Early detection examinations and prevention are particularly important in childhood and adolescence, as certain diseases are already developing and health-related attitudes and behaviour patterns are formed and implemented. Despite the importance of screening and prevention, not all families use the available services and programmes. The aim of this study is to identify factors associated with participation in an early detection and prevention programme for children and adolescents, as well as factors associated with actual uptake of an examination. The analyses are based on questionnaire data of an online survey of participants and non-participants. Descriptive analyses and logistic regression models are conducted on a defined sample (n = 1,289). The results show that both groups differ with regard to several factors: age, chronic diseases, federal state, living space, number of siblings, country of birth, migration background, language spoken at home, mother's occupational status, household income, treatment duration, and trust in treating physician. Regression I shows that participation in the programme is significantly associated with higher age, language spoken at home, mother's occupational status and greater trust in the treating physician. The latter demonstrates the highest predictive power. Regression II indicates that the actual uptake of an examination among participants is significantly affected by age, federal state and father's occupational status. Overall, the results of this study show that social background partly plays a role in participation, but that factors such as trust in the treating physician also have a significant impact. For the future, further research on the factors influencing participation in screening and prevention services or programmes for children and adolescents is important in order to develop strategies to overcome existing barriers and thus reach groups that have not been reached yet. In this context, trust in the treating physician and his or her influence on decision-making should in particular be considered.
Einleitung und Hintergrund: Mehrere Modellversuche täglichen Schulsports untersuchten die Auswirkungen auf die Gesundheit sowie das Bewegungsverhalten der Kinder und Jugendlichen. Möglichkeiten und Schwierigkeiten der Umsetzung in der Praxis aus Sicht der Stakeholder wurden bislang nicht hinreichend evaluiert. Die Göttinger Interventionsmaßnahme „fit für pisa“ ergänzt während der gesamten Grundschulzeit die obligatorischen zwei Schulstunden Sport/Woche durch drei weitere Sportstunden. Die qualitative Befragung der Stakeholder im Setting Grundschule soll Potentiale und Barrieren erfassen, die sich inhaltlich und organisatorisch bei der Einführung täglichen Sportunterrichts ergeben, ebenso sollen Lösungsmöglichkeiten zur Überwindung der Barrieren entwickelt werden. Material und Methoden: Zu den Potentialen täglichen Schulsports sowie zu den in der Umsetzung bestehenden Hindernissen wurde eine Zufallsstichprobe (n=44) der Interventionsschüler mittels Fokusgruppen unter Einsatz der Metaplan-Technik befragt. Bei Schulleitern (n=5), Klassenlehrern (n=16) und Übungsleitern (n=19) der am Projekt „fit für pisa“ beteiligten fünf Grundschulen wird eine Vollerhebung mittels teilstandardisierter Interviews derzeit durchgeführt. Bei den Eltern der Interventionsschulen werden extreme Befürworter und Kritiker der Interventionsmaßnahme befragt, die nach der Methode des Theoretical Sampling gezielt ausgewählt wurden. Ergebnisse: Die am Ende der 4. Klasse durchgeführten Fokusgruppenbefragungen zu Potentialen und Schwierigkeiten ergaben, dass 86% der Schüler den täglichen Sportunterricht sehr gut fanden, 84% würden ihn auf jeden Fall einführen. Bemängelt wurden seitens der Schüler vorwiegend strukturelle Rahmenbedingungen wie zu viele Erläuterungen vor dem Unterricht, Unpünktlichkeit der Lehrer, die Räumlichkeiten sowie Zeitmangel. Die Auswertung der Leitfadeninterviews von Schulleitern, Klassenlehrern, Übungsleitern sowie Eltern wird im September präsentiert. Zwischenergebnisse zeigen den Trend, dass Lehrer und Eltern positive Effekte auf Konzentrationsfähigkeit, Ausgeglichenheit und Sozialverhalten wahrgenommen haben. Zu den Barrieren zählen vorwiegend strukturelle Rahmenbedingungen. Diskussion/Schlussfolgerungen: Die Anfangs bestehenden Vorbehalte seitens der Eltern und Lehrer konnten durch die positiven Erfahrungen der Auswirkungen täglichen Schulsports weitgehend beseitigt werden. Die qualitative Erhebung verdeutlicht die Potentiale täglichen Schulsports. Die aufgezeigten Barrieren geben Ansatzpunkte zu ihrer Überwindung bei einer möglichen dauerhaften Implementierung.
