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Partizipation zu ermoglichen ist Teil des Auftrags der Offenen Kinder- und Jugendarbeit. Dazu gehort die Einbindung der Jugendlichen in die Angebotsentwicklung. Der Ansatz der Partizipativen Gesundheitsforschung kann einen Beitrag zur Umsetzung dieses Auftrags leisten. Die Durchfuhrung sog. „Autonomer Offnungen“ (AO) in Braunschweig, bei denen Jugendliche ihr Jugendzentrum (JZ) ohne Beisein der Fachkrafte offnen und die Zeit eigenverantwortlich gestalten, geht auf eine Forderung der stadtischen Jugendkonferenz zuruck. Jugendliche und Fachkrafte wurden mit partizipativen Methoden bei der Evaluation der AO wissenschaftlich begleitet. Diese Arbeit berichtet aus einem der drei mitwirkenden JZ. Nach jeder AO haben die Jugendlichen ihr Erlebtes in einem mit den Fachkraften erarbeiteten Fragebogen angegeben, der im digitalen Umfrageinstrument „Mentimeter“ hinterlegt ist. Die Erfahrungen der Fachkrafte wurden in Interviews erfragt. Im Zentrum der Erhebungen stehen das Einbringen eigener Interessen und die Entwicklung von Kompetenzen der Jugendlichen. Die Ergebnisse wurden von den Wissenschaftler*innen ausgewertet und in einem Workshop mit Jugendlichen und Fachkraften reflektiert. Im Zeitraum von zehn Monaten fanden zehn AO statt. Funf Jugendliche nahmen als Hauptverantwortliche und ca. 20 weitere als Mitverantwortliche teil. Es zeigte sich, dass die Jugendlichen ihre Interessen seit Beginn der AO verstarkt einbringen. Die Fachkrafte haben eine Entwicklung von Kompetenzen in verschiedenen Feldern beobachtet. Es wurden Kriterien zur Ubertragbarkeit der AO identifiziert. Belastbare Beziehungen, die einen vertrauensvollen Austausch auf Augenhohe zwischen Fachkraften und Jugendlichen ermoglichen, sind dabei bedeutsam.

Facilitating participation is part of the mandate of open child and youth work. This also means youths have a voice in the development of youth center offerings. The participatory health research approach can support accomplishing this mandate.As a consequence of the municipal youth congress's demand for more autonomy so-called "Autonomous Openings" (AO) - the opening of youth centers by the youths themselves and spending their time independently - were implemented in Braunschweig, Germany. Participatory research methods were used to scientifically support the center's youths and professionals in evaluating the AOs. This paper reports on one of three contributing youth centers.After each AO the adolescents reflected on their experiences by filling in a questionnaire jointly developed by researchers and professionals. The survey was accessible via the digital tool "Mentimeter". The professionals' perspective was captured in interviews. Topics such as revealing one's personal interests and the development of competencies were the main interest. The gathered data was assessed by the researchers and reflected upon together with youths and professionals during a workshop.Ten AOs took place throughout a period of ten months. Five adolescents were preliminary responsible and about another 20 were co-responsible. The results show that young people revealed their own interests more substantially. Moreover, the professionals observed a strengthening of competencies in various fields. Several factors were identified that can facilitate transferability to other youth centers. Reliable relationships that enable a trusting and equal exchange between professionals and youths are essential.HINTERGRUND: Partizipation zu ermöglichen ist Teil des Auftrags der Offenen Kinder- und Jugendarbeit. Dazu gehört die Einbindung der Jugendlichen in die Angebotsentwicklung. Der Ansatz der Partizipativen Gesundheitsforschung kann einen Beitrag zur Umsetzung dieses Auftrags leisten.Die Durchführung sog. „Autonomer Öffnungen“ (AÖ) in Braunschweig, bei denen Jugendliche ihr Jugendzentrum (JZ) ohne Beisein der Fachkräfte öffnen und die Zeit eigenverantwortlich gestalten, geht auf eine Forderung der städtischen Jugendkonferenz zurück. Jugendliche und Fachkräfte wurden mit partizipativen Methoden bei der Evaluation der AÖ wissenschaftlich begleitet. Diese Arbeit berichtet aus einem der drei mitwirkenden JZ.Nach jeder AÖ haben die Jugendlichen ihr Erlebtes in einem mit den Fachkräften erarbeiteten Fragebogen angegeben, der im digitalen Umfrageinstrument „Mentimeter“ hinterlegt ist. Die Erfahrungen der Fachkräfte wurden in Interviews erfragt. Im Zentrum der Erhebungen stehen das Einbringen eigener Interessen und die Entwicklung von Kompetenzen der Jugendlichen. Die Ergebnisse wurden von den Wissenschaftler*innen ausgewertet und in einem Workshop mit Jugendlichen und Fachkräften reflektiert.Im Zeitraum von zehn Monaten fanden zehn AÖ statt. Fünf Jugendliche nahmen als Hauptverantwortliche und ca. 20 weitere als Mitverantwortliche teil. Es zeigte sich, dass die Jugendlichen ihre Interessen seit Beginn der AÖ verstärkt einbringen. Die Fachkräfte haben eine Entwicklung von Kompetenzen in verschiedenen Feldern beobachtet. Es wurden Kriterien zur Übertragbarkeit der AÖ identifiziert. Belastbare Beziehungen, die einen vertrauensvollen Austausch auf Augenhöhe zwischen Fachkräften und Jugendlichen ermöglichen, sind dabei bedeutsam.

