Background: The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. Objectives: The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. Methods: The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7–17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. Results: Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. Conclusions: The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention.

Das Hauptanliegen meines Forschungsprojektes war die erneute Untersuchung der aus dem späten 3. bis 7. Jahrhundert n. Chr. stammenden griechischen medizinischen Papyri, die zwischen 1913 und 1914 hauptsächlich an einem Ort in der ägyptischen Stätte von Antinoopolis gefunden wurden. Antinoopolis bietet die Gelegenheit, diesen Dokumenten einen archäologischen Kontext zu geben, zumal die vorliegende geographische und chronologische Kontinuität einen detaillierten Vergleich der durch diese Quellen konservierten Daten begünstigt. Das Interesse an Antinoopolis aus medizinhistorischer Perspektive ist durch die diversen Heilpraktiken begründet, die von den dokumentarischen, literarischen und archäologischen Beweisstücken bezeugt werden, und deren Quantität und Bandbreite für ein ägyptisches Dorf außergewöhnlich sind. Das Ziel meiner Forschung an den Papyri ist sowohl philologischer als auch kulturhistorischer Natur. Erstens habe ich versucht, die Manuskripte wissenschaftlich zu präsentieren und ihre Eigentümlichkeiten, Charakteristika und Funktionen zu diskutieren. Ich wollte unser Verständnis dieser Fragmente durch die Identifizierung neuer Textabschnitte, die Integrierung von Textzusätzen und eine genauere Untersuchung ihrer formellen Struktur verbessern, was zu einer überarbeiteten Edition einiger ausgewählter Papyri führte. Darüber hinaus habe ich versucht, zum besseren Verständnis des allgemeinen Umfeldes dieser ägyptischen Gemeinschaft, besonders in Bezug auf religiöse Heilpraktiken im Zusammenhang mit der heiligen Stätte des Collouthus beizutragen, und die historischen und kulturellen Gegebenheiten zu untersuchen, in denen diese Texte genutzt wurden. Schlussendlich untersucht meine Forschung die Entwicklung des Kodex im Allgemeinen über den Zeitraum der späten Antike, die an verschiedenen Aspekten beobachtet werden kann. Eine der interessantesten Fragen dabei ist, wie die Texte gesammelt und präsentiert wurden, d.h. der Zusammenhang von Aufbewahrung der Papyri und ihrem Textinhalt. / The main aim of my research project was to re-examine the Greek medical papyri from the Egyptian site of Antinoopolis dating between late 3rd up to 7th century AD, discovered mostly in a single area between 1913 and 1914. Antinoopolis offers the potential for putting documents into an archaeological context, and this geographical and chronological consistency facilitates a close comparison between the data preserved in these sources. The interest in Antinoopolis, as far as the medical tradition is concerned, lies in the diverse healing practices attested by documentary, literary and archaeological evidence whose quantity and range is altogether exceptional among Egyptian villages. The objective of my research is both papyrological-philological and cultural-historical. Firstly, I have tried to present the manuscripts and discuss their peculiarities, characteristics and functions. I have sought to improve our understanding of these fragments through the identification of new portions of text, the integration of supplements and a better assessment of their formal arrangement, which resulted in the revised edition of a few outstanding papyri. In addition to this, I have tried to contribute to the evaluation of the general context of this Egyptian community, particularly as regards religious healing practices connected to the sanctuary of Collouthus, and to explore the historical and cultural circumstances in which these texts were used. Finally, my research investigates the development of the codex throughout late Antiquity, which can be observed in a number of respects. One of the most significant concerns how the texts were assembled and presented, namely the interplay between container and content.