Einleitung/Hintergrund: Zu den zentralen gesundheitlichen Risiken einer Bevölkerung gehören illegaler sowie legaler Drogengebrauch. Illegaler Drogenkonsum gehört zunehmend zum Experimentierverhalten während des Jugendalters und Erwachsenwerdens. Oftmals werden Verhaltensweisen, die zur Sucht führen können, bereits in diesem Alter geprägt [1]. Ein Prädiktionsmodell ermöglicht unter idealen Bedingungen eine frühzeitige Risikovorhersage potentieller juveniler Drogenkonsumenten und gestattet eine gezielte Prävention. Der vorliegende Beitrag analysiert die geschlechtsspezifische Entwicklung und Validierung von Prädiktionsmodellen zum illegalen Drogenkonsum bei Kindern und Jugendlichen in Schleswig-Holstein sowie dessen Prognosegüte. Material/Methoden: Anhand der von 1931 Kindern und Jugendlichen erhobenen Daten aus dem Ländermodul Schleswig-Holstein des Kinder- und Jugendgesundheitssurveys (KiGGS) des Robert Koch-Instituts wurden nach Geschlecht stratifizierte Prognosemodelle erstellt und zur Vermeidung der Überschätzung der Prognosegüte mittels der Methode „Leave one out“ [2] intern kreuzvalidiert. Die Modellberechnung erfolgte anhand einer schrittweise vorwärts gerichteten logistischen Regression. Die Bewertung sowie der Vergleich der Modellgüte erfolgten neben Cutpoint-abhängigen Testgüteparametern anhand von ROC-Analysen. Ergebnisse: Bei der stratifizierten Modellberechnung zeigt sich, dass Jungen und Mädchen sich hinsichtlich der Prädiktoren deutlich unterscheiden. Nach Prüfung bivariater Assoziationen sowie nach dem multivariablen Selektionsprozess gingen zwölf Variablen für Mädchen sowie acht Variablen für Jungen (p<0,05) in das jeweilige endgültige Prädiktionsmodell ein. Wichtige Prognosemerkmale sind bei den Mädchen vor allem Variablen zum Gesundheitsverhalten, verfügbaren Geld sowie zu Gewalterfahrungen, die sowohl Opfer- als auch Täterschaft von Gewalt beinhalten. Merkmale, die auf ein erhöhtes Risiko für illegalen Drogenkonsum bei Jungen hinweisen, sind neben der elterlichen Kenntnis über Alkoholkonsum und schulische Leistungen insbesondere der Konsum legaler Drogen und ein sehr häufiger Zeitvertreib mit Spielkonsolen. Diskussion/Schlussfolgerungen: Nach Angaben der BZgA zum Konsum illegaler Drogen sind die Geschlechterdifferenzen am Anteil der Drogenkonsumenten in Deutschland geringer gewordenen [3]. Die unterschiedlichen Prognosemerkmale der stratifizierten Modellberechnungen zeigen, dass die Geschlechtsperspektive zur wirksamen und zielorientierten Gestaltung präventiver Strategien zur Vermeidung illegalen Drogenkonsums notwendig sind. Vor Anwendung der Prognosemodelle für suchtpräventive Aktivitäten sollten eine externe Validierung sowie eine ethische Bewertung erfolgen.
Abstract Background Juvenile and childhood obesity or overweight are associated with various secondary diseases and physical limitations, as well as with the effects of discrimination and social exclusion. The early prevention of obesity remains a key area of action worldwide. Schools are considered as a classical setting. The analysis focuses on the effectiveness of interventions, the identification of effective components and conditions as well as barriers. The aim is to provide a differentiated presentation of the current study situation. Methods The systematic literature search in eleven databases included studies in English and German published in 1990 to 2015. A control group and posttest data were obligatory. Evaluated outcome measures must map effects on the prevalence of obesity (e.g., BMI, body fat percentage, waist-to-hip ratio). Included full texts were evaluated with the instrument ROBINS-I. Due to the heterogeneity of studies (especially in terms of design, intervention and outcomes) results were analysed qualitatively. Results 48 primary studies were included of which most studies report data on changes in mean BMI over time, and show predominantly (small) effects in favour of the intervention. Almost all identified interventions include behavioral measures, most of them combine the fields of nutrition and physical activity, with behavioral prevention being overrepresented in particular in activities addressing nutrition. Conclusions The results allow the conclusion, that school-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. There is clear evidence that the effects achieved tend to be maintained beyond the intervention. There are also clear indications for the cost-effectiveness of school-based obesity prevention. The studies from this field of research have clearly gained in quality over the years and are now flanked by health economic analyses. Funded by DIMDI Key messages School-based measures to prevent obesity are effective in terms of anthropometric outcome measures, but to a limited extent. In order to fully realize its potential, school-based measures to prevent obesity should be accompanied by interventions at other levels, like the health-promoting design of living environments.