Zusammenfassung Extremwetterereignisse nehmen durch den Klimawandel zu. Zu den gesundheitlichen Auswirkungen zählen psychische Erkrankungen. Diese stellen besonders im Globalen Süden eine hohe Gesundheitslast dar. Sie sind ungenügend erfasst und erforscht.

Background and Objectives Knee osteoarthritis (OA) is a significant public health burden. Rates of total knee arthroplasty (TKA) in OA vary substantially between geographical regions, most likely due to the lack of standardised indication criteria. We set out to define indication criteria for the German healthcare system for TKA in patients with knee OA, on the basis of best evidence and transparent multi-stakeholder consensus. Methods We undertook a complex mixed methods study, including an iterative process of systematic appraisal of existing evidence, Delphi consensus methods and stakeholder conferences. We established a consensus panel representing key German national societies of healthcare providers (orthopaedic surgeons, rheumatologists, pain physicians, psychologists, physiotherapists), payers, and patient representatives. A priori defined consensus criteria were at least 70% agreement and less than 20% disagreement among the consensus panel. Agreement was sought for (1) core indication criteria defined as criteria that must be met to consider TKA in a normal patient with knee OA, (2) additional (not obligatory) indication criteria, (3) absolute contraindication criteria that generally prohibit TKA, and (4) risk factors that do not prohibit TKA, but usually do not lead to a recommendation for TKA. Results The following 5 core indication criteria were agreed within the panel: 1. intermittent (several times per week) or constant knee pain for at least 3 – 6 months; 2. radiological confirmation of structural knee damage (osteoarthritis, osteonecrosis); 3. inadequate response to conservative treatment, including pharmacological and non-pharmacological treatment for at least 3 – 6 months; 4. adverse impact of knee disease on patientʼs quality of life for at least 3 – 6 months; 5. patient-reported suffering/impairment due to knee disease. Additional indication criteria, contraindication criteria, and risk factors for adverse outcome were also agreed by a large majority within the multi-perspective stakeholder panel. Conclusion The defined indication criteria constitute a prerequisite for appropriate provision of TKA in patients with knee OA in Germany. In eligible patients, shared-decision making should eventually determine if TKA is performed or not. The next important steps are the implementation of the defined indication criteria, and the prospective investigation of predictors of success or failure of TKA in the context of routine care provision in Germany.

Background Although total knee arthroplasty (TKA) is among the most frequent orthopedic procedures for end-stage knee osteoarthritis (OA), systematically developed patient treatment goals for this elective intervention are missing. This constitutes a relevant barrier toward patient-centered healthcare. Methods A Delphi consensus study was conducted. Patients who were candidates for TKA were recruited through 11 outpatient orthopedic surgeons, 4 physiotherapists, and a patient organization in Germany. The initial questionnaire included 20 potential treatment goals derived from a systematic review on outcomes assessed in TKA trials. Patients were asked to rate these potential treatment goals as "main goal," "secondary goal," or "no goal." It was specified that a main goal must be met to consider TKA as successful. Patients could add further goals which were included in the next questionnaire together with a feedback on their own and the group's previous rating. Patients could then confirm or revise their responses to find group consensus, which was defined as ≥70% of participants rating a treatment goal as main goal. Results From initial 108 participants, 93 (86%) completed the study. Consensus was achieved that symptom reduction ("pain reduction," "improvement of stability"), functional improvements (improvement of "physical function," "range of motion," "walking distance," "walking stairs," "physical activity"), "improvement of quality of life," and prevention and safety concerns ("prevention from secondary impairments," "long implant survival") are the main treatment goals of patients who are candidates for TKA. Conclusion Physicians should consider patient treatment goals in routine clinical decision making to meet the requirements of patient-centered healthcare. Researchers should consider those treatment goals in effectiveness studies on TKA.

Background The Outcome Measures in Rheumatology (OMERACT) initiative developed a core outcome set (COS) of domains to assess effectiveness of interventions for knee osteoarthritis. These domains (pain, physical function, patient global assessment, imaging at 1 year) should be assessed in every trial to make research evidence meaningful and comparable. We systematically evaluated and critically appraised the use of measurement instruments and outcome domains in prospective studies evaluating patients with knee osteoarthritis undergoing total knee arthroplasty (TKA) and assessed their accordance with the OMERACT COS. Methods Literature search was performed until August 26, 2014, in Medline and Embase. Clinical trials and prospective observational studies with ≥50 participants and a follow-up of ≥1 year were included. We collected general study characteristics, comprehensive information on measurement instruments, and corresponding domains used. Results This systematic review identified low accordance of used outcome domains with the OMERACT COS of domains published in 1997. Only 4 of 100 included studies included all recommended core domains. Pain (85% of studies) and physical function (86%) were assessed frequently, whereas patient global assessment (21%) and joint imaging (≥1 year; 27%) were rarely assessed. There was substantial heterogeneity in the use of measurement instruments (n = 111) investigating TKA. Conclusion More efforts are required to implement the existing COS. In addition, a more consistent use of adequate measurement instruments is important to make research evidence on TKA more relevant, better comparable, and thus more useful for guideline developers and clinical decision makers.