Search

Non-communicable, chronic diseases like type 2 diabetes, cardio-vascular diseases and cancer are meanwhile the most frequent causes of death and contribute to the rising costs in health care. The current focus on therapeutic procedures and medication requires more health promoting, preventive approaches to improve public health and thereby control costs. Decisions on measures that counteract rising costs in health care need to be evidence-based to ensure the responsible use of limited resources. This is accomplished by health-economic analyses of the cost-effectiveness of a measure, since both costs and effects are considered.Physical inactivity is one of the most crucial, modifiable risk factors of morbidity and mortality, therefore physical activity promoting interventions for schoolchildren should be first priority. In fact,althoughmeasures to promote physical activity in children are widespread, economic evaluations of these interventions are still very rare. This review articlepresents successful school-based interventions with proven cost-effectiveness. The assessment of cost-effectiveness is illustrated based on the examples of the German URMEL-ICE project and the Join the Healthy Boat health promotion programme. Both programmes were, with costs per child and year of 24.09 and 25.04 respectively, below the threshold of 123.24, determined by the parental willingness to pay.A practical and sensitive outcome measure for the determination of the effectiveness of a physical activity promoting intervention is the waist-to-height ratio (WHtR), a measure of abdominal obesity. Even without considerable weight loss, the exercise-induced reduction of abdominal fat mass generates health benefits.KEY WORDS: Cost-Effectiveness, Health Promotion, Exercise, Abdominal Obesity, Childhood

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study. Methods/Design The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up. Discussion At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494

The incidence of skin cancer is rising continuously. The time of diagnosis is decisive for the morbidity and mortality risk of patients. An optimal screening procedure has yet to be established. Non-contact imaging methods are of great interest but have not yet been sufficiently developed and investigated for large-scale use. Compared to digital photography, infrared thermography offers the additional information of heat radiation from the skin surface, which correlates strongly with malignant changes. Literature on the current scientific status of screening, diagnosis and monitoring of skin cancer using thermographic procedures was identified in PubMed, Embase, and Google Scholar. From a technical and information technology point of view, infrared thermography is very well suited for use as a non-invasive, cost-effective, time-saving, and easy-to-use screening instrument. However, there is still a lack of reliable evidence and practical implementation in 3D systems suitable for mass use. Research in this area should be intensified in order to develop, test and establish applicable systems on a large scale., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Metadata are often the first access to data repositories for researchers within secondary use. Through automatic metadata generation and metadata harvesting the amount of data about data has been growing ever since. In order to make data not only FAIR but also reliable, the aspect of metadata quality has to be considered. But as earlier assessments of metadata of different repositories showed, metadata quality still lacks behind its capability. Providing an extensive literature review the authors conclude nine measures to assess metadata in relation to clinical care repositories, such as Medical Data Integration Centers (MeDICs). Proceeding from these measures the authors propose an addition of the FAIR Guiding Principles by adding a fifth block for Reliability including three principles, that resulted from the measures presented. The results form the basis for the future work of an assessment of metadata, that is stored in a MeDIC.

Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical and environmental modalities. The diagnostic performance of thermography and the existence of specific reference data are evaluated, and research gaps and future tasks identified. The entire review process followed the Joanna Briggs Institute (JBI) approach and the results are reported according to PRISMA-ScR guidelines. The scoping review protocol is registered at the Open Science Framework (OSF). PubMed, CENTRAL, Embase, Web of Science, OpenGrey, OSF, and PROSPERO were searched using pretested search strategies based on the Population, Concept, Context (PCC) approach. According to the eligibility criteria, references were screened by two researchers independently. Seventy-two research articles were identified describing screening, diagnostic, or monitoring studies investigating the potential of thermography in a total of 17,314 participants within 38 different health conditions across 13 therapeutic areas. The use of several camera models from various manufacturers is described. These and other facts and figures are compiled and presented in a detailed, descriptive tabular and visual format. Thermography offers promising diagnostic capabilities, alone or in addition to conventional methods.

