Determinants promoting and hindering physical activity in primary school children in Germany: a qualitative study with students, teachers and parents

Background

Determinants affecting children's physical activity (PA) at an early age are of particular interest to develop and strengthen strategies for increasing the levels of children's PA. A qualitative study was conducted to investigate the views of primary school-aged children, their teachers and parents regarding barriers and facilitators to engage in PA.

Methods

Focus groups were conducted separately with primary school children, parents and teachers in a city in Northern Germany between October 2021 and January 2022. The semi- structured focus groups with children and teachers took part in person within school, whereas the focus groups with parents took place online. Data were transcribed verbatim and analysed using thematic analysis. During analysis, the socio-ecological model was identified as useful to map the determinants mentioned and was consequently applied to organize the data.

Results

Teachers (n = 10), parents (n = 18) and children (n = 46) of five primary schools in Germany participated in the focus groups. Participants of the three groups identified similar barriers and facilitators of PA in primary school-aged children, ranging across all four layers of the socio-ecological model. The barriers encountered were the preferences of children for sedentary activities (individual characteristics), the preference of parents to control their child's actions (microsystem), a lack of financial resources from parents and long sitting times in class (mesosystem), and barriers related to rainy weather and Covid-19 restrictions (exosystem). Facilitators mentioned were the childrens' natural tendency to be active (individual characteristics), involvement and co-participation of parents or peers in engaging in PA, support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities and favorable weather conditions (exosystem).

Conclusion

A range of determinants promoting and hindering PA, ranging across all layers of the socio-ecological model were identified by children, parents and teachers in this study. These determinants need to be kept in mind when developing effective PA intervention programs for primary school-aged children. Future interventions should go beyond individual characteristics to also acknowledge the influence of childrens' social surrounding, including parents, peers and teachers, and the wider (school) environment.

Use of a toolbox of tailored evidence-based interventions to improve children's physical activity and cardiorespiratory fitness in primary schools: results of the ACTIPROS cluster-randomized feasibility trial

BACKGROUND

School-based physical activity (PA) promotion is usually conducted by providing one specific intervention. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) toolbox provides a set of twelve evidence-based PA interventions serving different domains of the Health Promoting Schools framework that primary schools can select according to their requirements. In this study, we tested the feasibility of the toolbox approach in primary schools.

METHODS

A two-arm cluster-randomized feasibility trial at primary schools (n = 5 intervention schools [IS], n = 5 control schools) located in the Federal State of Bremen, Germany, was conducted. Children's habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Oct 2021 and July 2022, the ACTIPROS toolbox was implemented at IS. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1.

RESULTS

IS successfully implemented at least one intervention of the toolbox. In total, seven out of twelve possible interventions were selected. Two schools decided to replace an intervention with another during the trial. Results of the SIQ indicated that IS tended to choose similar interventions while implementation frequency was highly different. N = 429 students from two classes per school were recruited. The mean consent rate was 75.1% (n = 322). At t0 and t1, n = 304 (94.4%) and n = 256 (79.3%) of consented children took part in the DMT, respectively. The accelerometry sample included one class per participating school. At t0 and t1, n = 166 and n = 151 devices were handed out to students and n = 133 (80.1%) and n = 106 (70.2%) valid records could be retrieved, respectively. Linear mixed models showed an intervention effect of 15.5 min (95% CI: 4.5; 26.6) in children's daily MVPA at IS between t0 and t1 compared to controls.

CONCLUSIONS

All IS were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner, highlighting the feasibility of implementing the ACTIPROS toolbox. Good consent rates for accelerometer and motor skills data were achieved. Results indicate a substantial increase in MVPA associated with the ACTIPROS toolbox and need to be tested in a larger sample.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00025840.

How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists

BACKGROUND

The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation.

METHODS

We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories.

RESULTS

The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being 'free of costs', 'longevity' and 'integration into everyday school life'. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being 'efficacy', 'potential for reach' and 'feasibility'. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to 'evidence'.

CONCLUSIONS

Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions.