Resting heart rate (RHR) is positively related with mortality. Regular exercise causes a reduction in RHR. The aim of the systematic review was to assess whether regular exercise or sports have an impact on the RHR in healthy subjects by taking different types of sports into account. A systematic literature research was conducted in six databases for the identification of controlled trials dealing with the effects of exercise or sports on the RHR in healthy subjects was performed. The studies were summarized by meta-analyses. The literature search analyzed 191 studies presenting 215 samples fitting the eligibility criteria. 121 trials examined the effects of endurance training, 43 strength training, 15 combined endurance and strength training, 5 additional school sport programs. 21 yoga, 5 tai chi, 3 qigong, and 2 unspecified types of sports. All types of sports decreased the RHR. However, only endurance training and yoga significantly decreased the RHR in both sexes. The exercise-induced decreases of RHR were positively related with the pre-interventional RHR and negatively with the average age of the participants. From this, we can conclude that exercise—especially endurance training and yoga—decreases RHR. This effect may contribute to a reduction in all-cause mortality due to regular exercise or sports.

Malaria Impfstoffkandidaten, welche Sicherheit und Wirksamkeit gegen prä-erythrozytische Stadien bieten, sind nach wie vor in der Entwicklung. Experimentelle Immunisierungsstudien mit genetisch attenuierten Parasiten (GAP), welche die Entwicklung über das klinisch asymptomatische Leberstadium hinaus verhindern, erwiesen sich als sicher und effizient. ΔSLARP GAP-Sporozoiten arretieren vollständig in der Leber, bieten jedoch keinen langanhaltenden Schutz. Hingegen zeigen Immunisierungen mit ΔP36p/P36 Sporozoiten einen langanhaltenden Schutz, führen jedoch während der Immunisierung gelegentlich zu Blutstadieninfektionen. Diese Studie liefert eine systematische vorklinische Bewertung eines dreifachen KO GAP-Parasiten, durch die Kombination von ΔSLARP und ΔP36p/P36. KO Parasiten arretierten vollständig in vitro und in vivo, aber der zeitnahe Blutinfektionsbeginn nach einer Sporozoiteninfektion in Mäusen zeigte eine verminderte Wirksamkeit des Impfstoffs. Während ein besserer Schutz durch einen späten Leberstadien Entwicklungsstillstand erreicht werden kann, bleiben die zugrundeliegenden molekularen Mechanismen unklar. Eine Vorrausetzung für die Leberzellen Antigenpräsentation ist die Präsenz von parasitären Antigenen im hepatozyten Zytoplasma. Der Proteinexportkomplex PTEX ist in Leberstadien nicht vollständig funktionstüchtig, da das essentielle Hitzeschockprotein 101 (HSP101) nicht exprimiert wird. Um die Rolle von HSP101 für den Leberproteinexport zu klären, wurden transgene HSP101 exprimierende Parasiten erzeugt. Transgene Parasiten weisen in vitro und in vivo schwere Wachstumsstörungen im Leberstadium auf und bieten keinen Impfschutz. Die Ergebnisse legen nahe, dass die Expression von HSP101 streng kontrolliert wird und der Export im frühen Leberstadien nicht wiederhergestellt werden kann. Insgesamt können prä-klinische Studien und die Weiterentwicklung von GAP-basierten Impfstoffkandidaten die laufenden humanen Impfstoffstudien beeinflussen und vorantreiben. / Malaria vaccine candidates providing both safety and efficacy against pre-erythrocytic stages remain largely elusive. Experimental immunizations with live genetically attenuated parasites (GAPs) preventing the development beyond the clinically silent liver stage have proven safe and efficacious. GAP vaccine candidate ΔSLARP, provides the most robust life cycle arrest, however, immunizations do not elicit long-lasting immunity. In contrast, ΔP36p/P36 sporozoites elicit long-lasting immunity, but lead to breakthrough infections during immunizations. This study gives a systematic pre-clinical evaluation of a triple knockout (tKO) GAP by combining ΔSLARP and ΔP36p/P36. Complete arrest of tKO parasites in cultured hepatoma cells and sporozoite-infected mice was confirmed, but time to blood infection after a sporozoite challenge revealed reduced efficacy of the tKO vaccine. While superior immunity can be achieved by a late developmental arrest at liver-to-blood stage conversion, the underlying molecular mechanisms remain elusive. An important question is whether parasite antigens are exposed to the hepatocyte cytoplasm. Protein translocation into the host cell cytoplasm mediated by PTEX, a protein translocon, is absent during liver stage maturation as a core component of PTEX, Heat-shock-protein 101 (HSP101), is not expressed. To clarify the role of HSP101 in liver stage protein export transgenic HSP101 expressing Plasmodium berghei parasites were generated. Parasites expressing elevated levels of HSP101 show severe liver stage growth defects in vitro and in vivo, lack early liver stage export and inferior protection in immunized animals. Our results suggest that HSP101 expression is tightly controlled and PTEX dependent early liver stage export cannot be restored solely by HSP101 overexpression. Overall, pre-clinical analysis and improvement of GAP-based vaccine candidates can inform on-going human vaccine trials and boost malaria vaccine development.

