[Primary Prevention in General Medical Practice: A Survey]. / Primärprävention in der Allgemeinarztpraxis: Eine Befragung.

AIM OF THE STUDY: According to the German social insurance code §20 Sec. 1, statutory health insurance companies can reimburse up to 80% of costs incurred by primary prevention programs in physical activity, nutrition, stress management and drug consumption. Whether and how many general practitioners (GPs) provide their patients with information on such programs as part of their own practice is unknown. In this study, we investigate to which primary prevention programs primary care physicians refer their patients and whether they take into account reimbursability of programs. METHODS: Between November 2010 and February 2011, all GPs with a practice in Berlin (n=1 168) received a questionnaire that assessed if patients were referred to prevention programs and the type of programs they were referred to, if they ensured they are reimbursable and if they themselves offered prevention programs. Descriptive statistics and multivariate logistic regression was used for analysis. RESULTS: Of 474 respondents (response rate: 41%), 67% were female. Of the respondents, 22% offered reimbursable prevention programs and 42% at out-of-pocket expense. Patients were referred to reimbursable programs by 63%. GPs younger than 50 were twice as likely to offer reimbursable programs in their practice compared to those older than 50 (OR=1.7; 95% KI 1.1-2,8; p-value 0.025). CONCLUSION: A successful implementation of the new German prevention law needs awareness among GPs about reimbursable prevention programs, which may be lacking in some groups.

[Online Health Services for the Prevention of Stress-associated Psychological Impairments at the Workplace]. / Online-Gesundheitsangebote zur Vorbeugung von stressassoziierten psychischen Beeinträchtigungen innerhalb betrieblicher Lebenswelten.

Objective: The aim of this systematic review is to provide an overview of the evidence from randomized controlled trials (RCTs) on the effect of online health services for the prevention of stress-associated psychological impairments at the workplace. Methods: The databases EMBASE, PubMed and PsycINFO were systematically searched for English, French and German references. Included were RCTs that examined the influence of online health services on stress-associated impairment in adult employees at the workplace. The Critical Appraisal Skills Programme (CASP) checklist was used for quality appraisal. Results: Out of 5 632 identified references, 13 RCTs were included in this study. The intervention approaches included movement and relaxation exercises, imparting of knowledge, cognitive-behavioral/social-behavioral interventions, risk communication, health coaching, mindfulness training, and career identity training. In 4 RCTs among mainly white collar employees, the interventions led to improvements in stress-associated outcomes (2 RCTs of high, one of medium and one of low quality level). 9 further RCTs (5 of them of a medium and 4 of a low quality level) did not show a beneficial intervention effect. Conclusion: There are effective health services for the prevention of stress-associated psychological impairments at the workplace. A final conclusion on the kind of intervention that is effective cannot be drawn due to the limited number of RCTs using various intervention approaches. Interventions of at least 12 weeks and a combination of multiple approaches were more often effective.

[Approaches for the prevention of overweight through modified beverage consumption in the elementary school setting. The "trinkfit" study]. / Ansätze der Übergewichtsprävention durch verbessertes Trinkverhalten im Setting Grundschule. Die "trinkfit"-Studie.

There is still little evidence for effective interventions that prevent childhood overweight. A number of behavioral interventions have been implemented, but in order to achieve sustainable preventive effects, they should be combined with environmental interventions which target the obesogenic environment. A modifiable obesogenic factor is beverage consumption and targeting this behavior seems promising to prevent overweight in children. The behavioral and environmental approaches were combined in the "trinkfit" study, and effectiveness and feasibility were tested in a controlled intervention study. In order to prevent overweight, the intervention focused on increased water consumption of children in elementary schools. The intervention consisted of lessons on water given by the teachers (behavioral intervention) and the provision of water fountains and water bottles (environmental intervention). After one school year, the intervention had been effective in decreasing the risk of overweight in the children of the intervention group. However, this preventive effect was not observed among children with an immigrant background. Process evaluation results indicate that the combined intervention focusing on increased water consumption was sustainable and feasible in the school setting.

Long-term process evaluation of a school-based programme for overweight prevention.

BACKGROUND: The epidemic increase in childhood overweight demands effective and also feasible prevention programmes. A school-based environmental and educational intervention focusing on the promotion of water consumption was found to be effective for overweight prevention in children. Process evaluation and long-term surveillance are necessary to evaluate the feasibility and sustainability of the intervention programme in a school setting. METHODS: Process evaluation was conducted during the intervention period (one school year) and a 19-month follow-up after the intervention trial on the prevention of overweight in 17 elementary schools. Data were collected through measuring the water flow of water fountains installed in schools, and questionnaires and interviews were administered to teachers and headmasters of intervention schools. Main outcomes were implementation of the intervention components, behavioural modification of the children concerning water consumption, and teacher and headmaster attitudes towards the intervention. RESULTS: Eleven out of 17 intervention schools maintained the water fountains until 19-month follow-up. The mean water flow of the fountains decreased initially, but remained stable after the during the follow-up period. The implementation rate of the educational units by teachers varied between the units from 13% to 84%. Teachers graded the overall concept of the intervention as good, continuously during the intervention and follow-up period. The majority of teachers organized the water supply of the fountains on the class level during the intervention period but not during the follow-up. CONCLUSIONS: The long-term process evaluation showed that the combined educational and environmental intervention has potential for sustained modifications in the beverage consumption habits of children. It also identified barriers and promoting factors of a sustainable and feasible implementation of the preventive programme in a school setting.

The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review.

This systematic review examined longitudinal associations between weight change (weight gain and loss) and both physical and mental aspects of health-related quality of life (HRQOL) compared with stable weight in adults and children of the general population. MEDLINE, EMBASE, PsycINFO and PubMed databases were searched. Longitudinal observational studies measuring HRQOL with six predefined instruments were synthesized according to type of association: weight change and change in HRQOL (change-on-change association) and weight change and HRQOL at follow-up (predictive association). Twenty studies of adults (n = 15) or children (n = 5) were included. Fifteen studies used the SF-12 or SF-36. Results of nine studies in adults examining the change-on-change association were combined through a tallying of 606 analyses. Weight gain was most often associated with reduced physical, but not mental HRQOL, across all baseline body mass index categories and in both men and women. Weight loss may be associated with improved physical, but not mental HRQOL, among adults with overweight and obesity. Weight gain was more strongly associated with HRQOL than weight loss, implicating a greater need for preventative strategies to tackle obesity. Results in children and for the predictive association generally reflected these findings but require further research.