Stokes equation has to be extended by a conserved bulk noise term to accomplish the observed spectrum of capillary waves. Because of thermal fluctuations the spectrum changes from an exponential to a power law decay for large wave vectors. Also the time evolution of the typical wave vector of unstable perturbations exhibits noise-induced coarsening that is absent in deterministic hydrodynamic flow.

Motion of nanodroplets near edges and wedges

Nanodroplets residing near wedges or edges of solid substrates exhibit a disjoining pressure induced dynamics. Our nanoscale hydrodynamic calculations reveal that nonvolatile droplets are attracted or repelled from edges or wedges depending on details of the corresponding laterally varying disjoining pressure generated, e.g., by a possible surface coating.

A thin-film model for corotational Jeffreys fluids under strong slip

We derive a thin-film model for viscoelastic liquids under strong slip which obey the stress tensor dynamics of corotational Jeffreys fluids.

Slip vs. viscoelasticity in dewetting thin films

Ultrathin polymer films on non-wettable substrates display dynamic features which have been attributed to either viscoelastic or slip effects. Here we show that in the weak- and strong-slip regime, effects of viscoelastic relaxation are either absent or essentially indistinguishable from slip effects. Strong slip modifies the fastest unstable mode in a rupturing thin film, which questions the standard approach to reconstruct the effective interface potential from dewetting experiments.

Grazing-incidence small-angle X-ray scattering from thin polymer films with lamellar structures – the scattering cross section in the distorted-wave Born approximation

Grazing-incidence small-angle X-ray or neutron scattering of thin polymer films reveals information about the ordering and preferential orientations of the phase-separated microdomains within the films. The grazing-incidence geometry enhances the surface sensitivity; however, the scattering has to be treated within the framework of the distorted-wave Born approximation. In this work, the case of thin films with lamellar mesostructure is studied, where the orientation of the lamellae is either perpendicular or parallel to the film interfaces. For perpendicular lamellae, Bragg rods are found, which are extended along the film normal, whereas for parallel lamellae, peaks along the film normal appear. The positions of the maxima present in the latter case are explained by accounting for refraction at the film surface and reflection at the film–substrate interface. The results are relevant for thin films of lamellar diblock copolymers.

A thin-film equation for viscoelastic liquids of Jeffreys type

We derive a novel thin-film equation for linear viscoelastic media describable by generalized Maxwell or Jeffreys models. As a first application of this equation we discuss the shape of a liquid rim near a dewetting front. Although the dynamics of the liquid is equivalent to that of a phenomenological model recently proposed by Herminghaus et al. (S. Herminghaus, R. Seemann, K. Jacobs, Phys. Rev. Lett. 89, 056101 (2002)), the liquid rim profile in our model always shows oscillatory behaviour, contrary to that obtained in the former. This difference in behaviour is attributed to a different treatment of slip in both models.

Fracture in mode I using a conserved phase-field model

We present a continuum phase-field model of crack propagation. It includes a phase-field that is proportional to the mass density and a displacement field that is governed by linear elastic theory. Generic macroscopic crack growth laws emerge naturally from this model. In contrast to classical continuum fracture mechanics simulations, our model avoids numerical front tracking. The added phase-field smooths the sharp interface, enabling us to use equations of motion for the material (grounded in basic physical principles) rather than for the interface (which often are deduced from complicated theories or empirical observations). The interface dynamics thus emerges naturally. In this paper, we look at stationary solutions of the model, mode I fracture, and also discuss numerical issues. We find that the Griffith's threshold underestimates the critical value at which our system fractures due to long wavelength modes excited by the fracture process.