Alcohol use is one of the top five causes of disease and disability in almost all countries in Europe, and in the eastern part of Europe it is the number one cause. In the UK, alcohol is now the leading cause of death in men between the ages of 16–54 years, accounting for over 20% of the total. Europeans above 15 years of age in the EU on average consume alcohol at a level which is twice as high as the world average. Alcohol should therefore be a public health priority, but it is not. This paper puts forward a new approach to reduce alcohol use and harms that would have major public health and social impacts. Our approach comprises individual behaviour and policy elements. It is based on the assumption that heavy drinking is key. It is simple, so it would be easy to introduce, and because it lacks stigmatising issues such as the diagnosis of addiction and dependence, it should not be contentious.

Sie finden in dieser Broschüre gebündelte und praxisnahe Informationen zu den Themen Aktives Altern, Wohnen im Alter, Alltagserleichterungen, Gesundheit, Demenz, Pflege und Vorsorgeregelungen im Landkreis Meißen.

There are significant differences between developed countries and developing countries in education, life style and health behaviour to identify the effects of the standard of living in both countries on social and health aspects. Information on the negative and positive aspects of every culture is essential in the overall health context to enable policy makers to improve the populations’ general health. The aim of this study was therefore to determine the health and fitness status of sport science students in Germany and Egypt and to identify any relevant differences in these two populations in order to derive possible strategies to promote health in a higher education setting in both countries. The sample of this study was selected from university students as they represent the future elite of companies, communities and countries. 193 students were selected from Germany as a developed country - females (n = 104) and males (n = 89) and 406 were selected from Egypt as a developing country - females (n = 167) and males (n = 238). Sport science students firstly filled in a health questionnaire, and then they participated in anthropometric and fitness tests. The data collection was first contucted on German sport science students at Chemnitz University of Technology in October 2009 (one week). In November 2010 the second year (third and fourth term) sport science students of Menofia University (two weeks). In the comparison between Germany and Egypt in the General health section the results showed that there are significant differences between the German group and the Egyptian group in describing their health status (p = .044) and in looking after their health (p = .000) in females. However, in the male group of both countries no significant difference was found regarding the item looking after their health (p = .370). The overall comparison between the German sample (both genders) and the Egyptian sample (both genders) show that there are significant differences in the items describing their health status (p ≤ 0.05) as well as in looking after their health care (p = .000). In the physical and mental health comparison there is no significance difference in the “chronic pain” section in German females and Egyptian females and German and Egyptian males (p ≥ 0.05), while there are significant differences in all other items (p ≤ 0.05). In the German sample comparison of both genders there are no significant differences in: “Stomach problems”, “Abdominal discomfort”, “Weight loss/weight gain/loss of appetite” whereas there are significant differences in all another items (p≤ 0.05). In the Egyptian group