Background: Secondary use of routine medical data is key to large-scale clinical and health services research. In a maximum care hospital, the volume of data generated exceeds the limits of big data on a daily basis. This so-called "real world data" are essential to complement knowledge and results from clinical trials. Furthermore, big data may help in establishing precision medicine. However, manual data extraction and annotation workflows to transfer routine data into research data would be complex and inefficient. Generally, best practices for managing research data focus on data output rather than the entire data journey from primary sources to analysis. To eventually make routinely collected data usable and available for research, many hurdles have to be overcome. In this work, we present the implementation of an automated framework for timely processing of clinical care data including free texts and genetic data (non-structured data) and centralized storage as Findable, Accessible, Interoperable, Reusable (FAIR) research data in a maximum care university hospital., Methods: We identify data processing workflows necessary to operate a medical research data service unit in a maximum care hospital. We decompose structurally equal tasks into elementary sub-processes and propose a framework for general data processing. We base our processes on open-source software-components and, where necessary, custom-built generic tools., Results: We demonstrate the application of our proposed framework in practice by describing its use in our Medical Data Integration Center (MeDIC). Our microservices-based and fully open-source data processing automation framework incorporates a complete recording of data management and manipulation activities. The prototype implementation also includes a metadata schema for data provenance and a process validation concept. All requirements of a MeDIC are orchestrated within the proposed framework: Data input from many heterogeneous sources, pseudonymization and harmonization, integration in a data warehouse and finally possibilities for extraction or aggregation of data for research purposes according to data protection requirements., Conclusion: Though the framework is not a panacea for bringing routine-based research data into compliance with FAIR principles, it provides a much-needed possibility to process data in a fully automated, traceable, and reproducible manner., (© 2023. The Author(s).)

Background: Teaching medicine is a complex task because medical teachers are also involved in clinical practice and research and the availability of cases with rare diseases is very restricted. Automatic creation of virtual patient cases would be a great benefit, saving time and providing a wider choice of virtual patient cases for student training., Objective: This study explored whether the medical literature provides usable quantifiable information on rare diseases. The study implemented a computerized method that simulates basic clinical patient cases utilizing probabilities of symptom occurrence for a disease., Methods: Medical literature was searched for suitable rare diseases and the required information on the respective probabilities of specific symptoms. We developed a statistical script that delivers basic virtual patient cases with random symptom complexes generated by Bernoulli experiments, according to probabilities reported in the literature. The number of runs and thus the number of patient cases generated are arbitrary., Results: We illustrated the function of our generator with the exemplary diagnosis "brain abscess" with the related symptoms "headache, mental status change, focal neurologic deficit, fever, seizure, nausea and vomiting, nuchal rigidity, and papilledema" and the respective probabilities from the literature. With a growing number of repetitions of the Bernoulli experiment, the relative frequencies of occurrence increasingly converged with the probabilities from the literature. For example, the relative frequency for headache after 10.000 repetitions was 0.7267 and, after rounding, equaled the mean value of the probability range of 0.73 reported in the literature. The same applied to the other symptoms., Conclusions: The medical literature provides specific information on characteristics of rare diseases that can be transferred to probabilities. The results of our computerized method suggest that automated creation of virtual patient cases based on these probabilities is possible. With additional information provided in the literature, an extension of the generator can be implemented in further research., (©Christian Schmidt, Dorothea Kesztyüs, Martin Haag, Manfred Wilhelm, Tibor Kesztyüs. Originally published in JMIR Medical Education (https://mededu.jmir.org), 09.03.2023.)