A scoping review on characteristics of school-based interventions to promote physical activity and cardiorespiratory fitness among 6- to 10-year-old children

Physical inactivity, a leading cause of mortality, tracks from childhood to adulthood. Effective interventions to promote physical activity (PA) at a young age are therefore needed. The aim of this scoping review was to provide an overview of school-based interventions for the promotion of PA, cardiorespiratory fitness (CRF), and the reduction of sedentary behaviours (SB) among six- to ten-year-old school children, and map these interventions to the WHO Health Promoting Schools framework. Arksey and O'Malley's scoping review methodology framework guided the conduct of this review. A systematic electronic search of six databases was combined with a hand search of reference lists to retrieve studies published between 2010 and 2019. Data extraction included information on study and intervention characteristics, effectiveness on PA, SB and CRF outcomes, and features of the WHO HPS framework. 192 papers investigating 178 interventions were included. The majority of the identified interventions were single feature interventions (n = 84, 47%) while none of them encompassed all six features of the HPS framework. 'Health skills and education' (n = 104, 58%) was the most frequent feature followed by 'Links with parents or community' (n = 95, 53%). A higher percentage of effective interventions were found for theory-based interventions. Some single-feature interventions were found to be effective while no specific feature combination seemed to be associated with better intervention effectiveness. Theory-based single- as well as multi-feature interventions seem to have the potential to improve effectiveness with regard to PA, CRF, and SB outcomes.

Protocol for a scoping review to identify and map intervention components of existing school-based interventions for the promotion of physical activity and cardiorespiratory fitness among school children aged 6-10 years old

INTRODUCTION

Physical inactivity is known as a leading cause of mortality and tracks from childhood to adulthood. Many types of school-based single-component and multicomponent interventions to promote physical activity (PA) have been undertaken and evaluated, with mixed findings overall. Enlarging the intervention areas beyond the school setting is a promising approach. WHO's Health Promoting School (WHO HPS) framework is a holistic, setting-based approach where health is promoted through the whole school environment with links to other settings such as the home environment and wider community. In this paper, we outline our scoping review protocol to systematically review the published literature from the last 10 years to identify existing school-based interventions to promote PA and cardiorespiratory fitness among children aged 6-10 years old and to map intervention components according to the features of this framework.

METHODS AND ANALYSIS

Arksey and O'Malley's scoping review methodology framework will guide the conduct of this review. We will search Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sports Medicine & Education Index, Education Resources Information Centre and CENTRAL and hand search the reference lists of key studies to identify studies appropriate for inclusion. Any empirical study that evaluated the effectiveness of a school-based intervention promoting PA and/or cardiorespiratory fitness in children aged 6-10 years old will be included. Two reviewers will independently screen all abstracts and full texts for inclusion. One reviewer will extract general information, study characteristics and intervention contents to classify them according to the features of the WHO HPS framework. Results will be synthesised narratively.

ETHICS AND DISSEMINATION

Findings will be disseminated in conference presentations and peer-reviewed publications. A condensed version of the results will be made available for the public. Stakeholder meetings will be arranged to discuss and disseminate the findings.

Prescription of diamorphine, dipipanone and cocaine in England and Wales

The vast majority of substitute prescribing to opiate addicts in England and Wales is of oral methadone. The prescription of diamorphine, dipipanone and cocaine to addicts is allowed subject to the 1971 Misuse of Drugs Act. Prescription of these drugs has aroused international interest and controversy in the United Kingdom although research is scanty. This report is a description of the current attitudes about, and practice of, prescribing diamorphine, dipipanone and cocaine by medical practitioners in the addiction field in England and Wales. A questionnaire was devised and sent to drug services in England and Wales which provided a prescribing service. Among respondents who reported that they currently hold a licence for heroin, dipipanone or cocaine, the number of patients treated by each doctor varied widely; from a handful of patients to 100 heroin patients. Dosage currently used ranged from a minimum of 10 mg to a maximum of 1000 mg daily for heroin. Doses of dipipanone were lower. More respondents thought that heroin and dipipanone were clinically justified in some situations than thought that they should never be prescribed, while the opinions were reversed in the case of cocaine.

Pathways into receiving a prescription for diamorphine (heroin) for the treatment of opiate dependence in the United kingdom

In the UK, few doctors prescribe diamorphine for the treatment of opiate dependence to a small number of patients. A retrospective case note review of patients receiving diamorphine in 2000 was conducted in the UK to determine how and why these patients came to receive a prescription for diamorphine. Patient eligibility criteria were examined together with doctors' stated reasons for initiating a diamorphine (heroin) prescription. Two hundred and ten sets of patients' case notes were reviewed at 27 of the 42 (64%) drug clinics in England and Wales where diamorphine was prescribed by the doctor. There appeared to be a general consensus among the few doctors who had prescribed diamorphine that it was a treatment of last resort, for those with long histories of heroin use and injecting, and those who had not responded sufficiently well to previous other treatments. However, there was also a small number of patients initiated on diamorphine without ever having previously received opiate treatments and some because they were experiencing problems injecting methadone. This reflects the UK history of the individual doctor's clinical autonomy in deciding when diamorphine is appropriate and the previous lack of nationally agreed patient eligibility criteria.

