Petra Kolip

Changes in self-reported and parent-reported health-related quality of life in overweight children and adolescents participating in an outpatient training: findings from a 12-month follow-up study

BackgroundHealth-related quality of life (HRQoL) was found to improve in participants of weight management interventions. However, information on moderately overweight youth as well as on maintaining HRQoL improvements following treatment is sparse. We studied the HRQoL of 74 overweight, but not obese participants (32.4% male, mean age = 11.61 ± 1.70 SD) of a comprehensive and effective six-month outpatient training at four time-points up to 12 months after end of treatment.MethodsHRQoL was measured by self-report and proxy-report versions of the generic German KINDL-R, including six sub domains, and an obesity-specific additional module. Changes in original and z-standardized scores were analyzed by (2×4) doubly multivariate analysis of variance. This was done separately for self- and proxy-reported HRQoL, taking into account further socio-demographic background variables and social desirability. Additionally, correlations between changes in HRQoL scores and changes in zBMI were examined.ResultsThere were significant multivariate time effects for self-reported and proxy-reported HRQoL and a significant time-gender interaction in self-reports revealed (p < .05). Improvements in weight-specific HRQoL were evident during treatment (partial η2 = 0.14-0.19). Generic HRQoL further increased after end of treatment. The largest effects were found on the dimension self-esteem (partial η2 = 0.08-0.09 for proxy- and self-reported z-scores, respectively). Correlations with changes in weight were gender-specific, and weight reduction was only associated with HRQoL improvements in girls.ConclusionsPositive effects of outpatient training on generic and weight-specific HRQoL of moderately overweight (not obese) children and adolescents could be demonstrated. Improvements in HRQoL were not consistently bound to weight reduction. While changes in weight-specific HRQoL were more immediate, generic HRQoL further increased after treatment ended. An extended follow-up may therefore be needed to scrutinize HRQoL improvements due to weight management.Trial registrationclinicaltrials.gov NCT00422916

Gender differences in healthy life years within the EU: an exploration of the “health–survival” paradox

ObjectivesTo evaluated the female–male health–survival paradox by estimating the contribution of women’s mortality advantage versus women’s disability disadvantage.MethodsDisability prevalence was measured from the 2006 Survey on Income and Living Conditions in 25 European countries. Disability prevalence was applied to life tables to estimate healthy life years (HLY) at age 15. Gender differences in HLY were split into two parts: that due to gender inequality in mortality and that due to gender inequality in disability. The relationship between women’s mortality advantage or disability disadvantage and the level of population health between countries was analysed using random-effects meta-regression.ResultsWomen’s mortality advantage contributes to more HLY in women; women’s higher prevalence of disability reduces the difference in HLY. In populations with high life expectancy women’s advantage in HLY was small or even a men’s advantage was found. In populations with lower life expectancy, the hardship among men is already evident at young ages.ConclusionsThe results suggest that the health–survival paradox is a function of the level of population health, dependent on modifiable factors.

Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS).

BackgroundPhysical activity (PA) shows a marked decline during adolescence. Some studies have pointed to pubertal status or timing as possible PA determinants in this age group. Furthermore, it was supposed that the impact of pubertal changes on PA might be mediated by psychological variables like body dissatisfaction (BDS).MethodsThe 11- to 17-year-old subsample of the German Health Interview and Examination Survey (KiGGS) was used (n = 6 813; 51.3% male, response rate = 66.6%). Through sex-specific sequential multinomial logistic regressions we analysed the univariate and independent associations of chronological age, absolute pubertal status, relative pubertal timing, and BDS with the frequency of PA.ResultsChronological age showed a significantly negative association with PA in both sexes, independent of puberty. The odds of inactivity in contrast to nearly daily PA increased about 70% in boys and 35% in girls for each year of age, respectively. Adjusted for age and other possible confounders, inactivity was significantly less likely for boys in late pubertal stages (OR = 0.27, 95% CI = 0.09-0.78). The risk of inactivity was more than doubled in boys maturing earlier than peers in terms of relative pubertal timing (OR = 2.20, 95% CI = 1.36-3.56). No clear significant puberty effects were found in girls, but the inactivity was more likely for those with irregular menstruation (OR = 1.71, 95% CI = 1.06-2.75). BDS also contributed to the prediction of PA in both sexes. It partially mediated puberty effects in boys but not in girls.ConclusionsOverall, chronological age was a far more important predictor of PA in German adolescents than absolute pubertal status or relative pubertal timing. Further possible explanatory variables like sociocultural influences, social support or increasing time requirements for education should be analysed in conjunction with chronological age in future studies.