Objective: Little is known about the cooperation of different health care providers during the pandemic. The aim of this study was to develop a graphically mediated, deeper understanding of the processes involved, using a novel expert-supported visualization method, by taking a definite region in Baden-Württemberg as an example., Methods: The development of an overall picture ("mapping") of the pandemic situation in the Ulm/Alb-Donau district was based on the "Knowledge Visualization" method in several phases. First, semi-structured interviews were conducted with local players in the district of Ulm and the Alb-Donau. The visualized individual perspectives were then presented in a joint video conference. This was followed by a moderated discussion, with the aim to agree on common strategies for care in the pandemic. This process was documented with the help of a visulization expert ("Visionom") in the form of a professionally prepared overall picture ("mapping")., Results: All players showed great motivation and appreciated getting to know the perspectives of other regional players. The iterative visualization was strongly activating and stimulated reflection processes. Personal responsibilities proved to be not always clear, communication problems were revealed. A wish to continue the initiated process was expressed., Conclusion: Iterative visualizations can initiate implications at the level of action, metastructures and authorities. We recommend this method also for other questions related to local or regional structures., Competing Interests: PR ist als selbstständiger Visionom tätig und erhielt vom Institut für Allgemeinmedizin den Auftrag zur Erstellung der im Manuskript verwendeten Illustrationen. Die anderen Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Therapies with the continuous administration of anti-hormonal agents in sex-hormone-dependent malignancies such as prostate and breast carcinomas often lead to the development of resistant tumor cells. A systematic evaluation of the use and effects of the intermittent application of endocrine therapy could provide information on the state of knowledge in this research area. PubMed, Cochrane Library, Embase, and Web of Science will be systematically searched using pretested search strategies. Randomized and non-randomized controlled trials, pragmatic trials, case-control, and comparative cohort studies will be eligible. Primary outcomes will be progression-free survival, disease-free survival, and overall survival. The literature retrieved will be selected based on predefined inclusion and exclusion criteria. Relevant data will be extracted from included references into a pre-designed table. The risk of bias will be assessed, and the report of the results will follow PRISMA recommendations and include any deviations from this protocol. The increasing prevalence of breast and prostate cancer and limitations of current therapeutic approaches require a closer look at alternatives. Additionally, to explore new therapeutic agents, modalities of administration should be rigorously reviewed to determine the best regimens for patients. This proposed systematic review aims to summarize and evaluate the current knowledge regarding intermittent endocrine cancer therapy to provide a basis for further research., Competing Interests: The authors declare no conflict of interest.

Metadata describe information about data source, type of creation, structure, status and semantics and are prerequisite for preservation and reuse of medical data. To overcome the hurdle of disparate data sources and repositories with heterogeneous data formats a metadata crosswalk was initiated, based on existing standards. FAIR Principles were included, as well as data format specifications. The metadata crosswalk is the foundation of data provision between a Medical Data Integration Center (MeDIC) and researchers, providing a selection of metadata information for research design and requests. Based on the crosswalk, metadata items were prioritized and categorized to demonstrate that not one single predefined standard meets all requirements of a MeDIC and only a maximum data set of metadata is suitable for use. The development of a convergence format including the maximum data set is the anticipated solution for an automated transformation of metadata in a MeDIC., (© 2022. The Author(s).)

