RESUMEN
The fetal alcohol syndrome (FAS) is the most avoidable handicap of newborns. It describes prenatal damages which result from the alcohol consumption of the mother. These can be: reduced body length and weight (pre- and postnatal), microcephaly, musculoskeletal, mental and statomotoric developmental retardations and impaired coordinative ability. There are preventive measures of which the efficiency is examined. Already, short counseling interviews, so-called short interventions, increase the abstinence of pregnant women.
RESUMEN
HEALTH POLITICAL BACKGROUND: In 2006, the prevalence of overweight and adiposity among children and adolescents aged three to 17 years is 15%, 6.3% (800,000) of these are obese. SCIENTIFIC BACKGROUND: Obese children and adolescents have an increased body fat ratio. The reasons for overweight are - among others - sociocultural factors, and a low social status as determined by income and educational level of the parents. The consequences of adiposity during childhood are a higher risk of metabolic and cardiovascular diseases and increased mortality in adulthood. Possible approaches to primary prevention in children and adolescents are measures taken in schools and kindergarten, as well as education and involvement of parents. Furthermore, preventive measures geared towards changing environmental and living conditions are of particular importance. RESEARCH QUESTIONS: What is the effectiveness and efficiency of different measures and programs (geared towards changing behaviour and environmental and living conditions) for primary prevention of adiposity in children and adolescents, with particular consideration of social aspects? METHODS: The systematic literature search yielded 1,649 abstracts. Following a two-part selection process with predefined criteria 31 publications were included in the assessment. RESULTS: The majority of interventions evaluated in primary studies take place in schools. As the measures are mostly multi-disciplinary and the interventions are often not described in detail, no criteria of success for the various interventions can be extrapolated from the reviews assessed. An economic model calculation for Australia, which compares the efficiency of different interventions (although on the basis of low evidence) comes to the conclusion that the intervention with the greatest impact on society is the reduction of TV-ads geared towards children for foods and drinks rich in fat and sugar. There is a significant correlation between adiposity and socioeconomic deprivation. The lack of interventions (especially preventive measures geared towards changing environmental and living conditions) and studies focusing on this population group is noticeable. DISCUSSION: There are only a few primary studies of high quality on adiposity prevention in children and adolescents. Especially studies which compare different measures are lacking. This holds also true for the economic analysis, which seems logical insofar, as the basis for economic analyses are usually primary studies (preferably randomized controlled trials (RCT)) due to their evidence level). Studies on interventions geared towards changing environmental and living conditions and towards specific population groups (i. e. the socially disadvantaged) are hardly available. CONCLUSIONS: There are hardly any primary studies of high quality on adiposity prevention in children and adolescents, especially studies which compare different measures are lacking. Interventions geared towards specific population groups (particularly for the socioeconomically disadvantaged) are specifically underrepresented. Establishing such studies is an essential requirement of adiposity prevention. Recommended are a combination of measures geared towards changing environmental and living conditions and towards specific population groups. Furthermore, it is recommended to systematically register future programs (preferably online) in order to be able to draft criteria of success.
RESUMEN
HEALTH POLITICAL BACKGROUND: Methadone substitution treatment in Germany is introduced in 1988 in the framework of a scientific pilot study in North Rhein Westphalia. Recent statistics show that by now a broad offer of substitution treatment exists. From 1 June 2002 to 31 December 2003 113,000 substitution treatments have been recorded as being started of which around 56,000 have been recorded as ongoing treatments by 1 December 2003. SCIENTIFIC BACKGROUND: Substitution treatment (treatment of opioid-dependent persons using substitution substances) is one part of addiction treatment. Its goals are harm reduction and the stabilisation of opioid dependent persons. Integration of opioid-dependent persons in a treatment-setting, reduction of consumption of psychoactive substances, reduction of risk behaviour (primarily related to infectious diseases), decrease of mortality and improvements concerning the social, psychic and physic situation are seen as a success of substitution treatment as maintenance therapy. RESEARCH QUESTIONS: The aim of this HTA report is to investigate which indicators can be used to evaluate the effectiveness of substitution treatment. Based on these indicators an evaluation of the medical, social and economical benefit of substitution treatment - also in relation to abstinence oriented treatment - is carried out. METHODS: A systematic literature search was performed in 31 international databases which yielded 2451 articles with publication date between 1995 and February 2005. RESULTS: After a twofold selection process 32 publications were included for assessment and 276 publications were used as background literature. Despite serious restrictions due to selection bias and dropout in most studies focusing on substitution treatment, reduction of consumption of illegal opioids, reduction of risk behaviour, criminal behaviour, mortality and incidence of HIV can be seen as an empirically proven success of substitution treatment. Concerning the improvement of life and health situation the results of the studies are contradictory. The results show that retention rate of substitution treatment is higher than retention rate of abstinence oriented treatment. Regarding economical aspects substitution treatment is efficient in avoiding secondary illnesses (infections) and decreasing criminality. From the perspective of medical ethics substitution treatment as well as medical prescription of heroin is in principle acceptable. DISCUSSION AND CONCLUSIONS: Based on these results, it can be recommended that substitution treatment in principle should be made available for all opioid dependent persons. The decision whether substitution treatment or another treatment (e. g. abstinence oriented treatment) is more promising has to take into account the individual situation of the client. In addition a combination of substitution treatment and abstinence oriented treatment might be promising although there is a lack of studies about this approach. In any case the decision concerning a certain form of treatment should leave aside pseudo-moralic concerns and should be made on the base of established medical ethic principles - like the interest of the patient - taking into account the specific situation of the client.