there are significant differences in all another items (p≤ 0.05) except for “Weight loss/weight gain/loss of appetite”. In study and university related problems between Germay and Egypt in both genders, there is no significant difference in the item “problems during study” while there are significant differences in all other items (p≤ 0.05). In the Egyptian group, both gender comparisons show no significant differences in the items: “social isolation”, and the same prospects about “working conditions”. However, there are significant differences in all another items (p≤ 0.05). In the German group in the same context no significant differences were found (p ≥ 0.05). The comparison between Germany and Egypt in the nutrition section showed significant differences in all food types (p≤ 0.05), whereas in the German group there is a significant difference between females and males (p≤ 0.05), and in the Egyptian group there is no significant difference in Healthy food consumption (p ≥ 0.05). The results in the media usage section show a significant difference regarding the media usage behaviour between the German group and the Egyptian group and in the comparison between German group of both genders, and the Egyptian group comparison of both genders where (p ≤ 0.05). Regarding the fitness tests section the results prove that there are significant differences in all tests among the German and the Egyptian group (p≤ 0.05), except in the static pull ups test between German males and Egyptian males (p ≥ 0.05). Significant correlations were found between one of the food types (unhealthy food), some between physical and mental health problems and BMI. There are significant correlations between some items of study and university related problems, and food types and blood pressure, and between fat %, VO2max, and physical activity. A significant link between bad dietary habits in regards to healthy food consumption and students’ own health assessment in Germany was found (95% CI below = 0.10, 95% top = 0.99) with OR = 0.10 and in Egypt (95% CI below = 0.35, 95% CI top = 0.92) with OR = 0.56. Another significant link between a reduced health consciousness and insufficient physical activity in Germany (95% CI below = 0.06, 95% CI top = 0.99) was proven with OR = 0.24. The key results from this study can be summarised in the following points: 1) There is a significant difference between German and Egyptian students in health parameters. 2) Egyptian students have significantly more physical and mental health problems than their German counterparts. 3) The Egyptian students present significantly more study and university related problems compared to German students. 4) The Egyptian students show a significantly higher media usage. 5) Egyptian students participate significantly less in physical activity and therefore perform significantly less well in most fitness test parameters. 6) A high correlation was found between the anthropometric data and some physical and mental health problems as well as study and university related problems and food types. Furthermore, a high correlation between VO2max and physical activity could be identified. 7) Significant link between bad dietary habits in regards to healthy food consumption and their own health assessment. 