Closing Sexual Health Service Gaps With a New Service Model in Germany: Performance of an on-Site Integrated, Cross-Sectoral, Low Threshold Sexually Transmitted Infections/HIV Counseling and Treatment Service.

Purpose: In Germany, the incidence of bacterial sexual transmitted infections (STI) is on the rise and still high for HIV infections. The Center for Sexual Health Freiburg (CSHF) was established to offer low threshold access for STI/HIV counseling, testing, HIV pre-exposure prophylaxis (PrEP), and on-site treatment. The objective of this study was to analyze the performance of CSHF. Methods: Longitudinal study that includes all clients presenting between 1 May 2020 and 28 February 2021 at CSHF and willing to sign informed consent. Results: In the study period, 536 clients presented at CSHF of whom 417 clients were included in the study resulting in 668 client contacts. Clients' median age was 28.1 years (range: 18.0-73.1), 55.9% were men, 42.0% were women, 0.3% were transman, and 1.7% were not binary. Clients' sexual orientation was heterosexual (56.6%), homosexual men (26.2%), and bisexual (13.6%). STI screening resulted in the detection of any STI in 3.4% (95% confidence interval (CI): 0.7-6.1) of women, in 3.1% (95% CI: 0.0-6.5) of heterosexual men, and in 22.2% (95% CI: 13.0-31.5) of men having sex with men (MSM) not taking PrEP. Eighty-one MSM received PrEP with a total follow-up of 57.3 person-years and 0.44 STIs per person-year. Conclusion: The substantial burden of STI in the study population emphasizes the need for regular and low threshold STI screening services. The concept of CSHF may facilitate access to STI/HIV counseling, testing, and PrEP for a wide spectrum of people and may prove to be an important contribution to the efforts to reduce STI and HIV incidence in Germany.

Gamma-glutamyl transferase is strongly associated with degree of overweight and sex.

Gamma-glutamyl transferase (GGT) is a marker for cardiovascular risk and an independent predictor of long-term outcome in adults. Epidemiological data from pediatric cohorts are rare. We studied the association of GGT to body mass index as a standard deviation score, sex, and age in 68,415 children (age 11.7 ± 4.4 years; 48% boys; body mass index 27.2 ± 7.4 kg/m2; GGT measured in n = 23,955). GGT >50 U/L is strongly associated with extreme obesity (odds ratio 27.13, 95% confidence interval 15.07-48.85) and male sex (odds ratio 2.60, 95% confidence interval 2.03-3.31). GGT seems to be of clinical relevance and may be marketable as a surrogate in risk profiling for children with obesity.

Health-related quality of life in overweight and obese youths: results of a multicenter study.

BACKGROUND: We examined treatment-seeking overweight and obese youths to better understand the gender, age, and treatment modality differences in generic and disease-specific health-related quality of life (HRQOL). METHODS: This multicenter study included 1,916 patients (mean = 12.6 years; 57% females; mean zBMI = 2.4) who started treatment for overweight and obesity in 48 treatment facilities between July 2005 and October 2006. The facilities offered either inpatient treatment or outpatient programs. Prior to treatment, all participants completed the generic KIDSCREEN-27 HRQOL-questionnaire, the self-perception subscale of the generic KIDSCREEN-52 and the disease-specific obesity module of the KINDLR.The patients' HRQOL was compared to the KIDSCREEN reference sample from the general population by one-way analyses of variance, adjusting for age, gender, and socioeconomic status. Independent t-tests were conducted to compare disease-specific HRQOL scores between patients by gender and age group. Significant mean differences in HRQOL between inpatients and outpatients were explored by one-way analyses of variance, adjusting for age, gender, and zBMI. Effect sizes 'd' were calculated employing the estimated marginal means and the pooled standard deviation (m(treatment) - m(norm)/SD(pooled)). RESULTS: The patients' HRQOL scores were impaired relative to German norms, with effect sizes up to d = 1.12. The pattern of impairment was similar in boys and girls as well as in children and adolescents. In each of the analyses, at least three of six KIDSCREEN subscales were affected. Regardless of gender and age group, the highest impairments were found in self-perception and physical well-being. Because of the strong decrease in HRQOL in the general population during adolescence, compared to age-specific norms, adolescents were less impaired than were children. However, overweight and obese adolescents (especially females) reported the lowest absolute HRQOL scores. HRQOL varied with the intensity of treatment. Inpatients had significantly lower scores than did outpatients, even after adjusting for age, gender and zBMI. CONCLUSIONS: The results suggest the presence of differences in HRQOL with regard to gender, age, and treatment modality in treatment-seeking overweight and obese youths. Research and clinical practice must consider the particular impairments of inpatients as well as the impairments of (especially female) adolescents.

Screening for co-morbidity in 65,397 obese pediatric patients from Germany, Austria and Switzerland: adherence to guidelines improved from the year 2000 to 2010.

