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1

Let’s discuss the Criteria of Bradford Hill (1965)

100%

Ulmer H.-V.

Health Promotion & Physical Activity

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2021

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tom 15

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nr 2

56-57

EN

On 10th October 2020, the German Federal Ministry for the Environment had responded to an inquiry concerning causality, as follows: The nine criteria of Hill [1] are a “central pillar for the determination of causality in epidemiology.” The reason of the inquiry was the dramatic press release: “Air pollution is responsible for more than 400,000 premature deaths/year in Europe.” Among others, the “central pillar” agrees e. g. with reference [2]. Applying to expert discussions, a colleague had commented on this matter: “All our environmental epidemiologists refer to the Bradford Hill criteria”. Is this also the case in publications?Whilst reading through numerous epidemiological publications on sport & health respectively environment & health, the author had never come across these criteria – the reason for this letter to the editor.In 1965, HILL had given detailed considerations to the conditions that would have to be fulfilled in the case of epidemiological associations found before they could be used as a reason to “cry causation”.Extensive annually published reports of the EEA (European Environment Agency) deal with air pollution and human health. In 2019 as key message ([3] p. 63): “Air pollution is the single largest environmental health risk in Europe, with around 400 000 premature deaths attributed to air pollution¼ in 2018” ([3] p. 63) and again in 2020: “Air pollution is a major cause of premature death ¼, responsible for around 400 000 premature deaths per year” ([4] p. 10).The corresponding EEA studies are based on epidemiological surveys, collected in the categories urban – suburban – rural ([4] p. 11). The results, often calculated using the DPSEEAModel ([5] to Healthcare Waste Management), are correctly described from a statistical point of view as: “Deaths attributed to” ([2] p. 63), “associated with” ([1] p. 10), “relationship (between exposure to ambient pollutant concentrations and health outcome” [1] p. 106), “Estimates are produced” or: “the impacts attributable to exposure” ([4] p. 106). But then there is a mind jump to causality by complaining: “Air pollution is a major cause of premature death” ([4] p.10) and implicite with “air pollution is currently the most important environmental risk to human health” ([4] p.9): A typical case of “cry causation”, but without prior examination of the Bradford-Hill-criteria. These are neither mentioned in the text nor in the reference list, nor are alternative criteria (e.g. [6]). However, the published conclusions claiming causality led to serious environmental policy consequences. Yet the question of causality should be decisive for avoiding a so-called stork statistic.Therefore: Let’s discuss the Bradford-Hill-criteria! I am interested to find environmental epidemiological studies in which all of the 9 criteria have been thoroughly discussed rather than having to endure serious environmental policy consequences triggered as “cry causation”. An orienting PubMed analysis did not reveal any reference to environmental epidemiology among 79 hits, but in other research fields associations were often evaluated using all 9 Bradford-Hill-criteria, in two cases even resulting in the rejection of a hypothesis.Therefore, if anyone knows of an environmental health epidemiological study in which the 9 Bradford-Hill criteria were discussed individually prior to “cry causation”: Please provide the author with the bibliographical details: ulmer@uni-mainz.de.The Editor in Chief has agreed to publish a corresponding list of entries in issue 3/2021.

2

"Objective Measurements" and "Non-Objective Observations" as Methods for Assessment of Athletic Fitness and Health

100%

Ulmer H.-V.

Human Movement

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2010

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tom 11

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nr 1

42-44

EN

The sentence "measure what is measurable, and make measurable what is not so" (Galilei) can be seen as a postulate for using only objective physical or chemical methods in science to obtain hard data. Athletic fitness and health are complex states, however, including more than objective personality traits, described by hard data. Therefore, in the context of assessment of athletic fitness and health the questions arose: What does "measure" mean and how important are data that are immeasurable? Hard data are necessary, but not sufficient for assessment of all personality traits relevant for athletic fitness and health. Soft data are important as well. "Measure" in the context of athletic fitness and health should not only be restricted to physical or chemical methods, but should also include soft data, obtained by all systematic inside- and outside-observations using rating methods or only descriptions of qualitative items. For interpretation of both hard and soft data experience is necessary: this step of scientific work includes subjectivity in all cases. In order to gain experience, subjective methods must be trained, and this requires estimation of soft data and their appertaining methods, too. In conclusion, "measure" in the context of athletic fitness and health should include all objective and subjective methods for description of relevant personality traits.

3

Physical activity of pupils during school-sport and leisure time, depending on their body weight: are overweight pupils physically inactiv?

63%

Ulmer H.-V. , Hüttlin K.

Physiotherapy

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2010

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tom 18

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nr 1

32-34

EN

It seems to be common sense, that hypomobility is an essential cause for overweight and adiposity. As a consequence, physical activity usually is recommended against adiposity. In literature doubts, based on empirical studies, could be found, that the lamentations about an unfit and by this fat youth seems to be rather a sociological phenomenon of an imaginary crisis than an empirically based fact.Especially concerning young people in Germany, physical inactivity is accused to be an important cause of adiposity. Therefore we are interested in the spontaneous intensity of physical activity of pupils during their physical education and in leisure time in relation to their body mass index.Pupils (10-19 y old, 15 forms) were observed during their physical education systematically regarding quantitative and qualitative items. Additionally the intensity of physical and sporting activities in leisure time were investigated by questionnaire. The results show, that the rate of underweight was higher than of adiposity in the researched group. Between the intensity of physical activity in physical education and in leisure related to the deviations of normal weight (BMI) no relevant correlations could be stated.Discussing these results, the hypotheses: Physical inactivity is a central cause of adiposity and physical activity is a very good action against adiposity seems to be too simple. Eating behaviour, genetic disposition, psychological factors etc. obviously are very relevant, too. This must be considered in public recommendations against adiposity as well as the risks of uncontrolled physical activities for joints, bones and muscles especially in case of overweight.

4

Practicability of Enteritis – prevention in Trekking and Mountaineering at High Altitude by Systematic Hand Disinfection

51%

Ulmer H.-V. , Risse J. , Küpper T.

Health Promotion & Physical Activity

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2020

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tom 13

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nr 4

25-28

EN

Introduction: The hygienic conditions during trekking or mountaineering at high altitudes are reduced, especially regarding defecation and hand hygiene. An additional problem exists in regions above the snowline, especially in highly frequented regions: snow may be contaminated by faecal microbes, causing diarrhea. Prevention against faecal-oral infections must include not only disinfection of drinking water, but hand disinfection, too, e.g. by a water-free hand gel. The practicability of this measure was tested during a Himalaya expedition on the way to Mt. Everest. Material and methods: 10 participants were instructed to use Stokosept-Gel, an alcohol based skin disinfectant, at least prior to meals, after using a toilet and after handling boot-laces and to note each use (including additional occasions). Results: A very good practicability of using the hand gel, which was absorbed quickly (ca. ¼ min) was reported. 100 ml were sufficient for at least 2 weeks and there were no side effects or problems at the skin. During the mountaineering phase which included a total of 250 person days in the field no diarrhea occurred. Conclusion: We conclude that using such hand gels is – additional to other procedures – a very practical prevention against diarrhea in mountaineering at high altitude.