8) Significant link between a reduced health consciousness and insufficient physical activity. It is evident from this study that there are significant differences between the developed country Germany and the developing country Egypt in regards to general well-being, health problems, which in some parameters is also gender specific in Egypt, physical activity and fitness. The aim of this study was to identify these differences in order to direct future interventional studies in this area as a next step in improving the health of students in different countries. This information could potentially aid policy makers in improving the infrastructure in health care and physical activity and thereby change and/or develop society. / Es gibt signifikante Unterschiede zwischen Industrieländern und Schwellenländern bzgl. Bildung, Lebensstil und gesundheitsbezogenes Verhalten. Daher sind Informationen über die negativen und positiven Aspekte jeder Kultur im Gesundheitskontext essentiell, um Entscheidungsträger in die Lage zu versetzen die allgemeine Gesundheit der Bevölkerung zu verbessern. Die Zielsetzung dieser Studie war in diesem Zusammenhang den Gesundheits- und Fitnessstatuts von Studenten der Sportwissenschaft in Deutschland und Ägypten zu bestimmen und relevante Unterschiede in den beiden Populationen aufzudecken, um daraus mögliche Strategien abzuleiten, Gesundheit im univesitären Bereich in beiden Ländern zu fördern. Die Stichprobe für diese Studie rekrutierte sich aus Universitätsstudenten, da diese die zukünftige Elite von Firmen, Gemeinden und ganzen Ländern darstellen. 193 Studenten aus Deutschland, als Industrieland, wurden eingeschlossen – 104 weibliche und 89 männliche. Weitere 406 Studenten wurden in Ägypten, als Schwellenland, rekrutiert – wovon 167 Frauen und 238 Männer waren. Die Probanden füllten zuerst einen Gesundheitsfragebogen aus und nahmen dann an anthroprometrischen Messungen und Fitnesstests teil. Die Datenerhebing wurde zuerst an den Sportstudenten der TU-Chemnitz in Deutschland im Oktober 2009 duchgeführt. Im November 2010 wurden dann die Sportstudenten an der Menofia Univesität in Äypten getestet. Die Ergebnisse im Vergleich des Allgemeinen Gesundheitsteils zwischen Deutschland und Ägypten zeigte signifikante Unterschiede zwischen der deutschen und der ägyptischen Gruppe bzgl. des Items Beurteilung des eigenen Gesundheitszustandes (p = 0.44) und in Auf seine Gesundheit achten (p = 0.000) bei den Frauen. Allerdings konnte kein signifikanter Unterschied bei den Männern beider Länder nachgewiesen werden (p = 0.370). Der Gesamtvergleich der deustchen und der ägyptischen Stichprobe (beide Geschlechter) wiesen signifikante Unterschiede auf bzgl. der Items Beurteilung des eigenen Gesundheitszustandes (p ≤ 0.05) und auch Auf seine Gesundheit achten (p = 0.000). In der Sektion körperliche und geistige Gesundheit konnte kein signifikanter Unterschied festegestellt werden in den Items „Rücken-, Nacken- und Schulterschmerzen zwischen der ägyptischen und deutschen Population (beide Geschlechter) (p ≥ 0.05), aber dafür in allen anderen Items (p ≤ 0.05). In der deutschen Gruppe wurden keine Unterschiede gefunden bei „Magenbeschwerden/Gewichtszunahme/ Appetitlosigkeit“ – allerdings wurden signifikante Unterschiede in allen anderen Items gefunden (p ≤ 0.05) – in der ägyptischen Gruppe verhielt es sich ebenso. In der Sektion Studium und universitätsbezogene Probleme wurde zwischen Ägypten und Deutschland, auβer bei „Mangelnde praktische Relevanz des Studiums, Tests und Seminararbeiten“, in all anderen Items signifikante Unterschiede nachgewiesen (p ≤ 0.05). Der Geschlechtervergleich der ägyptischen Stichprobe zeigte keine signifikanten Unterschiede in den Items „Anonymität und Isolation an der Uni, und generelle Isolation“ wie auch „Schlechte Karriere, Arbeitslast zusätzlich zur Uni, schlechte Arbeitsbedingungen“. Jedoch sind signifikante Unterschiede zwischen den Geschlechtern in allen anderen Items zu verzeichnen (p ≤ 0.05). Dies traf jedoch nicht auf die deutsche Stichprobe zu (p ≥ 0.05). Der Vergleich zwischen den deutschen und ägyptischen Studenten in der Sektion Ernährung zeigte signifikante Unterschiede in allen Nahrungstypen (p ≤ 0.05) und zusätzlich in der deutschen Gruppe noch signifikante Unterschiede in der Ernährungsweise zwischen Män und Frauen (p ≤ 0.05). Die Ergebnisse in der Sektion Mediennutzung zeigten signifikante Unterschiede zwischen der gesamten deutschen und ägyptischen Stichprobe – wie auch innerhalb deutschen und ebenso ägyptischen Geschlechtervergleich (p ≤ 0.05). Bzgl. der Fitnessektion zeigten die Ergebnisse signifikant bessere Ergebnisse in der deutschen Kohorte im Vergleich zur Ägyptischen (p ≤ 0.05), mit der Ausnahme der „Statischen Klimmzüge“ bei den männlichen Studenten in Deutschland und Ägypten (p ≥ 0.05). Des Weiteren wurden signifikante Korrelationen gefunden zwischen dem Nahrungstypus „ungesundes Essen“ und einigen Parametern der körperlichen und geistigen Gesundheitsprobleme wie auch BMI. Es gibt ebenfalls signifikante Korrelationen zwischen weiteren Items der Sektion Studiums und universitätsbezogenen Problemen, und Nahrungstypen und Blutdruck – wie auch Körperfett %, VO2max und körperlicher Aktivität. Eine signifkante Verbindung der Wahrscheinleichtkeiten wurde zwischen schlechten Ernährungsgewohnheiten bzgl. Konsum von gesundem Essen und der Selbsteinschätzung der Gesundheit der Studenten wurde festgestellt (95% CI below = 0.10, 95% top = 0.99) mit einer OR = 0.10 und in Ägypten (95% CI below = 0.35, 95% CI top = 0.92) mit einer OR = 0.56. Ein weiterer signifikante Wechselbeziehung konnte zwischen einem reduzierten Gesundheitsbewuβtsein und unzureichender körperlicher Aktivität in Deutschland nachgewiesen werden (95% CI below = 0.06, 95% CI top = 0.99), mit einer OR = 0.24. Die Kernergebnisse dieser Studie lassen sich in folgenden Punkten zusammenfassen: 1) Es gibt eine signifikante Differenz zwischen deutschen und ägyptischen Studenten bzgl. Gesundheitsparameter. 2) Ägyptische Studenten haben signifikant mehr körperliche und mentale Gesundheitsprobleme als die deutsche Stichprobe. 3) Die ägyptischen Studenten zeigten signifikant mehr Studiums- und universitätsbezogene Probleme als die deutschen Studenten. 4) Die ägyptischen Studenten hatten einen signifikant höheren Medienkonsum als die deutsche Stichprobe. 5) Ägyptische Studenten wiesen signifikant weniger körperliche Bewegung auf als die deutschen Studenten und schnitten daher auch mit einer signifkant geringeren Leistung in den Fitnesstests ab. 6) Eine hohe Korrelation konnte nachgewiesen werden zwischen den anthropometrischen Daten und einigen körperlichen und psychischen Gesundheitsproblemen. Des Weiteren wurde erwartungsgemäβ auch eine hohe Korrelation zwischen VO2max und körperlicher Aktivität gezeigt. 7) Es gibt einen signifikantnten Zusammenhang zwischen schlechten Ernährungsgewoheiten bei dem Konsum von gesunden Nahrungsgewohnheiten bei dem Konsum von gesunden Nahrungsmitteln und der eigenen Gesundheitseinschätzung. 8) Des Weiteren gibt es einen signifikanten Zusammenhang zwischen einem reduzierten Gesundheitsbewusstsein und unzureichender körperlicnher Aktivität. Es ist durch die Ergebnisse dieser Studie evident, dass es signifikante Unterschiede zwischen Industrieländern und Schwellenländern gibt bzgl. des allgemeinen Wohlbefindens, Gesundheitsproblemen, von denen einige Parameter in der ägyptischen Population auch geschlechtsspezifisch sind, körperlicher Aktivität und Fitness. Das Ziel dieser Studie war es diese Unterschiede zu identifizieren und damit zukünftigen Interventionsstudien Anhaltspunkte zu liefern, um im nächsten Schritt die Gesundheit von Studenten in verschiedenen Ländern zu verbessern. Diese Informationen kann potentiell Entscheidungsträgern helfen, die Infrastruktur bzgl. Gesundheitsversorgung und die Rahmenbedingungen für körperlicher Aktivität zu verbessern und dadurch die Gesellschaft zum positiven zu verändern bzw. weiterzuentwickeln.