OBJECTIVE: The aim of the study was to analyze the adherence to current guidelines for co-morbidity screening in overweight and obese pediatric patients participating in the Adipositas-Patienten-Verlaufsdokumentation (APV) initiative in three German-speaking countries. METHODS: APV database: 181 centers from Germany, Austria and Switzerland, specialized in obesity care, contributed standardized, anonymous data of medical examinations from 65,397 patients performed between 2000 and 2010. Completeness of screening for hypertension, dyslipidemia, and impaired glucose metabolism was analyzed using adjusted means. RESULTS: Mean age of the cohort was 12.5 ± 2.9 years and 46.5% were male. 17.3% were overweight (>90th-97th percentile), 45.1% obese (>97th-99.5th percentile), and 37.7% extremely obese (>99.5th percentile). In 2000, blood pressure was documented for 55.1% of patients, increasing to 88.7% in 2010. The rate of lipid diagnostics also improved from 45.0 to 67.7%, and screening for diabetes rose from 32.7 to 62.3% in the same time period. Blood pressure measurements were performed more often during inpatient care (88.5%) compared to outpatient programs (77.5%). Screening was more complete with increasing age and increasing degree of obesity. In boys screening rate was higher than in girls. CONCLUSION: During the 11-year period, screening for co-morbidity improved significantly in overweight or obese children and adolescents. However, adherence to guidelines is still insufficient in some institutions. Quality control based on benchmarking may improve obesity care and outcome.

Sensitivity analysis of weight reduction results of an observational cohort study in overweight and obese children and adolescents in Germany: the evakuj study.

In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI-SDS) of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient) weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT) and per protocol data obtained at the end of the intervention (T1), one year (T2), and two years (T3) after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT) for BMI-SDS reduction of at least -0.2 (successful treatment) and at least -0.5 (good treatment success) were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER). At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients) and 57 to 66% (outpatients), indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51), and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25). Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight.

The hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire predicts short- and long-term weight loss in overweight children and adolescents treated as outpatients.

OBJECTIVE: The success of treatment for pediatric obesity is variable and often unsatisfactory. This study elucidates the influence of inattention and hyperactivity/impulsivity on short- and long-term weight loss and maintenance after outpatient treatment. METHODS: We included 8- to 16-year-old overweight and obese participants treated in 17 multidisciplinary outpatient treatment centers in a nationwide observational study. All treatment centers that reported long-term (1-year) follow-up weight data of at least 60% of the participants were included. At the beginning and end of treatment and at 1 year follow-up weight and height were measured at the center. Inattention and hyperactivity/impulsivity were assessed with the hyperactivity/inattention subscale (HI) of the parent-rated Strengths and Difficulty Questionnaire (SDQ). General linear models were used with the standard deviation scores of the BMI (BMI-SDS) as dependent variable and HI scores as main independent variable adjusting for age, sex, baseline BMI-SDS, and center. RESULTS: 394 participants were included (57% female, age: 11.7± 2.0 years, baseline BMI-SDS 2.32 ±.46 kg/m(2)). HI scores were significantly associated with short- and long-term BMI-SDS (p < 0.0005), with higher baseline HI scores predicting less weight loss. CONCLUSIONS: Our results indicate that inattention and hyperactivity/impulsivity are linearly associated with reduced short- and long-term weight loss. Implications for treatment are discussed.

Does obesity lead to a specific lipid disorder? Analysis from the German/Austrian/Swiss APV registry.

Overweight and obese youth represent a challenge for the affected individual, the healthcare system as well as society as a whole. Increased long-term cardiovascular risk is one of the major consequences of early-onset obesity, affecting both life expectancy and quality of life. The aim of this report is to study the effects of age, gender and obesity category on the presence of individual components of dyslipidemia using normal-weight subjects from the population-based German KIGGS study including 17,641 randomly selected children and adolescents, aged 0-18 years (11,110 normal-weight subjects with lipid measurements) and the German-Austrian-Swiss APV registry, including 57,239 overweight or obese children, adolescents and young adults from 162 specialized obesity care centers (lipid measurements available in 29,711 subjects). Subjects were classified according to BMI category based on the age- and gender-adjusted BMI-z-scores as recommended by the AGA (German Pediatric Obesity working group). Cut-offs for dyslipidemia were based on the recommendations by the American Heart Association: total cholesterol: > 5.2 mmol/l, HDL-cholesterol < 0.9 mmol/l, LDL-cholesterol > 3.4 mmol/l, triglycerides > 1.7 mmol/l. Using SAS 9.2-software, hierarchic modeling with both linear and logistic regression analysis was applied. Within the group of normal-weight children, fasting triglycerides were elevated in 3.3%, LDL-cholesterol in 7.2% and HDL-cholesterol was reduced in 3.1%. With increasing BMI-category, the prevalence of hypertriglyceridemia and reduced HDL-cholesterol increased rapidly. A weaker relationship was present for LDL-cholesterol and total cholesterol. Among obese youth, 30.5% displayed any dyslipidemia, underlining the importance of adequate screening and intervention.