Sebastian Liersch

Correlates of physical activity of children and adolescents: A systematic review of reviews:

Objective: The aim of this study was to identify promoting and inhibiting correlates associated with the physical activity (PA) of children and adolescents (aged 3–18). The intention was to demonstrate the complexity of correlates of PA and to determine possible influencing factors. Design: A systematic review of reviews. Methods: Systematic database research was carried out in Medline, Cochrane Library, EMBASE, PsycInfo, Springer Link and Thieme Connect. Inclusion criteria were that the study: (a) was classified as a systematic review with or without meta-analysis; (b) was published between 2000 and 2009; (c) dealt with children and adolescents aged 3–18; (d) had as its dependent variable any measure of overall PA; and (e) reviewed associations between quantitatively measured variables and PA. The internal validity of the systematic reviews thus identified was evaluated using a validated quality instrument. Results: Nine systematic reviews without meta-analysis and one systematic review with meta-analysis were selected. Altogether 16 correlates were identified which were consistently associated with PA of children and/or adolescents: sex, age, ethnicity, parental education, family income, socioeconomic status, perceived competence, self-efficacy, goal orientation/motivation, perceived barriers, participation in community sports, parental support, support from significant others, access to sport/recreational facilities und time outdoors. Conclusions: Although the findings of the reviews covered are to some extent heterogeneous, it is possible to identify consistent correlates of PA in children and adolescents. The results show that PA is a complex and multi-dimensional behaviour determined by numerous biological, psychological, sociocultural and environmental factors.

Cost-Effectiveness of Treating Hepatitis C with Sofosbuvir/Ledipasvir in Germany.

Background Infections with the hepatitis C virus (HCV) are a global public health problem. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. Newly introduced direct acting antivirals, especially interferon-free regimens, have improved rates of sustained viral response above 90% in most patient groups and allow treating patients who were ineligible for treatment in the past. These new regimens have replaced former treatment and are recommended by current guidelines. However, there is an ongoing discussion on high pharmaceutical prices. Our aim was to assess the long-term cost-effectiveness of treating hepatitis C genotype 1 patients with sofosbuvir/ledipasvir (SOF/LDV) treatment in Germany. Material and Methods We used a Markov cohort model to simulate disease progression and assess cost-effectiveness. The model calculates lifetime costs and outcomes (quality-adjusted life years, QALYs) of SOF/LDV and other strategies. Patients were stratified by treatment status (treatment-naive and treatment-experienced) and absence/presence of cirrhosis. Different treatment strategies were compared to prior standard of care. Sensitivity analyses were performed to evaluate model robustness. Results Base-case analyses results show that in treatment-naive non-cirrhotic patients treatment with SOF/LDV dominates the prior standard of care (is more effective and less costly). In cirrhotic patients an incremental cost-effectiveness ratio (ICER) of 3,383 €/QALY was estimated. In treatment-experienced patients ICERs were 26,426 €/QALY and 1,397 €/QALY for treatment-naive and treatment-experienced patients, respectively. Robustness of results was confirmed in sensitivity analyses. Conclusions Our analysis shows that treatment with SOF/LDV is cost-effective compared to prior standard of care in all patient groups considering international costs per QALY thresholds.

The influence of psychological well-being on academic success

AimTo investigate the influence of psychological well-being on academic success in school and to test for interaction effects of socioeconomic status (SES) and subjective well-being (SWB) on academic success.Subject and methodsThe analyzed data set contained information on 508 boys and girls in the sixth grade. The study had a cross-sectional design. The KIDSCREEN-27 questionnaire, an instrument for assessment of health-related quality of life in children and adolescents, which contains scales such as “Psychological well-being” and “School environment”, was used in this study. The combined average grade (CAG) in German and mathematics served as the indicator of academic success. The statistical analyses were using multiple linear regressions.ResultsOur analysis revealed an unexpected negative effect of psychological well-being on the CAG, but also an indirect positive effect, which was detected on the School Environment scale. The two effects more or less cancelled each other out overall. No interaction with socioeconomic status could be detected.ConclusionThe results of the present study are inconsistent and are only partly in conformity with the findings of previous empirical research on this topic, which rarely reported both negative and positive effects of well-being on academic success.

Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practitioners’ sample

BACKGROUND Implementing pay-for-performance (P4P) programs is a non-trivial task. As evaluation studies showed, P4P programs often failed to improve performance quality. A crucial element for the successful implementation of P4P is to gain acceptance with health care providers. OBJECTIVES The aim of our study was to determine, if (and at what bonus rate) German general practitioners (GPs) would participate in a P4P program. We further examined differences between respondents who would participate in a P4P program (participants) versus respondents who would not participate (non-participants). METHODS A mail survey was conducted among 2493 general practitioners (GPs) in Lower Saxony (with a response rate of 36.2%). The questionnaire addressed attitudes toward P4P and included a willingness to accept experiment concerning P4P implementation. RESULTS The participation rate increased from 28% (at a bonus of 2.5%) to 50% (at a bonus of 20%). Participants showed better performance in target achievement and expected higher gains from P4P than non-participants. Major attitude differences were found in assessing feasibility of P4P, incentivizing performance and unintended consequences. The crucial factor for (not) accepting P4P might be the sense of (un)fairness of P4P. CONCLUSION To convince GPs to participate in P4P, better evidence for the effectiveness of P4P is required. To address the concerns of GPs, future endeavors should be directed to tailoring P4P programs. Finally, program implementation must be well communicated and thoroughly discussed with health care providers.

Do Children's Health Resources Differ According to Preschool Physical Activity Programmes and Parental Behaviour? A Mixed Methods Study

Preschool can have positive effects on the development of a healthy lifestyle. The present study analysed to what extent different conditions, structures and behavioural models in preschool and family—children’s central social microsystems—can lead to differences in children’s health resources. Using a cross-sectional mixed methods approach, contrast analyses of “preschools with systematic physical activity programmes” versus “preschools without physical activity programmes” were conducted to assess the extent to which children’s physical activity, quality of life and social behaviour differ between preschools with systematic and preschools without physical activity programmes. Differences in children’s physical activity according to parental behaviour were likewise assessed. Data on child-related outcomes and parent-related factors were collected via parent questionnaires and child interviews. A qualitative focused ethnographic study was performed to obtain deeper insight into the quantitative survey data. Two hundred and twenty seven (227) children were interviewed at 21 preschools with systematic physical activity programmes, and 190 at 25 preschools without physical activity programmes. There was no significant difference in children’s physical activity levels between the two preschool types (p = 0.709). However, the qualitative data showed differences in the design and quality of programmes to promote children’s physical activity. Data triangulation revealed a strong influence of parental behaviour. The triangulation of methods provided comprehensive insight into the nature and extent of physical activity programmes in preschools and made it possible to capture the associations between systematic physical activity promotion and children’s health resources in a differential manner.

Integration of health management in schools using the Balanced Scorecard as a strategic management instrument

AimOrganizational development is crucial to health promotion in different settings. The Learn to Live Healthy intervention [German: Gesund Leben Lernen (GLL)] is a new school health promotion strategy designed to develop schools into healthy environments for all those who work and study there. GLL focuses on strengthening available health resources and reducing negative and excessive health stresses. The Balanced Scorecard (BSC), a strategic management instrument designed to support change processes, is employed in this BMBF-funded study. This research will assess the suitability of the BSC as a management and evaluation instrument for schools.Subjects and methodsGLL assists schools in implementing health management programs with the aid of school coaches. