[DEVASYS - Development of an Online Tool to Support Systematic Evaluation of Intervention Projects in Prevention and Health Promotion]. / DEVASYS ­ Entwicklung eines Online-Tools zur Unterstützung der systematischen Evaluation von Interventionsprojekten der Prävention und Gesundheitsförderung.

OBJECTIVES: To date, knowledge about the effects and implementation quality of disease prevention and health promotion projects in Germany is limited. Only a few structured evaluation systems exist that can be easily used and which include features for evaluating research and practice projects. The aim of the current project was to develop and carry out a pilot study of an online evaluation tool that enables structured self-evaluation of projects in disease prevention and health promotion practice and contributes to an improved documentation and cyclical development of projects. METHODS: The mixed-methods approach taken in this project included 2 steps: a) search of literature and database to develop a theoretical framework for the tool and b) adaptation process to test the fit of the tool for practice, including a focus group discussion and a usability test with different disease prevention and health promotion stakeholders (N=12). RESULTS: The resulting documentation and evaluation system (DEVASYS) is comprised of the components "planning", "documentation", and "evaluation" which can be used independently of one another. The conceptual basis of the tool is the RE-AIM framework. To determine the quality of an individual project, dimensions of both the output (reach, acceptance, implementation) and the outcome levels (effectiveness, maintenance) can be documented with the tool. CONCLUSION: DEVASYS is a practice-oriented tool contributing to an improved evaluation of existing practice-related intervention projects and the overall quality of future projects in the area of disease prevention and health promotion. Systematic dissemination and implementation of the tool are the next steps to be taken.

Examples of sex/gender sensitivity in epidemiological research: results of an evaluation of original articles published in JECH 2006-2014.

BACKGROUND: During the last decades, sex and gender biases have been identified in various areas of biomedical and public health research, leading to compromised validity of research findings. As a response, methodological requirements were developed but these are rarely translated into research practice. The aim of this study is to provide good practice examples of sex/gender sensitive health research. METHODS: We conducted a systematic search of research articles published in JECH between 2006 and 2014. An instrument was constructed to evaluate sex/gender sensitivity in four stages of the research process (background, study design, statistical analysis, discussion). RESULTS: In total, 37 articles covering diverse topics were included. Thereof, 22 were evaluated as good practice example in at least one stage; two articles achieved highest ratings across all stages. Good examples of the background referred to available knowledge on sex/gender differences and sex/gender informed theoretical frameworks. Related to the study design, good examples calculated sample sizes to be able to detect sex/gender differences, selected sex/gender sensitive outcome/exposure indicators, or chose different cut-off values for male and female participants. Good examples of statistical analyses used interaction terms with sex/gender or different shapes of the estimated relationship for men and women. Examples of good discussions interpreted their findings related to social and biological explanatory models or questioned the statistical methods used to detect sex/gender differences. CONCLUSIONS: The identified good practice examples may inspire researchers to critically reflect on the relevance of sex/gender issues of their studies and help them to translate methodological recommendations of sex/gender sensitivity into research practice.

Face-to-face Sun Protection Training and Text Messages Improve Sun Protection Behaviour in Adolescent Organ Transplant Recipients: HIPPOlino Feasibility Study.

Adolescent organ transplant recipients have an increased risk of developing skin cancer. The aim of this study was to evaluate the technical feasibility and acceptability of short messaging service-based sun protection recommendations for adolescent patients. Sun-protective knowledge and behaviour were also evaluated using standardized questionnaires and telephone interviews. Twenty-six organ transplant recipients aged 13-22 years participated in face-to-face sun protection training. Subsequently, participants received sun protection reminders via text messages for 4 weeks. Of the participants 95% reported that they checked text messages on a regular basis. Of the 26 organ transplant recipients 19 completed questionnaires before sun protection training and 4 weeks later; 16% (3/19) knew the meaning of the UV-index before training. After training, 74% (14/19) remembered that the term UV-index describes the maximum daily level of local UV radiation. Text message-based sun protection recommendations are well accepted and technically feasible in adolescent organ transplant recipients.

Primary prevention from the epidemiology perspective: three examples from the practice.

BACKGROUND: Primary prevention programmes are of increasing importance to reduce the impact of chronic diseases on the individual, institutional and societal level. However, most initiatives that develop and implement primary prevention programmes are not evaluated with scientific rigor. On the basis of three different projects we discuss necessary steps on the road to evidence-based primary prevention. DISCUSSION: We first discuss how to identify suitable target groups exploiting sophisticated statistical methods. This is illustrated using data from a health survey conducted in a federal state of Germany. A literature review is the more typical approach to identify target groups that is demonstrated using a European project on the prevention of childhood obesity. In the next step, modifiable risk factors and realistic targets of the intervention have to be specified. These determine the outcome measures that in turn are used for effect evaluation. Both, the target groups and the outcome measures, lay the ground for the study design and the definition of comparison groups as can be seen in our European project. This project also illustrates the development and implementation of a prevention programme. These may require active involvement of participants which can be achieved by participatory approaches taking into account the socio-cultural and living environment. Evaluation is of utmost importance for any intervention to assess structure, process and outcome according to rigid scientific criteria. Different approaches used for this are discussed and illustrated by a methodological project developed within a health promotion programme in a deprived area. Eventually the challenge of transferring an evidence-based intervention into practice and to achieve its sustainability is addressed. SUMMARY: This article describes a general roadmap to primary prevention comprising (1) the identification of target groups and settings, (2) the identification of modifiable risk factors and endpoints, (3) the development and implementation of an intervention programme, (4) the evaluation of structure, process and outcome and (5) the transfer of an evidence-based intervention into practice.

Diagnostic agreement in the histopathological evaluation of lung cancer tissue in a population-based case-control study.

Only few studies have compared the agreement of histological lung carcinoma diagnosis of a population-based case series and an independent pathology review. We analyzed data of our population-based lung cancer case-control study to determine the agreement in the histopathological evaluation of lung cancer. Six-hundred and sixty-eight out of 1004 interviewed male and female lung cancer cases were histologically evaluated according to the 1981 WHO classification by regional pathologists and a central pathologist who was blinded to the evaluations of the regional pathologists. The observed agreement was 0.65 with kappa = 0.54 (95% CI: 0.49-0.58). It was highest for small-cell carcinoma (0.94; kappa = 0.82) and lower for squamous-cell carcinoma (0.81; kappa = 0.58) and adenocarcinoma (0.81; kappa = 0.55). Agreement was slightly higher among women than men. The observed agreement among non-smoking cases was 58% as compared to 67% heavy smoking cases. The moderate agreement for squamous-cell and adenocarcinoma complicates epidemiological studies that address these histological subtypes.

Pet birds and risk of lung cancer in North-Western Germany.

In a case-control study on lung cancer and occupational exposures, a subgroup of 144 cases and 253 population-based controls interviewed in the last 16 months of the study, were additionally asked about their exposure to pet birds and other pets. We used the same questionnaire as a previous German study that found a positive association between pet bird keeping and lung cancer. Odds ratios were calculated for lifetime and adulthood exposure respectively. The adjusted odds ratio for ever keeping pet birds was 0.85 (95% CI: 0.53-1.35), and 0.87 (95% CI: 0.56-1.36) for adulthood exposure. There was no evidence of a trend for increasing lung cancer risk with duration of pet bird keeping. With decreasing age at diagnosis, an apparent risk emerged, yielding an odds ratio of 7.62 (95% CI: 2.15-26.95) for ever versus never in the youngest age group (< or =55 years). This odds ratio was reduced to 3.82 (95% CI: 0.98-14.92) after adjustment for smoking and was only 1.39 (95% CI: 0.49-3.95) for adulthood exposure. In general, our results indicate that pet bird keeping does not seem to increase the risk of lung cancer. The divergent findings at younger ages may be explained by age-related recall bias, but should be investigated in future studies.

A population-based case-control study on social factors and risk of testicular germ cell tumours.