Porous silicon formation and electropolishing

Electrochemical etching of silicon in hydrofluoride containing electrolytes leads to pore formation for low and to electropolishing for high applied current. The transition between pore formation and polishing is accompanied by a change of the valence of the electrochemical dissolution reaction. The local etching rate at the interface between the semiconductor and the electrolyte is determined by the local current density. We model the transport of reactants and reaction products and thus the current density in both, the semiconductor and the electrolyte. Basic features of the chemical reaction at the interface are summarized in the law of mass-action-type boundary conditions for the transport equations at the interface. We investigate the linear stability of a planar and flat interface. Upon increasing the current density the stability flips either through a change of the valence of the dissolution reaction or by a nonlinear boundary condition at the interface.

PR-1 protein inhibits the differentiation of rust infection hyphae in leaves of acquired resistant broad bean

Treatment of broad bean leaves with salicylic acid (SA) or 2, 6-dichloro-isonicotinic acid (DCINA) induces resistance against the rust fungus Uromyces fabae resulting in reduced rust pustule density. Light-microscopy studies showed that in induced resistant plants the rust fungus is inhibited immediately after penetration through the stomatal pore. The differentiation of infection structures growing within the intercellular space of the leaf, i.e. infection hyphae and haustorial mother cells, is inhibited. Furthermore, low-temperature scanning electron microscopy studies of freeze fractures revealed protrusions at the tips of infection hyphae growing in induced resistant broad bean leaves. Treatment of in vitro-differentiating rust infection structures with intercellular fluids (IFs) from induced resistant plants confirmed that the fungus is sensitive towards an apoplastic anti-fungal activity only after having formed appressoria. Other legume rusts such as U. vignae and U. appendiculatus were likewise inhibited in the presence of IF from SA-treated broad bean leaves. Heterologous antibodies were used to study changes in the extracellular pathogenesis-related (PR) protein pattern after resistance induction. Western blots indicated that chitinases and beta-1,3-glucanases were present in both induced and control plants. In contrast, PR-1 proteins were newly synthesized in response to SA or DCINA application. The major induced PR-1 protein was purified and exhibited strong differentiation-inhibiting activity towards U. fabae infection structures. We conclude that the inhibition of rust infection hyphae in acquired resistant broad bean plants is mainly due to the anti-fungal activity of this induced basic PR-1 protein.

[Pulmonary arterial hypertension and primary biliary cirrhosis]

The authors report a case of the association of primary biliary cirrhosis and pulmonary hypertension presenting with syncopal complete atrioventricular block. The clinical, aetiopathological and therapeutic aspects of this pathology are reviewed with special emphasis on the value of early diagnosis of the pulmonary hypertension in cases of unusual dyspnoea in patients with primary biliary cirrhosis especially those of an age when they could benefit from liver-heart-lung transplantation.

[Total permanent auricular paralysis. Review of the literature apropos of 109 cases]

Analysis of 109 well documented cases of permanent total atrial paralysis reported in the literature illustrated the features of this arrhythmia which is a well defined entity consisting of suppression of all electrical and mechanical activity of both atria lasting for more than 6 months. Standard electrocardiogram reveals junctional bradycardia of about 40 bpm without any visible P waves and narrow supraventricular QRS complexes in 80% of cases. This diagnosis can only be confirmed by meticulous bipolar endocavitary recordings exploring all atrial walls without recording an auriculogram and by right intra-atrial and coronary sinus stimulation which proves to be ineffective. This disease has a male predominance in two-thirds of cases and a familial nature in 18% of cases. Seventy one per cent of affected subjects are under the age of 50 years. In 33% of cases, it is associated with Emery-Dreifuss muscular dystrophy, in which it constitutes a specific sign allowing this dystrophy to be differentiated from all other forms, especially facio-scapulo-humeral myopathy, and in 30% of cases, it is associated with a degenerative disease such as diabetes, amyloidosis or primary cardiomyopathy. Idiopathic dilatation of the right atrium is revealed in 15% of cases. The arrhythmia is responsible for syncope or faintness in 31% of cases, cerebral vascular accidents in 21% of cases and heart failure in 35% of cases. Cardiac activation is dependent on a junctional escape rhythm. The mechanism of the lesion responsible is atrial fibrosis which may extend to the sinoatrial node. The treatment of choice consists of implantation of a VVI or VVIR mode cardiac pacemaker in combination with anticoagulant therapy.