In den letzten Jahrzehnten ist die Zahl der Erwachsenen und Jugendlichen, die an nicht organisierten oder wettbewerbsorientierten Sportarten teilnehmen, gestiegen. In der Pubertät beeinflussen sowohl hormonelle Veränderungen als auch mechanische Belastungen die Entwicklung von Muskeln und Sehnen. Derzeit gibt es keine Informationen über die Interaktion dieser beiden Stimuli, aber es besteht die Vermutung, dass im Zuge der Pubertät bei Athleten und Nicht-Athleten im Vergleich zu Muskelkraft und Sehnensteifigkeit ungleiche Verhältnisse auftreten können. Die Folge dieses Ungleichgewichts könnte eine höhere mechanische Belastung für die Sehnen sein, was weiter zu Verletzungen führen kann. Angesichts der unzureichenden Beweise für die Entwicklung des muskulotendinösen Gewebes während der Pubertät und des Mangels an Kenntnissen darüber, wie die Reifung die Muskel-Sehnen-Einheit, insbesondere die Interaktion mit überlagerten mechanischen Belastungen, beeinflusst, untersucht diese Arbeit die morphologische und mechanische Entwicklung von Knieextensoren und Patellasehne, indem Nicht-Athleten und Athleten aus drei Altersgruppen verglichen werden (frühe Pubertät: 12–14 Jahre, engl.:EA; späte Pubertät: 16–18 Jahre, engl.: LA; Erwachsene: 20–35 Jahre, engl.: YA). Athleten erreichten häufiger Dehnungsgrößen von mehr als 9% Dehnung im Vergleich zu Nicht-Athleten, was auf einen erhöhten mechanischen Bedarf an der Sehne hinweist. Obwohl das Training die Eigenschaften der M. quadriceps femoris-Sehnen-Einheit verbessert, bleibt ihre Entwicklung von früher Pubertät bis zum Erwachsenenalter bei Athleten und Nicht-Athleten ähnlich, mit dem Hauptunterschied zwischen früher Pubertät und später Pubertät. Alter und sportliches Training waren jedoch mit einer höheren Prävalenz von Ungleichgewichten innerhalb der Muskel-Sehnen-Einheit und einer damit einhergehenden erhöhten mechanischen Belastung oder Beanspruchung für die Patellasehne verbunden. / In recent decades, the number of adults and especially adolescents who participate in some kind of non-organized or competitive sports has been increasing. During adolescence, the development of muscle and tendons is affected both by maturation, due to hormonal changes, and by mechanical loading. However, there is no information currently on the interaction of this double fold stimulus although there is reason to believe that during adolescence in athletes and non-athletes there may be imbalances developing between muscle strength capacity and tendon stiffness. The result of this imbalance could be the tendon exposure to high mechanical demand by the associated working muscles, which might further lead to tendon injury. Considering the not satisfactory evidence of the musculotendinous tissue development during adolescence, and the lack of knowledge about how maturation affects the muscle-tendon unity, especially in interaction with superimposed mechanical loading, this thesis investigates the morphological and mechanical development of the knee extensors and patellar tendon, by comparing non-athletes and athletes in three different age groups (i.e., early adolescents: EA 12–14 years; late adolescents: LA 16–18 years, and young adults: YA 20–35 years). Athletes were more likely to reach strain magnitudes higher than 9% strain compared to non-athlete controls indicating an increased mechanical demand for the tendon. Although athletic training enhances the properties of the quadriceps femoris muscle-tendon unit, their development from early-adolescence to adulthood remains similar in athletes and non-athletes with the major alterations between early and LA. However, both age and athletic training were associated with a higher prevalence of imbalances within the muscle-tendon unit and a resultant increased mechanical demand for the patellar tendon.

