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Participatory research approaches are becoming increasingly established in both academic and practice settings. The participation of people with varied lived experiences and professional backgrounds can help academia and practitioners to learn from and empower each other. In the exchange of different perspectives, needs and ideas, it is possible to plan, reflect on, implement and evaluate projects in the health sector jointly and with attention to the needs of all stakeholders. The Community Based Participatory Research (CBPR) Model is often used internationally to guide participatory processes. However, an accessible translation has been lacking for application in German-speaking countries. To address this problem, a multidisciplinary working group composed of academic researchers and practitioners came together within the German-speaking Participatory Health Research Network (PartNet) to adapt the CBPR model for German-speaking countries and to test the adapted version with potential users. The adaptation was more than a translation, as the four model components "Contexts", "Partnership Processes", "Intervention & Research" and "Outcomes" as well as their associated contents are not directly applicable to the socio-structural and political contexts of the German-speaking countries. This article describes the process of adapting the model. This includes how translation drafts for German-speaking countries were first discussed in detail and then agreed upon as an initial template for testing in practice. Subsequently, various users reflected on the German-language model based on their experience of testing it in different projects, focusing on accuracy, comprehensibility and applicability. At the same time, the model was presented and discussed at conferences. The diverse feedback was incorporated into further revisions of the model. The result is a German-language version called "Modell für partizipative Gesundheitsforschung (PGF-Modell)"., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Participatory health research is gaining increasing recognition in the public health sector. The people whose lives or work are central to wicked issues around health inequalities are integrated into the projects. Including diverse forms of knowledge and perspectives has the capability of strengthening health equity in specific settings. That proffers agency to the voices of those who are seldom heard. Often, participatory health research (PHR) is done with communities. Finding the truly isolated - those who are not connected to others or to services, the seldom heard - presents a challenge for research. Without hearing the voices of those most distanced from mainstream discourse we run the risk of misunderstanding issues pertinent to their lives. This narrative overview highlights this problem and aims to contribute a solution approach for research practice., Methods: An extensive literature review for participatory research references in the German language was used and the international literature was also screened. Furthermore, the processes of three participatory research projects were evaluated., Results/discussion: The specified strategies to involve the seldom heard refer to lowered systemic barriers and improved local capacity for their participation. For example, before research can start, time should be given for a preparatory phase. This can be used to invest in relationships and co-operation to bridge the distance to research.

In medical research, it is established practice to discuss ethical issues, usually based on the criteria informed consent and voluntary participation, protection from harm, confidentiality, and anonymity. The discussion of ethical questions is also gaining importance in social science research. The same applies to participatory research, which is not yet very widespread in Germany. Because this approach is based on equality between all those involved, it results in relationships uncommon in nonparticipatory research. Therefore, ethical questions are raised in a different way. Partly based on an analysis of documents, a case study from participatory health research will be used to illustrate how the principle of harm reduction can be recognized. The case study shows this from the perspective of both the researchers and the peer-researchers.From the peer-researchers' perspective, there are different challenges in participatory teamwork, which can bring impairments and consequently result in a risk of harm. This can lead to disappointments, for example, when from the peer-researchers' perspective individual support during a research process is insufficient.Conclusions for dealing with ethical aspects in participatory research projects will be derived from the gathered experiences. The application of the criteria used in nonparticipatory research can be an opportunity to strengthen the discussion of ethical issues as part of participatory processes. It can also be a chance to combine the ethical discourse in participatory and qualitative social science research.

To achieve sustainable effects of health promotion interventions, first of all, long-term implementation is needed. However, there are just a few studies that explore how to maintain health-promoting structures and activities after external funding comes to an end. Using a mixed-methods approach, the evaluation study of the Bielefeld University analysed long-term implementation of government-funded projects. Our results show that maintenance of project structures and activities is a multiplex and contextual process. Apart from conceptual factors that can be influenced by project activities, interviewees reported on contextual factors (e. g., political support) that particularly affect successful long-term implementation. Thus, strategies need to be planned and initiated in the early stages of a project., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Although the transfer of an existing project can be a resource-efficient form of implementation of successful interventions, project transfers are rarely carried out in practice. The aim of this article is to pool the experience of 3 projects about the transfer of their prevention approaches to other municipalities and regions, as well as to make recommendations for future trans-regional transfer processes in the field of disease prevention and health promotion. To achieve this, documentation sheets were used and interviews were conducted with team members of the transfer projects. The results show that the ability to adapt intervention to context is an essential condition of successful implementation. In addition, there has to be a need for the intervention in the transfer region and a benefit to the participant organizations as well as to the team members. Furthermore, constructive and personal communication and cooperation between the participants of the original and the transferred project are required for successful transfer., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In line with the National Action Plan "IN FORM" the German Federal Ministry of Health funds the establishment of 11 regional community health promotion networks (alliances). To meet quality development standards, an external evaluation project has been established in addition to the alliances' internal evaluation. Scientific monitoring focuses on alliance-spanning investigation of quality of planning, structures and processes and uses different methods and instruments (e.g., guided interviews, analytical framework, Goal Attainment Scaling). Regional networks also receive support for their efforts to quality development. Up to now concluding analysis can be done on aspects of planning quality based on findings of the analytical framework developed within the project. 5 selected results presented in the article reveal a heterogeneous picture: on one hand the standard on which the alliances' rationales on demands justifying the project's strategy are written at is very encouraging. The situation is similar with the descriptions of the work planning and statements concerning the sustainability at which the implemented activities are aimed. On the other hand, in explaination criteria like consideration of target group's needs or definition of goals the possibilities are not exhausted yet considering the state of the debate. Hence in similar future projects there is a clear necessity of assistance in approaching these aspects, provided preferably in an early stage of the planning phase., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated., Patients and Methods: Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits., Results: The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good., Conclusions: This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).