Introduction: Thermography offers a non-invasive radiation-free methodology for diagnostic imaging and temperature measurement, but the extent of the current application is unclear, as is the level of evidence for each use case. Moreover, population-based thermographic reference values for diagnostic purposes are nearly unknown. The aim of this scoping review is to identify patient populations and diseases in which thermography is applied, cataloguing of technical and environmental modalities, investigation of the existence of specific reference data and finally exploration of gaps and future tasks., Methods and Analysis: PubMed, Cochrane Database of Systematic Reviews and CENTRAL, Embase, Web of Science and OpenGrey are to be searched using pretested suitable search strategies, with no language restriction, but abstracts should be available in English or German and articles should not have been published before 2000. This limited time frame is due to the rapid technological progress, which makes it necessary to exclude reports based on outdated technology. The literature found will be selected on the basis of previously defined inclusion and exclusion criteria. Subsequently, relevant data will be extracted from the included references into a predesigned table. The selection and extraction process will be conducted by two researchers independently. The report of the results will be according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The entire review process will follow the Joanna Briggs Institute approach. The scoping review protocol is registered at the Open Science Framework., Ethics and Dissemination: Ethical approval is not required for this work, but ethical medicine also obliges us to carefully consider diagnostic alternatives and compare them with current standards. The dissemination of the results will take place in a variety of ways. First and foremost through publication in an open access journal, but also through conference proceedings. In addition, this scoping review will serve to open up new research foci with regard to thermography., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The prevalence of obesity already reached epidemic proportions many years ago and more people may die from this pandemic than from COVID-19. However, the figures depend on which measure of fat mass is used. The determination of the associated health risk also depends on the applied measure. Therefore, we will examine the most common measures for their significance, their contribution to risk assessment and their applicability. The following categories are reported: indices of increased accumulation of body fat; weight indices and mortality; weight indices and risk of disease; normal weight obesity and normal weight abdominal obesity; metabolically healthy obesity; the obesity paradox. It appears that BMI is still the most common measure for determining weight categories, followed by measures of abdominal fat distribution. Newer measures, unlike BMI, take fat distribution into account but often lack validated cut-off values or have limited applicability. Given the high prevalence of obesity and the associated risk of disease and mortality, it is important for a targeted approach to identify risk groups and determine individual risk. Therefore, in addition to BMI, a measure of fat distribution should always be used to ensure that less obvious but risky manifestations such as normal weight obesity are identified.

Time-restricted eating (TRE) has rapidly gained interest in the public and the scientific community. One presumed mechanism of action is the adaptation of the eating-fasting rhythm to the evolutionary circadian rhythm of the metabolism. Study results regarding the suggestion that earlier beginning of food intake leads to better outcomes are heterogeneous. We conducted a secondary analysis of pooled data from two pilot studies on TRE to examine an association between the timing of onset of food intake with obesity-related outcomes. Participants ( n = 99, 83 females aged 49.9 ± 10.8 years) were asked to restrict their daily eating to 8-9 h for three months. Tertiles of the onset of food intake were assessed for changes in anthropometry, blood lipid levels, and health-related quality of life. We detected no significant differences in outcomes between early (before 9:47), medium (9:47-10:50), and late onset (after 10:50) of food intake. However, the duration of the eating period was longest in the group with the earliest (8.6 ± 1.0 h) and shortest in the group with the latest onset (7.5 ± 0.8 h). Subsequently, fasting duration was longest in the last group (16.5 h). This may have compromised the results. More research is needed in this area to address this question.

Background: The ongoing epidemic of lifestyle-dependent diseases in industrialized countries threatens to overtax the health and social systems of these nations. New approaches beyond the usual therapeutic and preventive measures which have been applied so far must be tested. A paradigm shift with regard to nutrition and associated illness is overdue. Time-restricted eating (TRE) offers a low-threshold and easy-to-implement lifestyle change which may have what it takes for broad, population-wide applicability and a widely diversified range of possible effects. In this pilot study, we examine the feasibility and adherence of TRE in healthy adult employees. Methods: Pre-post design study with healthy volunteers from the staff of Ulm University and Ulm University Hospital. Participants were asked to reduce their daily eating time to 8-9 hours for three months. Surrounding the eating time, they were allowed drinks other than water for 12 hours, and water for the rest of the day. Anthropometric measurements were taken by trained staff, and blood samples were taken at baseline and follow-up. Pre- and post-data on lifestyle, health and health-related quality of life (HRQoL, recorded with the Visual Analog Scale (VAS) of the EuroQol 5-Dimension (EQ-5D)), and attitudes towards TRE were collected in questionnaires. During the course of the study, timing of the first and the last meal, as well as sleep duration and quality, were assessed in diaries. Primary outcome was the percentage of days with achievement of the fasting goal out of the total number of days recorded per participant. Results: Sixty-three participants (aged 47.8±10.5 years, 86% female) were recruited and started the intervention immediately after the baseline assessment. Two persons dropped out while all others finished the study. Ratings of compatibility of TRE with professional activities were good in 78% of participants, neither good nor difficult in 3%, and 18% reported to have encountered some difficulties. On average, the fasting target was reached on 72.2±18.9% of the recorded days. After three months of TRE, participants showed moderate reductions in weight (-1.3±2.3 kg, p≤0.001) and waist circumference (-1.7±3.2 cm, p≤0.001). HRQoL increased significantly by 5.8±12.4 (p=0.008) points between baseline and follow-up. Conclusion: TRE is feasible and well accepted, even in regularly employed persons, and may improve HRQoL. TRE may help to reduce obesity and abdominal obesity in adult working people, thereby preventing lifestyle-dependent diseases; however, volunteers need more guidance to increase effects., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Kesztyüs et al.)