The majority of the world’s population lives in urban areas, and more and more people are migrating to urban areas. However, the health hazards of urban life affect the population as well. They often suffer from non-communicable diseases, cardiovascular diseases, cancer and psychosocial problems. To address the increasing concerns about urban health, the WHO developed health promotion initiatives, known as the Healthy Cities programmes in 1986, which aim to place health high on the agendas of decision-makers and to promote comprehensive local strategies for health promotion and sustainable development. It successfully engages local governments in health development from thousands of cities worldwide in both developed and developing countries, including China. In 1994, China started to develop Healthy City pilot projects in the name of Healthy Cities with the suggestion of the WHO. However, the Chinese government started related activities about the environment and health long before WHO introduced the concept of Healthy Cities. The Patriotic Health Campaign was launched in 1952; despite it being a social movement that was not exclusively oriented to urban areas, it paved the way for Healthy Cities programmes in China. Since 1984, the National Government developed more than 40 policies and National Hygienic Cities to improve the urban environment and support Healthy Cities-related activities. However, the implementation of national policies depends on local level actions where collaboration across sectors is problematic, especially since different ministries tend to work separately according to their own prioritized programme. Shanghai is the first mega-city in China to initiate the action for Healthy City development. It was successful in raising high standards for the health status of the population and improving the urban environment in a quantitative way. However, institutional change, especially intersectoral collaboration remains a big challenge for the implementation. Therefore, it would be interesting to know how the local actors develop the Healthy City programme in the specific context of China. However, there is a lack of empirical studies on the Healthy City programme, and few studies focus on intersectoral relationships in Healthy City development; some researches only include limited actors, and some fail to identify the local institutional settings and connect with the international context. On this background, it looks into the policy making processes of making different programmes at different stages as well as the respective modes of policy implementation. This research aims to unfold how local actors develop the Healthy City programme in Shanghai. Two propositions are guiding the analysis: first, whereas policies in China are mainly developed on a national level where everyday challenges of individual local level entities do not play a decisive role, Healthy City policies are implemented on the local level (of cities or city districts) where municipal specificities and local conditions heavily influence the action potentials and actions of authorities and other stakeholders. Second, whereas Healthy City-oriented policies are comprehensive in nature, their implementation is rather fragmented and sectoral. The study applies an approach that is influenced by the discussion about actor-centered institutionalism. The interpretive lens of actor-centered institutionalism is taken to identify the main actors, analyse how they interact with each other, and the underlying institutional settings that are crucial to interpreting policy making and policy implementation. The study will also find out whether the actor-centered institutionalism approach is fully applicable under the conditions of China, or whether certain modifications are to be made. The research follows a qualitative approach, collecting data from multiple sources such as documents, including historic documents in archives, and interviews, combining a variety of research methods including stakeholder analysis, discourse analysis and network analysis. Shanghai is used as a case study as it has the longest experience with the implementation of Healthy City programmes in China, and was also the first to issue a Healthy City Action Plan in 2003. It established the first municipal committee for health promotion in 2005. Whereas the older programmes are analysed based on documents, the latest Healthy City programme is scrutinised by employing document analysis and interviews of different stakeholders in order to get an in-depth understanding of the policy making and implementation processes. This thesis aspires to contribute to the empirical knowledge of the development of public policies, the understanding of actors and actor constellations in Healthy City programmes with reference to specific institutional settings in China, and examining the compatibility and limitations of this interpretive lens in the Chinese context. Moreover, policy recommendations related to practice in Shanghai are provided as further motivation and commitment to Healthy City development in China.

Objective: Lower levels of anabolic hormones in older age are well documented. Several studies suggested that low insulin-like growth factor I (IGF-I) or testosterone levels were related to increased mortality. The aim of the present study was to investigate the combined influence of low IGF-I and low testosterone on all-cause mortality in men. Methods and results: From two German prospective cohort studies, the DETECT study and SHIP, 3942 men were available for analyses. During 21,838 person-years of follow-up, 8.4% (n = 330) of men died. Cox model analyses with age as timescale and adjusted for potential confounders revealed that men with levels below the 10th percentile of at least one hormone [hazard ratio (HR) 1.38 (95% confidence-interval (CI) 1.06–1.78), p = 0.02] and two hormones [HR 2.88 (95% CI 1.32–6.29), p < 0.01] showed a higher risk of all-cause mortality compared to men with non-low hormones. The associations became non-significant by using the 20th percentile as cut-off showing that the specificity increased with lower cut-offs for decreased hormone levels. The inclusion of both IGF-I and total testosterone in a mortality prediction model with common risk factors resulted in a significant integrated discrimination improvement of 0.5% (95% CI 0.3–0.7%, p = 0.03). Conclusions: Our results prove that multiple anabolic deficiencies have a higher impact on mortality than a single anabolic deficiency and suggest that assessment of more than one anabolic hormone as a biomarker improve the prediction of all-cause mortality.