Objective: To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children.Design: Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each child's age, gender, immigrant background and maternal education.Setting: Eighteen pre-schools from three south German regions.Subjects: Healthy children aged 3–6 years.Results: Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4·26 (sd0·78) years; the majority (53·2 %) were boys. Children's fruit and vegetable intakes increased significantly (P< 0·001 andP< 0·05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted.Conclusions: Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

With rates of childhood obesity increasing, physical activity (PA) promotion especially in young children has assumed greater importance. Given the limited effectiveness of most interventions to date, new approaches are needed. The General Systems theory suggests that involving parents as intervention targets may be effective in fostering healthier life styles in children. We describe the development of a parent-focused participatory intervention and the procedures used to evaluate its effectiveness in increasing daily PA in preschoolers.

While ICF-CY-based models of care are promising avenues for improving participation of children with chronic health conditions, feasible and valid instruments to assess participation as an outcome in routine are still needed. We aimed to validate a German parent-report version of the Child and Adolescent Scale of Participation (CASP) in children with chronic health conditions of different severity. Cross-sectional data were collected in 327 children (mean age 7.8 years, 55% boys) from two paediatric centres (n = 112) and one population-based sample (n = 215). Cronbach’s alpha, factor analyses, face validity assessments, correlation analyses, receiver operating characteristics (ROC) curves, and parent-reported health-related quality of life (HRQoL: KINDL) were used to examine internal consistency, test-retest reliability, and capacity to differentiate between disease severity groups. Disease severity was operationalized according to ICD-diagnosis groups and/or parent-reports on health problems, medical and educational support, and medication. A newly developed item “overall perceived participation” was added to the CASP and evaluated. We found good to excellent content validity, excellent internal consistency, and good-to-excellent test-retest reliability of the instrument. While children with mild disease had a significantly greater extent of participation (higher CASP scores) than children with severe disease, they did not differ from healthy children. Children with mild compared to severe disease much more differed in participation as measured by the CASP compared to the KINDL (area under the ROC curve: 0.92 vs. 0.75). In addition, the item “overall perceived participation” was highly correlated (r = 0.86) with the CASP total score, indicating the potential value of this specific single item. Finally, we provided preliminary reference values for the CASP obtained in a population-based sample of children without chronic health conditions. The German version of the CASP and the new item are efficient, valid and reliable measures of social participation in childhood. The CASP-measured participation focuses more on attendance than on involvement into social circumstances of everyday life. To detect children with a high burden of disease on everyday life, the CASP may be more accurate than HRQoL instruments such as the KINDL. As outcome measurement, the CASP may facilitate the implementation of patient-centred paediatric health care.

This conceptual paper aims to illustrate the ways in which communities are able to advance health improvements on a population level. Outcome measures may include increased physical activity and healthier eating habits in particular, as well as an improved health-related quality of life and social cohesion as more generic outcomes. The paper begins by asking initial questions: Why did previous health-specific interventions only show moderate effects on an individual level and mixed effects on a population level? What is the added value of a community-based public health perspective compared to the traditional biomedical perspective when it comes to prevention? Why are we living the way we are living? Why do we eat what we eat? Why do we move the way we move? Subsequently, we illustrate the broad spectrum of contextual interventions available to communities. These can have geographical and technological as well as economic, political, normative and attitude-specific dimensions. It is shown that communities have a strong influence on health-related contexts and decision-making of adults, adolescents and children. In addition contextual characteristics, effects, mediators, moderators and consequences relevant for health can differ greatly between age groups. Both small-scale settings and overarching sectors possess physical, economic, political and sociocultural characteristics that can be proactively influenced by community decision-makers in the sense of a “health in all policies”-strategy. After presenting various interdisciplinary approaches to community-based health interventions, the manuscript closes with the following core message: Successful community-based health promotion strategies consist of multilevel – multicomponent interventions on the micro, meso and macro-level-environments.

Older children, its utility in correctly classifying PA in preschoolers is unknown. Methods: Thirty-three children (64% were boys) were recruited from four German preschools. Data included direct observation and Actiheart (CamNtech, Cambridge, UK) monitoring during 2.5 ± 0.7 h (derivation data) and 1.5 ± 0.3 h (validation data). Observers assessed PA using the Children's Activity Rating Scale (CARS). Moderate-to-vigorous PA (MVPA) was defined by a CARS score of 4 or 5, and sedentary behavior (SB) was defined by a CARS score of 1 or 2. Actiheart recordings were linked to CARS level, with means and 95% confidence intervals calculated for ACC and HR at each observed CARS level and for MVPA/SB. Using receiver operating characteristic analysis, gender-specific ACC and HR cutoffs for correctly classifying MVPA and SB were first determined in a derivation data set and then tested in a separate validation data set of observations. Results: By combining HR and ACC cutoffs, 91% and 87% of the 15-s intervals observed as MVPA were correctly classified in girls and boys, respectively. Although generally lower, correct classification rates for SB were highest when only ACC cutoffs were applied (69% for girls and 67% for boys) rather than when combined cutoffs were used. Conclusions: Devices that combine HR and ACC data yield an accurate classification of MVPA in preschoolers but perform less well for classifying SB. These differences underscore the need to match evaluation methods with the objectives of future PA interventions....