Cooperation behaviour of primary care paediatricians: facilitators and barriers to multidisciplinary obesity management.

BACKGROUND: Multidisciplinary management of obesity by primary care paediatricians, providing a promising approach to tackle childhood obesity includes cooperation with other health care professionals. However, facilitators for and barriers to multidisciplinary cooperation in ambulatory care are not yet well understood and are investigated in the present study. METHODS: A nationwide, cross-sectional survey of 83% of German primary care paediatricians was conducted, using a questionnaire based on qualitative expert interviews. Frequency of paediatricians' cooperation with external partners (i.e. nutrition counsellors; sports groups; interdisciplinary obesity centres; inpatient rehabilitation centres; and endocrinologists) was assessed. Individual and structural factors were associated with cooperation patterns. Missing values were addressed using multiple imputation. RESULTS: Out of the 6081 primary care paediatricians approached, 2024 (33.3%) responded. Almost half of the respondents (40.8%) stated that they disengaged in the field of obesity prevention due to perceived inefficacy. Lack of financial reimbursement for consultation was agreed on by most of the respondents (90.4%). Identified barriers to cooperation included: higher proportion of patients with migration background, lack of time and available services. A more comprehensive conception of the professional role regarding overweight prevention, higher age, female gender, higher proportion of overweight/obese patients and practice location in urban or socially strained areas surfaced as facilitators for cooperation. CONCLUSION: Low-perceived self-efficacy in obesity management and insufficient financial reimbursement for consultation are commonly stated among German paediatricians. For cooperation behaviour, however, other individual and structural factors seem to be relevant, which provide indications on how multidisciplinary childhood obesity management can be improved.

[Health promotion and overweight prevention-a systematic evaluation of available information materials with a focus on risk groups]. / Gesundheitsförderung und Übergewichtsprävention ­ systematische Bewertung verfügbarer Informationsmaterialien mit Fokus auf Risikogruppen.

BACKGROUND: Children and adolescents from families with a migration background and/or low social status belong to risk groups for the development of overweight. At the same time, they are considered difficult to approach for health promotion. This paper aims to provide an overview of freely available print and web-based materials on health promotion and to evaluate these in terms of formal, content-related, and target-group-specific criteria. METHOD: From August to September 2017, print media and websites were screened using systematic keyword searches in a large search engine. Search results were evaluated by an evidence-based catalogue of criteria and rated by comparative analysis. Health apps freely available from an app store were investigated, tested, and evaluated descriptively. RESULTS: Eighty-nine print media, 58 websites and 32 apps were found. Of the print media items, 11.2% are available in different languages; in 29% culturally sensitive aspects are considered and in 12.4% the material makes use of clear, nontechnical language. In 40.6% of the websites, either another language can be chosen or foreign language downloads are available. Most common are translations into English (37.5%), Turkish (31.3%), Arabic (28.1%), and Russian (25%). In 37.5% of the websites, the material addresses culturally sensitive aspects. From the tested apps (n = 25), only a few qualitatively high-ranked ones are aimed at parents and pregnant women and these are often text-based and exclusively available in German. DISCUSSION: Only few informational materials are directly oriented to the everyday world of risk groups. For this target group, material drawn up in clear language with multiple translations as well as with culturally adapted designs is recommended.

Current Guidelines for Obesity Prevention in Childhood and Adolescence.

OBJECTIVE: Current guidelines for prevention of obesity in childhood and adolescence are discussed. METHODS: A literature search was performed in Medline via PubMed, and appropriate studies were analyzed. RESULTS: Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children. CONCLUSION: Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an 'obesogenic environment' is crucial for sustainable success of future obesity prevention programs.

A modified ultrarush insect venom immunotherapy protocol for children.

The prevalence of insect venom allergy in the European population is approximately 5%. Hymenoptera venom allergy is an important epidemiological problem. Ten to 40 deaths are reported annually in Germany. In contrast to conventional dose increase schedules lasting a minimum of 5 days, shorter protocols reduce the patient's stay in the hospital and provide an earlier protection toward stings. Clinical studies on ultrarush protocols have been published for adult patients, but very little data are currently available for children. Therefore, we investigated the safety and tolerability of a shortened insect venom immunotherapy (VIT) in children and adolescents. Forty-three children and adolescents (aged 4-18 years) with insect venom allergy were treated in this study. Five children were hyposensitized according to the ultrarush protocol with nine injections (as suggested by Brehler et al. (Safety of a two-day ultrarush insect VIT protocol in comparison with protocols of longer duration and involving a larger number of injections. J Allergy Clin Immunol 105:1231-1235,2000); 38 children received the modified ultrarush schedules with only eight subcutaneous injections. With both protocols the maintenance dose (100 microg) was achieved in 24 hours. Twenty-five patients (58.1%) showed no reaction after the injections. In 11 patients (25.6%), extensive erythema (>5 cm, maximum of 20 cm) was found at the injection site. Erythema and edema (>5 cm, maximum of 15 cm) were observed in seven patients (16.2%). The maintenance dose was well tolerated, with no systemic reaction in any patient. The modified ultrarush protocol for insect VIT used in this study showed very good tolerability and safety in children and adolescents. This dose regimen can increase compliance by shortening inpatient stay and reduces hospital costs.