Background: Therapeutic fasting may improve health-related quality of life (HRQoL) and sleep but is not applicable for everyone. Time-restricted eating (TRE) offers a low threshold alternative but research on associations with HRQoL and sleep is rare., Methods: We conducted a secondary analysis of two pilot studies in a pre-post design, which examined TRE in healthy employees at the Ulm University and in abdominal obese patients in a general practitioners office. Participants reported their HRQoL (EQ-5D visual analogue scale) before and after 3 months of restricting their daily eating to 8-9 h. They kept a diary to protocol timing of first and last meal, sleep quality (analogue scale) and duration. Pearson's correlation coefficient was applied to test bivariate correlations between continuous variables and linear regression analyses were conducted to identify associated factors with the pre-post differences in HRQoL and the differences in sleep quality., Results: Ninety-nine participants (aged aged 48.9 ± 1.1, 83.8% female) reached the fasting target of 15-16 h on average on 77.2 ± 18.7% of all recorded days. HRQoL increased by 7.8 ± 12.6 and sleep quality by 9.6 ± 13.9 points, but sleep duration was not extended. Regression analysis revealed mean fasting duration and baseline sleep quality as significant factors associated with changes in HRQoL. Improvements in sleep quality correlated with baseline sleep quality and HRQoL at follow-up but not with fasting. Changes in anthropometry did not correlate with the HRQoL or sleep quality., Conclusions: TRE correlates with increased HRQoL and sleep quality independent from weight loss. TRE is easily applicable with or without medical supervision. The potential effects of TRE on health and sleep should be further investigated in larger randomized trials., Trial Registration: German Register for Clinical Trials (DRKS), DRKS-ID: DRKS00015057 . Registered 4 July 2018.

Background: Health promotion has to start early. Many prevention programmes lack proof of effectiveness. A programme that promotes an active and healthy lifestyle for primary school children in Baden-Württemberg is "Join the Healthy Boat"., Aim: The effect of this one-year school-based intervention on endurance performance and incidence of paediatric abdominal obesity was investigated in a large cluster randomised study., Methods: Data of 1739 children (7.1±0.6 years) were available at baseline and follow-up. Background variables were assessed via parent questionnaires. Endurance performance (6-minute run) and anthropometric data were collected on-site. Children with waist-to-height-ratio (WHtR) ≥ 0.5 were classified as being abdominally obese. The difference in endurance capacity and the incidence of abdominal obesity between baseline and follow-up were calculated and analysed in simple and hierarchical regression models taking into account the school effect., Results: Adjusted for gender and grade level, the difference in completed meters in the intervention group after one year was significantly greater (70.5±128.6 vs. 59.2±106.6 m, n=1708). However, after taking into account data clustering of schools, the significance was lost. Odds for the development of abdominal obesity in the intervention group were more than halved after adjustment for gender, grade, baseline WHtR and no-breakfasts (odds ratio=0.48, 95% CI [0.25; 0.94], n=1535)., Conclusion: Children should learn to make healthy choices from an early age. With the prevention of abdominal obesity as an indicator, this intervention is characterised as an effective health promotion., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity., Methods: Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants., Results: General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181)., Conclusions: Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies., Trial Registration: DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks&#95;web/.