Christina Bock

The prevalence of gestational diabetes in advanced economies

Abstract Aims: One of the first steps in optimizing future prevention and appropriately allocating resources to future diagnosis and treatment of Gestational diabetes (GDM) is to quantify its burden. The aim of this study was therefore to conduct a systematic review of current international literature on the prevalence of GDM with a focus on advanced economies. Methods: Based on literature searches with the database “PubMed” we included studies with a publication date between 2000 and 2011. All studies were classified independently by two authors. In accordance with the PRISMA Statement we identified 27 original studies. Results: The prevalence of GDM varies substantially between populations with a range of 1.7–11.6%. Patient self-reports yield higher prevalence estimates than values that are based on medical diagnosis or clinical diagnostic tests. Prevalence seems to vary considerably within Europe with higher prevalence values being observed in Southern Europe than in Northern and Central Europe. Prevalence values from studies from Australia and North America were within this range. Conclusion: This review provides a comprehensive and sound summary of the current state of research on the prevalence of GDM in advances economies as a first step in identifying starting points for future interventions.

Sunbed Use, User Characteristics, and Motivations for Tanning Results From the German Population-Based SUN-Study 2012

OBJECTIVES To calculate sunbed use prevalence rates, to investigate the motivations for tanning, and to identify typical target groups for interventions to prevent skin cancer. DESIGN Cross-sectional, representative, population-based study, primary analysis of the SUN-Study 2012 (Sunbed-Use: Needs for Action-Study). SETTING Nationwide telephone survey of the general population in Germany. PARTICIPANTS Study participants (n=4851) aged 14 to 45 years. MAIN OUTCOME MEASURES Frequency of sunbed use and, if applicable, motivational reasons for use, the location of the most recent use, and the available advisory service. Characteristics of typical sunbed users were identified using logistic regression analysis. RESULTS The overall prevalence of sunbed use was 39.2% (ever users); 14.6% had used a sunbed within the last 12 months (current users). Among minors and persons with skin types I or II, this proportion was 5.2% and 8.9%, respectively. Positive determinants of current sunbed use (quantified as odds ratios [95% CIs]) were female sex (1.97 [1.64-2.37]), immigrant background (1.46 [1.21-1.77]), and full-time (1.93 [1.53-2.43]) or part-time employment (1.44 [1.11-1.85]). The main motivations for tanning were relaxation and increased attractiveness. Sunbeds were mainly used in tanning studios (74.9%), and many users had never been advised about potential health risks (72.8%). CONCLUSIONS The results of this study emphasize the need for more frequent and higher-quality educational interventions to change tanning behavior, particularly among women, people with darker skin, and those with an immigrant background. Owing to their elevated vulnerability, minors and people with pale skin should also be the focus of such interventions.

Community-based efforts to promote physical activity: A systematic review of interventions considering mode of delivery, study quality and population subgroups

OBJECTIVES Despite the known benefits of physical activity, the majority of adults in developed countries lead sedentary lifestyles. The community setting is a promising venue for physical activity-promoting interventions. Our objectives were to investigate the effectiveness of community-based physical activity interventions by mode of delivery, study quality and to analyse intervention effectiveness in different subgroups in the population. DESIGN We conducted a systematic literature review in Medline and other databases to identify controlled, community-based physical activity interventions published between 2001 and 2012. METHODS We performed several post hoc subgroup comparisons for mode of delivery, study quality and selected population characteristics, using net per cent change in physical activity outcomes between baseline and follow-up as an effect measure. RESULTS We identified 55 studies on exercise/walking sessions, face-to-face counselling, public campaigns and interventions by mail, the Internet and telephone presenting data on 20,532 participants. Overall, half of the studies reported positive physical activity outcomes (total net per cent change: 16.4%; p=0.159; net per cent change for high-quality studies, i.e. studies meeting more than 5 out of 7 quality criteria: 16.2%; p=0.010). Interventions using face-to-face counselling or group sessions were most effective (net per cent change: 35.0%; p=0.014). Net per cent change was also higher in studies exclusively tailored to women (27.7%; p=0.005) or specific ethnic groups (38.9%; p=0.034). CONCLUSIONS This systematic review supports the effectiveness of community-based physical activity interventions in high-quality studies. Our results suggest that interventions using personal contact as well as tailored interventions are most promising.

Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings: A Systematic Review of Practice and Associated Factors

Cardiovascular disease carries a substantial public health burden. Physician advice on modifying behavioral risk factors is effective, yet the practice of and factors associated with behavioral counseling in primary care have not been systematically investigated. The authors conducted a systematic review that identified 18 studies providing data on 6,338 physicians. The provision of preventive services differed by patients’ individual risk. Physicians’ counseling on smoking cessation was most commonly reported. The proportions of physicians counseling about nutrition and physical activity were notably lower and few physicians took further action by using more intensive counseling approaches. As studies were mainly based on self-reports, current delivery of preventive services may be overestimated. There is a need to increase the frequency of behavioral counseling in primary care settings, particularly for nutrition and physical activity, and to emphasize that counseling may also benefit individuals without cardiovascular disease risk factors.

Physical activity promotion in primary health care: results from a German physician survey.

Abstract Background: Primary care physicians are positioned to play an important role in changing physical activity and other health behaviour of their patients. However, little is known about the practice of physical activity promotion in German primary care settings and the factors associated with physical activity promotion. Methods: 260 randomly selected physicians from the State Medical Association of Baden-Wuerttemberg, Germany, took part in this survey (response rate: 13.3%) and provided data on physical activity promotion (physical activity assessment and advice), attitudes towards health promotion and cooperation activities. Factors associated with physical activity promotion were identified using logistic regression. Results: The physicians who replied had positive attitudes towards health promotion. However, 26.9% reported they had inadequate knowledge to provide counselling and 36.7% felt they were unsuccessful in motivating their patients to increase physical activity. Physical activity assessment and advice occurred in 54.9% of the physicians. Compared to their counterparts, physicians in large cities (odds ratio (OR) 3.93; and 95% confidence interval (95%CI): 1.55–9.99), those convinced to offer their patients a great deal in the way of lifestyle counselling (OR 1.92; 95%CI: 1.09–3.40) and those cooperating with sports clubs (OR 1.75; 95%CI: 1.03–2.96) were more likely to provide physical activity promotion. Conclusion: There is a need for interventions to increase the frequency of physical activity promotion by primary care physicians. In particular physicians in rural regions should be assisted and cooperation activities with sports clubs or other health care providers should be encouraged.

Sunbed use in Germany: trends, user histories and factors associated with cessation and readiness to change

Sunbed use is considered carcinogenic in humans. Studies that examine behavioural patterns related to sunbed use over time are needed for developing skin cancer prevention strategies.

Modifying Health Behavior to Prevent Cardiovascular Diseases: A Nationwide Survey among German Primary Care Physicians

Cardiovascular diseases (CVD) are a major public health concern as they are the leading cause of death in developed countries. Primary care is considered to be the ideal setting for CVD prevention. Therefore, more than 4,000 German primary care physicians (PCPs) were asked about their attitudes towards and their activities regarding the prevention of CVD in the nationwide ÄSP-kardio Study. The focus of the study was on health behavior modification. Two thirds of the participating PCPs stated that they routinely provided brief inventions to assist patients in reducing both their tobacco (72%) and alcohol (61%) consumption, to encourage them to increase their levels of physical activity (72%), and to assist them in adjusting to a more healthy diet (66%), and in achieving a healthy body weight (69%). However, only between 23% (quitting smoking) and 49% (diet modification) of PCPs felt that they had been successful in helping patients modify their lifestyles. Insufficient reimbursement, cultural diversity and a lack of time were reported to be the most problematic barriers to successful intervention in the primary care setting. Despite these obstacles, the majority of German PCPs was engaged in prevention and health behavior intervention to reduce the incidence and progression of CVD.

Building awareness of the health risks of sunbed use: identification of target groups for prevention

Sunbed use, a recognized risk factor for skin cancer development, is common in developed countries. Cost‐efficient interventions to reduce the negative health consequences of sunbed use are needed. As a first step to identify what kind of intervention might be useful, we aimed to assess the awareness of potential health risks of sunbed use in current, former, and never users as well as in current users with differing risk profiles.