Background: Benefit assessment of drugs and medical products has become a legally established feature of medical research. A standardized assessment of benefits using scientifically sound and valid methods is essential., Objective: Development, validation and practical evaluation of an instrument to record patient benefit in treatment of acne., Patients and Methods: In open interviews with n = 50 patients, possible benefits of the therapy from the patients' point of view were recorded. The item pool thus generated was reviewed by a panel of dermatologists, psychologists and patients and transferred to a 23-item questionnaire. This is used prior to therapy to assess patients' desired benefits and after therapy to record the perceived benefits. The therapy goals and the resulting benefits are then used to generate a weighted 'Patient Benefit Index' (PBI). The procedure has been tested for its validity and feasibility in n = 923 patients with acne., Results: Patients accepted the instrument and deemed it to be easily understandable. Additionally, the method proved itself to be internally consistent, constructively valid and sensitive to changes., Conclusions: The Patient Benefit Index (PBI) is a valid and highly accepted practical instrument for recording patient benefit. The PBI permits an individualized, patient-weighted assessment of the benefits of acne therapy.

Hypertension is a frequent disease and renal artery stenosis, as a potential cause of hypertension, can be cured. Therefore, we frequently need to exclude a renal artery stenosis in patients with hypertension in our daily routine. This calls for a screening procedure which is non-invasive, highly effective and not too expensive. This paper describes the advantages and limitations of colour Doppler ultrasound in diagnosing renal artery stenosis. Colour Doppler ultrasound with intrarenal Doppler analysis is an ideal tool in the screening for relevant renal artery stenosis in patients with hypertension. This technique, however, requires a careful approach and extrarenal abnormalities need to be considered.

Practically all municipal health authorities, including the Bremen health authorities, now offer advice with regard to healthy environmental protection, i. e. environmental-medical consulting activities. The majority of the consultantcy services deal with individual inquiries made by citizens. This is supplemented by counselling and discussions with groups in various contexts. It is frequent for extremely difficult counselling contents, situations and deficits in the conducting of the discussions by the consultants who are specialised in natural science subjects to coincide. Within the framework of a further training course designed for these specific needs, the staff of the Bremen health authorities, with specialist instruction, were successful in acquitting skill in the communication of risks, which is a qualification that should become self-evident also in this sphere.

The establishment of medical environmental centres at public health offices is hardly questioned any longer even though it means a crucial shift regarding the points of emphasis in human ecology in general as well as the extension of the fields of activity in public health services. It is doubtful whether the individual-orientated approach of environmental medicine can meet the complexity of medical problems due to environmental factors or which rating preventive medicine can have in this context. Environmental medicine could well not only overtax the personnel resources of public health offices, as previous experience shows, but also change the fields of activity of public health services qualitatively. At present the lack of knowledge and experience in environmental medicine enables only research-orientated institutions to perform appropriate work in this field.

New legal provisions set a limiting value of 0.1 mg TCE/m3 air in flats. Follow-up examinations by the Public Health Office Bremen show again that so far this limit can not be complied with in flats adjacent to dry cleaners. Interviews with affected residents give no hint for a change in utilisation habits. The Upper House of the German Federal Parliament has taken the legislative initiative for a complete prohibition of TCE in consequence of the fundamental problem of limiting values.

The paper describes the concentration of tetrachlorethen (TCE) in the air of flats in Bremen adjacent to drycleaners and the resulting TCE concentration in the food and blood of the residents. The results indicate that--regardless of the cleaning system--a high TCE pollution must be expected with nearly everybody living next to a TCE dry cleaning shop. The currently propagated guiding value of 0.1 mg TCE per m3 of air or 0.1 mg TCE per kg of food can hardly be complied with--even after reorganisation in the drycleaning shop. The problem of guiding and limit values of TCE and possible alternatives to dry cleaning with TCE are discussed. The paper shows that Public Health Offices--in cooperation with other institutions--can make relevant contributions to investigations in the field of environmental health.