Abstract Background The “AOK-Junior” care program of the AOK Nordost (a German statutory health insurance) completes the primary care for children and adolescents (C&A) in the federal states of Berlin, Brandenburg and Mecklenburg-Vorpommern in Germany. The focus of this program is on prevention and early detection of illness on C&A. Furthermore, the aim is to maintain the health of C&A and to prevent, detect and treat illness on time. Elements of the program are not only the integrated care of C&A, but also, for example, weight reduction and additional medical checkups U10, U11 and J2. The evaluation of the complex intervention should provide information about the effectiveness of early disease detection and costs-effectiveness as well as of other parameters like satisfaction. Methods The evaluation is performed on the levels of structural-, process- and results-quality. The cost effectiveness is also assessed by means of a health economic evaluation. In addition to the collection of qualitative and quantitative primary data from participating and non-participating C&A and paediatricians, routine data from a statutory health insurance are used in the evaluation. Furthermore, a cross-sectional design is used to evaluate the structure and process quality. The effectiveness is evaluated in longitudinal section design on the basis of the secondary data. The quantitative surveys include net n = 1096 C&A and n = 340 pediatricians. For the focus groups, a sample of 72 to 96 parents as well as pediatricians will be sought by using the method of theoretical sampling. Discussion Around 560 pediatricians and 63,000 C&A currently participate in the AOK Nordost care program. The project provides information to what extent secondary preventive measures can lead to the early detection of diseases and on the associated cost-effectiveness. Furthermore, potentials and barriers of the program implementation are identified. The results of the evaluation study are expected not only to contribute to the further development of the care program, but also to derive recommendations for action. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00015280 . Prospectively registered on 18 March 2019 .
A lack of effective coordination and communication between ambulatory care physicians and hospitals, including the lack of follow-up care, poses a challenge to the recovery process of patients suffering from cardiac disease, often resulting in rehospitalisation and adverse outcomes. This innovative care programme aims to bridge the gap between ambulatory and hospital care. A key element of this programme is specifically trained care managers (Cardiolotse) who provide post-discharge support, access to additional resources and help the patient to navigate successfully through the healthcare system. The study is set up as a prospective, randomised, controlled trial. Allocation to intervention group (support of care managers) and control group (usual care) follows an allocation ratio of 1:1 using block randomisation. Sample size calculations resulted in 1454patients per group after adjusting for potential non-compliance. All participants are surveyed at discharge, after 3 and 12 months. The primary outcome of the study is the 12-month rehospitalisation rate. Secondary outcomes include differences in length of hospital stay, mortality, quality-adjusted life years, costs and patient satisfaction. Statistical analysis and economic evaluation will be complemented by a process evaluation. The new healthcare programme is designed to support patients when leaving hospital with cardiac conditions by easing the transition between sectors through access to Cardiolotses and individualised care plans. We hypothesise that the programme reduces rehospitalisation and improves clinically relevant patient outcomes. German Clinical Trial Register, DRKS00020424. Registered 2020-06-18, http://www.drks.de/DRKS00020424
Purpose: To investigate associations between maternal and paternal sport participation, and children’s leisure-time physical activity, and to explore differences by child gender. Method: The sample comprised 737 year five students (mean age: 11.0 ± 0.6 years, 52% male) recruited through the Fit for Pisa Project which was conducted in 2008 at 6 secondary schools in Goettingen, Germany. Maternal and paternal sport participation were assessed through child reports of mothers’ and fathers’ weekly participation in sport. Children’s leisure-time physical activity was measured as minutes/week that children engaged in organized and nonorganized sport. Multiple linear regression was used to assess associations between maternal and paternal sport participation, and children’s leisure-time physical activity. Results: Both maternal and paternal sport participation were positively associated with children’s leisure-time physical activity (maternal: b = 34.20, p < .001; paternal: b = 25.32, p < .05). When stratifying analyses by child gender, maternal sport participation remained significantly associated with leisure-time physical activity in girls (b = 60.64, p < .001). In contrast, paternal sport participation remained significantly associated with leisure-time physical activity in boys (b = 43.88, p < .01). Conclusion: Both maternal and paternal modeling positively influence children’s leisure-time physical activity.