Geschlechtergerechte Gesundheitsförderung und Prävention

ZusammenfassungIn der Planung von Gesundheitsförderungs- und Präventionsaktivitäten müssen Geschlechtsunterschiede im gesundheitsrelevanten Verhalten berücksichtigt werden. Männer konsumieren häufiger Alkohol in riskantem Ausmaß. Der Tabakkonsum sinkt in der männlichen Bevölkerung, während er in der weiblichen Bevölkerung steigt. Frauen ernähren sich gesünder. Männer verhalten sich in der Freizeit und im Straßenverkehr riskanter; aus diesem Grund sind die Mortalitätsraten in der männlichen Bevölkerung, insbesondere in den jungen Altersgruppen, aufgrund von Unfällen deutlich höher. Die epidemiologischen Daten lassen den Schluss zu, dass Gesundheitsförderung und Prävention gendersensibel umgesetzt werden müssen. Die Strategie des Gender Mainstreamings ist hier besonders hilfreich, sie wird als Schlüsselstrategie zum Erreichen gesundheitlicher Chancengleichheit zwischen den Geschlechtern betrachtet. Der Beitrag knüpft an den Public Health Action Cycle an und zeigt, dass in jedem Schritt die Berücksichtigung der Kategorie Geschlecht die Qualität der Intervention erhöhen kann. Die Umsetzung von Gender Mainstreaming erfordert einen Sensibilisierungsprozess. Es wird ein Instrument vorgestellt, das in der Stiftung „Gesundheitsförderung Schweiz“ den Sensibilisierungsprozess unterstützt. Anschließend werden einige Beispiele für gelungene geschlechtergerechte Interventionen kurz skizziert.AbstractNumerous gender differences in health-related behaviour are relevant in the planning of health promotion and prevention. More men than women consume amounts of alcohol that are a risk to their health. Tobacco consumption has fallen slightly among men but has risen among women. Women eat more healthy food. Man behave risky in leisure time and traffic, thus their mortality rates due to accidents are much higher, especially in young age groups. The epidemiological data lead to the conclusion that gender sensitive health promotion and prevention is necessary. Gender mainstreaming is declared as the main strategy to enhance gender equity in health. The paper focuses on the public health action cycle and demonstrates that at each step gender mainstreaming improves the quality of intervention. To implement gender mainstreaming in health promotion and prevention, a process of sensitization has to be initialized. An instrument is presented that supports this process at the foundation “Health Promotion Switzerland”. A short description of some examples of gender adequate interventions is given at the end of the paper.

Overweight children and adolescents – is there a subjective need for treatment?

Objectives:We report on the first months of recruitment for a study to evaluate outpatient training for moderately overweight youths.Methods:Various recruitment strategies were employed, including media exposure, paediatricians, school events, and the distribution of flyers. Roughly 6 160 overweight and 4 720 obese children and adolescents of the target age range were estimated to live in the study area.Results:Altogether, 172 families enrolled for participation. Only 38 enrolled children (22.1%), however, were overweight and thereby eligible for participation, 132 children (76.7%) were obese and two were normal weight. Most eligible participants were recruited via media or paediatricians.Conclusions:Reaching overweight, but not obese, children and adolescents for intervention is difficult, where a low recognition of the condition in its less extreme form might be a particular problem.

Der Fragebogen zur Erfassung körperlichen Wohlbefindens (FEW 16)

Zusammenfassung. Subjektivem korperlichen Wohlbefinden wird eine zunehmend grosere Bedeutung im Rahmen der Gesundheitsforschung zugesprochen. Die vorliegenden Instrumente beschranken sich aber mit ...

Physical activity and screen-based media use: cross-sectional associations with health-related quality of life and the role of body satisfaction in a representative sample of German adolescents

Purpose: Although it is widely accepted that physical activity (PA) positively, and screen-based media use (SBM) negatively, affects well-being, there is a lack of studies relating PA and SBM to health-related quality of life (HRQoL) in adolescents. We examined these associations in German adolescents for different HRQoL subdomains and explored the role of body satisfaction as a possible mediator. Methods: The 11–17-year-old subsample of the German Health Interview and Examination Survey (2003–2006) was analysed (N = 6813; 51.3% male). Cross-sectional associations of self-reported PA frequency and amount of daily SBM with HRQoL subscale scores (according to KINDL-R) were examined by hierarchical linear regression models, adjusting for the clustering of the sample and for a variety of possible confounders. The size and significance of indirect effects via body (dis)satisfaction (BDS) were examined by mediation analyses. Results: Higher PA frequency was significantly associated with higher HRQoL on nearly all subscales and dose–response-relationships were observable. Variations were greatest in terms of social well-being in boys (effect size d = 0.59) and physical well-being in girls (d = 0.43). Higher SBM was related to lower HRQoL on all subscales in girls and on some subscales in boys, with the largest effects for school functioning in both genders (d = 0.31 and 0.37, respectively). The mediated effects for PA and SBM were significant in both genders, but the sizes and the proportions of total effects mediated by body satisfaction were rather small. Conclusions: Higher PA frequency was associated with higher self-reported HRQoL, and higher SBM was associated with lower self-reported HRQoL in both genders, even after adjusting for relevant covariates. The results support the assumption of independent health impacts of both behaviours, although no causal relationship can be confirmed with these cross-sectional data. Mechanisms other than body satisfaction must largely account for the effects of PA and SBM on well-being.