[Acute respiratory distress syndrome in the initial phase of myocardial infarction in adults]

Four patients developed an acute respiratory distress syndrome characterised by clinical and radiological signs of pulmonary oedema, a protein-rich oedema, severe hypoxemia refractory to oxygen therapy, contrasting with normal left ventricular filling pressures and indicating increased permeability of the alveolo-capillary membrane, 24 to 72 hours after the onset of acute myocardial infarction. After having excluded the usual causes of the acute respiratory distress syndrome, the authors suggest that acute myocardial infarction, especially when extensive, may cause a lesion of the alveolo-capillary membrane by an unknown mechanism. Treatment consisted in mechanical ventilation with positive expiratory pressures in 3 cases and with continuous positive pressure during spontaneous respiration in the third patient and in relay with controlled ventilation in the other two. These techniques of ventilation improved the hypoxemia and led to complete cure in all cases without evolution to pulmonary fibrosis. In addition to mechanical ventilation, all patients were given systematic antibiotic therapy because of the possibility of an infectious etiology while waiting for the results of microbiological and serological testing and because of the high risk of superinfection which plays an essential part in the outcome of the condition. The immediate response to treatment was favourable in all cases. One patient died suddenly of cardiogenic shock two weeks after this episode. The other patients are still alive 39, 38 and 20 months after infarction. The importance of the diagnosis of the acute respiratory distress syndrome in the acute phase of myocardial infarction resides in its therapeutic implications which are quite different to those of cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

[Annulo-aortic ectasia]

On the basis of a literature review and the study of 18 cases, the authors examine annuloaortic ectasia, which involves dilatation of the fibrous ring of the heart at the aortic orifice, marked by aortic regurgitation and dystrophic aneurysm of the ascending aorta. The authors noted a predominantly muscular disorder (14 males, 4 females) often detected from an assessment of aortic regurgitation without clinical, radiologic or specific electrical features. The value of echocardiography and Doppler echocardiography is clearly apparent from the diagnosis of the disease, monitoring of progress, selection of patients for invasive pre-operative explorations and post-operative surveillance. The developing gravity of this disease is stressed, rapid repercussions in the left ventricle intervening more than complications due to ectasia itself. This indicates the urgency of complete replacement of the whole ascending aorta and of the aortic valve with reimplantation of coronary arteries as in the Bentall or Bentall-Cabrol surgical intervention, seven cases of which have been reported with satisfactory results.

[Evaluation of left ventricular function by external methods. Comparative study of systolic intervals and apexcardiography]

In a number of conditions characterised by major disturbance of myocardial contractility (15 cases of thyrotoxicosis, 18 of hypokinetic cardiomyopathy and 9 of hypertrophic cardiomyopathy), the authors have compared the results of measuring the systolic intervals as derived from the quotient PPE/TE with an analysis of the upstroke of the apex electrocardiogram derived from measurement of the t-da/dt interval and from the quotient da/dt/A. The quotient PPE/TE is markedly lowered in the hypokinetic cardiomyopathies. On the other hand this quotient does not differentiate between normal subjects and patients with thyrotoxicosis or hypertrophic cardiomyopathy. By contrast the measurements derived from the electrocardiogram, and especially the quotient da/dt/A, differentiate very clearly between the various pathological conditions.

[Carcinoid of the small intestines with right cardiac involvement. Clinical, phonomechanographical hemodynamic and anatomical study]

The authors report a case of carcinoid of the small intestine with liver metastases in whom the entire right side of the heart was affected, with severe tricuspid incompetence and pulmonary stenosis. The extent of the fibrosis, which affected all three layers of the heart on the right side has lead the authors to reconsider the various factors which cause the heart failure in carcinoid syndrome. This must now be included in the wider category of APUD. The severity of the tricuspid lesions compared with the derangement of the valvular and subvalvular structures makes an argument in favour of surgical correction.