Patients receiving a prescription for diamorphine (heroin) in the United Kingdom

The United Kingdom is unusual internationally in that it is one of few countries able to prescribe diamorphine for the treatment of opiate dependence. Prescribing diamorphine has been part of the UK response to drug problems since the 1920s. Despite this, little is known about who receives diamorphine and how treatment is delivered. This study aims to describe the characteristics and treatment regimes of opiate-dependent drug users receiving a prescription for diamorphine in the United Kingdom in 2000, and report on their status in 2002. A retrospective case-note review was conducted in England and Wales. Two hundred and ten (72%; 210/292) patients' sets of case-notes were reviewed at 27 of the 42 (64%) drug clinics where diamorphine was prescribed by the doctor. Patients had been receiving a prescription for diamorphine for a median length of six years. The majority were unemployed white males, with a median age of 44 years. Illicit drug use and criminal activity, while low, had not been eliminated totally. The majority were prescribed ampoules and few had significant health problems. In some cases patients had been transferred to injectable diamorphine from injectable methadone to reduce injection related problems. There were wide variations in dose. The majority of patients had no serious drug, health or social problems. Diamorphine prescribing was a long-term commitment. The experience from the United Kingdom has been one of long-term prescribing with the aim of retaining patients in treatment and reducing the harms caused by illicit drug use. Prospective studies are needed to determine the long-term consequences of receiving a diamorphine prescription.

Neuromuscular assessment in elderly workers with and without work related shoulder/neck trouble: the NEW-study design and physiological findings

Musculoskeletal disorders in the neck and shoulder area are a major occupational concern in the European countries especially among elderly females. The aim was to assess these disorders based on quantitative EMG indicators and functional tests. 252 female computer users (45-68 years) were recruited from four European countries in two contrast groups: (1) 88 neck/shoulder (NS) cases reporting trouble in the neck and/or shoulder region for more than 30 days during the last year, and (2) 164 NS-controls reporting such trouble for no more than 7 days. Questionnaires, functional/clinical tests, and physiological recordings were performed in workplace related field studies. The results showed no differences in anthropometrics but NS-cases reported more strained head positions and more eye problems than controls. The psychosocial working factors were similar, although, NS-controls had slightly better scores on working conditions, general health, and vitality compared to cases. The NS-cases had lower maximal voluntary contraction (MVC) during shoulder elevation (mean (SD) 310 (122) N) compared to the controls (364 (122) N). During 30% MVC electromyography (EMGrms) in the trapezius muscle was lower in NS-cases (194 (105) muV) than in controls (256 (169) muV), while no differences were found regarding endurance time. Estimated conduction velocity was not different between NS-cases and -controls. Four functional computer tests were performed equally well by NS-cases and -controls, and the corresponding EMG variables also did not differ. A major finding in this large-scale epidemiological study is the significantly lower MVC in NS-cases compared with NS-controls together with lower EMGrms value at 30% MVC, while computer tasks were performed at similar relative muscle activation. The study was unable to reveal quantitative EMG indicators and functional tests that could objectively assess disorders in NS-cases.

A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses

AIMS

To evaluate the effect of an intervention to reduce work related skin problems in gut cleaning departments in Danish swine slaughterhouses. The intervention consisted of an evidence based prevention programme and a documented method for implementation.

METHODS

Randomised controlled intervention study with a one year follow up. The intervention included educational activities and evidence based recommendations. The effect of the intervention was evaluated by telephone interviews using a standardised questionnaire based on the Nordic Occupational Skin Questionnaire (NOSQ-2002) with modified and additional questions on exposure, preventive measures, information, and discussions on prevention of skin problems, etc.

RESULTS

A total of 644 (87.5%) responded at the baseline interview and 622 (71.6%) at the one year follow up interview. A total of 495 participated in both interviews (67.3%). In the intervention departments the frequency of eczema on hands or forearms within the past three months at follow up was reduced significantly from 56.2% at baseline to 41.0% at follow up, while a slight non-significant increase was observed in the comparison departments (from 45.9% to 50.2%). The intervention activities resulted in more frequent use of protective gloves in general and the use of cotton gloves worn underneath rubber and plastic gloves. At follow up three times as many in the intervention departments used the recommended high fat skin care products introduced as part of the intervention activities. At follow up, discussion of skin problems was increased in the intervention group while no changes were observed in the comparison group.