Physician gender and lifestyle counselling to prevent cardiovascular disease: a nationwide representative study

Background Primary care physicians (PCPs) have a key role in the prevention of cardiovascular diseases (CVD). However, it is not clear whether lifestyle counselling behaviour differs between female and male PCPs. Nonetheless, this information might be helpful to develop need-based advanced training for female and male PCPs. Therefore, our aim was to identify potential gender differences in the implementation of health promotion and the prevention of CVD in primary care. Design and Methods In a Germany-wide survey called the ÄSP-kardio Study, we collected data from 4074 PCPs (40% female; from October 2011 to March 2012). We compared the provision of prevention measures, the attitude towards counselling, and the potential barriers in counselling among female and male German PCPs. We used chi2 tests, Mann-Whitney U tests, and logistic regression analysis. Results We found differences in all of the above-mentioned aspects. Female PCPs were less likely to perceive barriers than male and more likely to ask patients about lifestyle, for example, nutrition (OR=1.62, P≤0.001). Additionally, female PCPs were more likely to feel well prepared (84.2% vs. 76.0%, P≤0.001) and successful (75.6% vs. 68.0%, P≤0.001). Male PCPs were more likely to mention barriers in daily practice that hinder lifestyle counselling. Conclusions Overall, both female and male PCPs had a positive attitude towards lifestyle counselling. Nevertheless, in view of the barriers that they indicated, incentives such as better reimbursement may help output-oriented PCPs to translate their positive attitude into action. Moreover, awareness of gender differences may help PCPs to acquire the specific advanced training that they need for effective lifestyle counselling in CVD. Significance for public health Lifestyle counselling is an important instrument to reduce the burden of cardiovascular disease. Here, primary care physicians (PCPs) play an important role as health advisors. Our study was able to identify deficits in the health promotion behaviour of PCPs. Because of the gender differences revealed in our study, male PCPs in particular should be sensitized to the importance and the potentials of prevention and health promotion. Overcoming the barriers of prevention and health promotion identified by the PCPs may be an important starting point. If, for instance, PCPs were better financially compensated for offering lifestyle counselling, which was rated as the most important barrier, it is conceivable that more PCPs would start to incorporate such measures into their daily routine. Additionally, a stronger focus on prevention and health promotion during advanced training programs for PCPs could increase the use of lifestyle counselling.

Die Aufnahme des Screenings auf Gestationsdiabetes mellitus in die Mutterschaftsrichtlinien aus Sicht niedergelassener Gynäkologen: Eine qualitative Studie

BACKGROUND In March 2012, the screening for gestational diabetes was included as a 2-step screening into the German maternity directive. However, up to now it is unclear what resident gynaecologists, who are affected directly by this change in the maternity directive, think about the inclusion of the screening and the kind of screening introduced. METHODS In order to approach this topic from a scientific point of view, gynaecologists in the German cities Mannheim, Ludwigshafen, and Heidelberg were interviewed face-to-face using a semi-structured interview guide with open-ended questions (mean interview length: 33:12 min). The interviews were audiotaped, transcribed verbatim (191 pages), coded by 2 independent reviewers, and analysed using qualitative content analysis. RESULTS The majority of the gynaecologists supported the introduction of the screening into the maternity directives. However, some gynaecologists felt that this amendment is not strong enough criticising the GCT with 50 g glucose. Many gynaecologists would prefer an oral glucose tolerance test (OGTT, 75 g glucose). But there were also some gynaecologists who thought that the OGTT would strain pregnant women too much and thus deemed it unsuitable for a screening. Additionally, the gynaecologists named difficulties concerning the implementation of the test such as, for example, the non-availability of a ready-made glucose syrup for the GCT and the delayed introduction of billing codes. DISCUSSION In the framework of this qualitative study, resident gynaecologists--the main actors in the conduct of the screening--had the possibility to offer their opinion on this current topic. The results provide a first insight into the conduct of the screening and may serve as a basis for larger, quantitative studies.