OBJECTIVES: Incidence rates for testicular cancer have risen over the last few decades. Findings of an association between the risk of testicular cancer and social factors are controversial. The association of testicular cancer and different indicators of social factors were examined in this study. DESIGN: Case-control study. SETTING: Population-based multicentre study in four German regions (city states Bremen and Hamburg, the Saarland region and the city of Essen). PARTICIPANTS: The study included 797 control participants and 266 participants newly diagnosed with testicular cancer of which 167 cases were classified as seminoma and 99 as non-seminoma. The age of study participants ranged from 15 to 69 years. METHODS: Social position was classified by educational attainment level, posteducational training, occupational sectors according to Erikson-Goldthorpe-Portocarrero (EGP) and the socioeconomic status (SES) on the basis of the International SocioEconomic Index of occupational status (ISEI). ORs and corresponding 95% CIs (95% CIs) were calculated for the whole study sample and for seminoma and non-seminoma separately. RESULTS: Testicular cancer risk was modestly increased among participants with an apprenticeship (OR=1.7 (95% CI 1.0 to 2.8)) or a university degree (OR=1.6 (95% CI 0.9 to 2.8)) relative to those whose education was limited to school. Analysis of occupational sectors revealed an excess risk for farmers and farm-related occupations. No clear trend was observed for the analyses according to the ISEI-scale. CONCLUSIONS: Social factors based on occupational measures were not a risk factor for testicular cancer in this study. The elevated risk in farmers and farm-related occupations warrants further research including analysis of occupational exposures.

Residential exposure to overhead high-voltage lines and the risk of testicular cancer: results of a population-based case-control study in Hamburg (Germany).

BACKGROUND: In a population-based case-control study we examined the association between residential exposure to overhead high-voltage lines and testicular cancer. METHODS: We recorded the residential biography of cases with testicular cancer identified by the Hamburg Cancer Registry and of controls that were randomly selected from the mandatory registry of residents in Hamburg. The study included 145 incident cases between 15 and 69 years of age, diagnosed between 1995 and 1997, and 313 controls, matched for age in 5-year strata. In model A, exposure was defined by distance (ever vs never). Model B took into account residence time and the inverse distance from the nearest high-voltage line. It distinguished between low and high exposure, the never exposed persons serving as a reference group. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by unconditional logistic regression. For men below the age of 40 years and men aged 40 years and over separate analyses were carried out. RESULTS: Within a corridor of 100 m the prevalence of exposure to high-voltage lines in Hamburg was 6.9% in cases and 5.8% in controls (OR=1.3; 95% CI=0.56-2.80). In the more complex model B we found an OR of 1.2 (95% CI=0.60-2.47) for low exposure and 1.7 (95% CI=0.91-3.32) for high exposure. Younger men show slightly increased risks in both models. CONCLUSIONS: In all, residential exposure to high-voltage lines did not seem to be a major risk factor for testicular cancer in our study. Yet, the fact that risks for men below the age of 40 years were slightly increased in both exposure models deserves further attention.

Testicular cancer and electromagnetic fields (EMF) in the workplace: results of a population-based case-control study in Germany.

OBJECTIVES: In a population-based case-control study, we examined the association of testicular cancer and electromagnetic fields (EMF) in the workplace. METHODS: Incident cases (n = 269) were recruited between 1995 and 1997. A total of 797 controls matched on age and region were randomly selected from mandatory registries of residents. EMF exposure was assessed for five categories in standardized face-to-face interviews using closed questions. For each exposure category, odds ratios (OR) were calculated, stratified by age and region, and in a more complex model weighted by duration and distance using conditional logistic regression. Subgroup analyses were conducted for seminoma and non-seminoma and for blue- and white-collar workers. Additionally, potential radar exposure was individually assessed by experts based on all available information including free text. RESULTS: There was no excess risk for cases who reported to have ever worked near the following: radar units (OR = 1.0; 95% CI = 0.60-1.75); radiofrequency emitters (OR = 0.9; 95% CI = 0.60-1.24); electrical machines (OR = 1.0; 95% CI = 0.72-1.33): high-voltage lines or high-voltage electrical transmission installations (OR = 0.7; 95% CI = 0.38-1.18); or visual display units or complex electrical environments (OR = 0.9; 95% CI = 0.67-1.21). The results for the weighted exposure and subgroup analyses did not differ substantially. For radar exposure as assessed by the experts, the OR was 0.4 (95% CI = 0.13-1.16). CONCLUSIONS: EMF exposure in the workplace does not seem to be a relevant risk factor for testicular cancer in our study.