Der Einfluss von Geschlecht und sozialer Lage auf Ernährung und Übergewicht im Kindesalter

ZusammenfassungDer Anteil adipöser Erstklässler wird in Deutschland auf etwa 5% geschätzt, und zunehmend werden primär- und sekundärpräventive Interventionsangebote entwickelt. Bei der Konzeptionierung von Präventionsmaßnahmen ist darauf zu achten, dass diese auf Zielgruppen und Settings abgestimmt sind. Eine Analyse der epidemiologischen Daten hinsichtlich Geschlecht, sozialer Schicht und ethnischer Herkunft gibt erste Hinweise darauf, wo erhöhter Interventionsbedarf besteht: Die Prävalenzraten für Übergewicht und Adipositas sind bei sozial benachteiligten Kindern deutlich erhöht, während die Befunde zu den Geschlechtsunterschieden aufgrund unterschiedlicher Referenzsysteme inkonsistent sind. Nach einem Überblick über die epidemiologischen Daten in Deutschland werden Ansatzpunkte für eine ernährungsbezogene Prävention diskutiert. Im Zentrum der Argumentation steht der Vorschlag einer intersektoralen Kooperation zwischen Gesundheits-, Bildungs- und Sozialbereich,um sozial benachteiligte Kinder zu erreichen, ohne diese und ihre Familien zu stigmatisieren.AbstractOverweight and adiposity in children and adolescents are increasing problems in Germany, and more and more primary and secondary prevention programs are being developed. When planning and designing prevention strategies, one should be aware of the target groups and settings. Analysis of epidemiological data for sex/gender, social class, and ethnicity indicates where there is increased need for intervention. Clearly elevated prevalence rates for overweight and adiposity can be found in socially underprivileged children, whereas findings for sex differences are inconsistent because of different systems of reference. This paper gives an overview of epidemiological data in Germany and discusses starting points for prevention. The argumentation focuses on the idea of cooperation between health,education, and social services to reach socially underprivileged children without stigmatizing them and their families.

Evaluation, Evidenzbasierung und Qualitätsentwicklung

ZusammenfassungIn jüngster Zeit wird der Evidenzbasierung von Prävention und Gesundheitsförderung sowie der Evaluation und Qualitätssicherung verstärkt Aufmerksamkeit geschenkt. In der Diskussion werden die Begriffe allerdings häufig als Synonyme verwendet, obwohl sie an unterschiedlichen Punkten des Interventionsprozesses ansetzen. Unter Bezug auf den „Public Health Action Cycle“ werden in dem Beitrag die Begriffe erläutert.Evidenzbasierung wird zu Beginn einer Interventionsplanung relevant, wenn anknüpfend an eine Bestandsaufnahme Strategien entwickelt werden, um Gesundheitsprobleme zu reduzieren. Die Formulierung erfolgt unter Rückgriff auf vorhandene Evaluationsstudien, die für ähnliche Interventionen gezeigt haben, ob sie eine Wirkung haben bzw. ob sie effizient sind – die Summe vorhandener Evaluationsstudien bildet somit den Korpus der Evidenz. Qualitätsentwicklung hingegen bezieht sich auf die Umsetzung der Intervention und hat zum Ziel, diese möglichst nach den zuvor definierten Standards zu etablieren, um die Wirkung zu erhöhen.AbstractIn recent times, there is a greater emphasis on the basis for the evidence regarding prevention and health promotion, as well as evaluation and quality assurance. In discussions, the terms are often used as synonyms, although they are linked to different points in the process of intervention. The purpose of this paper is to attempt to define and explain the terms in the context of the Public Health Action Cycle.The evidence base becomes relevant in planning an intervention strategy to reduce health problems, having first clearly identified and defined the problem. Planning an intervention has to be based on existing evaluation studies, which show the results and impact of the strategies conducted for similar interventions. Hence it is the totality of these existing studies of evaluation that form the corpus of evidence. Quality development, however, is focused on the implementation of the intervention and has as its objective, wherever possible, to use previously defined standards to amplify its effectiveness.

Involvement of first-time mothers with different levels of education in the decision-making for their delivery by a planned Caesarean section. Women’s satisfaction with information given by gynaecologists and midwives

AimsWe investigated the involvement of first-time mothers, who had a planned Caesarean section, in the decision to have a Caesarean section, taking into account their different educational levels.Subjects and methodsA self-assessment questionnaire was sent in July 2005 to women who had undergone a Caesarean section in 2004. Participants were 2,685 members of a statutory health insurance fund who had given birth by Caesarean section (response rate: 48.0%). Included were primiparae with planned Caesarean section (n = 352).ResultsThe women in this cross-sectional study felt well informed about the procedure of a section but not its consequences. They used several sources of information and were most satisfied with the information provided by doctors and midwives. Of the women in this study 20% did not have a midwife. No major differences were observed between different educational levels.ConclusionAlthough most women were satisfied with their decision, they felt that they did not receive enough information about the consequences of a Caesarean section. This information need could be met by a further involvement of midwives in maternity care.