CONCLUSIONS

A significant 27% relative reduction of occupational eczema in a high risk group was feasible through implementation of an evidence based prevention programme.

Addiction

Addiction to tobacco, alcohol and drugs is a major problem. Dependence and problem drug use are now defined syndromes and their psychological, genetic and brain mechanisms are being elucidated. Social policy can influence the consumption of drugs and treatment strategies are becoming more effective.

Skin cancer attitudes: a cross-national comparison

A questionnaire concerning attitudes towards skin cancer, sun exposure and general environmental issues was administered to 132 holiday-makers on a beach in south-west England and (in translation) to 142 visitors to another beach in north-west Italy. Following the Janis & Mann (1977) classification of strategies for coping with decision conflicts, subscales were derived measuring tendencies to 'avoid' thinking about environmental issues, to 'bolster' prior attitudes (by playing down the seriousness of the risk of skin cancer while attending to the pleasures of sunbathing), and to be 'vigilant' concerning risk information and the need for specific protective behaviour (e.g. sunscreen use). The British scored higher than the Italians, and women higher than men, on vigilance, but there were no gender or nationality differences on the other subscales considered as a whole. Responses were also related to the covariates of age and self-reported vulnerability to sunburn. Those who showed less concern with environmental issues also tended to play down the risks of skin cancer and be less vigilant with regard to self-protection. It is suggested that health promotion should address both cultural norms concerning exposure to the sun and people's intuitive notions about their relative personal vulnerability.

Communicating the diagnosis of lung cancer

In order to assess their reaction to the information given, 50 patients underwent a semi-structured interview with a social worker within 1 week of having been told the diagnosis of lung cancer. There were 32 men and 18 women with a mean age of 63 (range 38-82) years. Thirty-eight (76%) belonged to Registrar General social class IV or V, and 45 (90%) had left school at the age of 15 years. Two patients were unaware of the diagnosis despite having been told that they had lung cancer. Two patients would have preferred not to have been told the diagnosis and two were unsure, while 46 (92%) felt that telling them the diagnosis truthfully had been correct. No patient felt that they had been given too much information, but 13 (26%) indicated a lack of information about prognosis. Despite being told 'bad news', 31 (62%) felt more reassured after their interview with the doctor, 5 (10%) felt less reassured, and 14 (28%) were uncertain. Twenty-one (42%) patients were experiencing a sense of guilt or regret at having smoked. Many patients had concerns about specific symptoms which they expected to suffer. In general, patients wanted to be told their diagnosis truthfully and required a high level of information. Many patients felt reassured by the discussion of such details.

The effect of dementia on acute care in a geriatric medical unit

Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients. Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an admitting diagnosis, even though it may have been the proximate cause of the medical morbidity which led to the acute hospitalization. In addition, despite the significant impact of dementia on the hospital course and costs, it was a factor in hospital reimbursement in less than one third of cases. The results indicate that dementia was not considered to be an acute diagnosis, nor was it recognized as a complex medical illness. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.

AIDS in the elderly: a case and its implications

Although acquired immunodeficiency syndrome (AIDS) remains relatively uncommon in the elderly, there are serious and unique implications associated with the diagnosis of AIDS in this age group. The most common mode of transmission is transfusion. With the growing number of elderly, an increase in AIDS in the elderly will occur despite improved screening methods. Dementia is a serious morbidity associated with AIDS in the elderly, which presents considerable diagnostic and ethical dilemmas. A case is presented which illustrates the geriatric multidisciplinary team approach to the care of a 90-year-old man with AIDS.

MAST-associated compartment syndrome (MACS): a review

Compartment syndromes occur following lower extremity injuries and have been associated with the use of pneumatic or "medical" antishock trousers (MAST). Review of 12 previously reported cases and 15 new cases suggests that lower extremity trauma and systemic hypotension are cofactors responsible for the development of compartment syndrome but MAST use also contributes to the process by prolonging muscle ischemia. Complications of lower limb compartment hypertension may be averted by early recognition and fasciotomy. Associated amputations and mortality are directly related to the severity of injury, or indirectly to delay in diagnosis and treatment of the compartment syndrome and its complications.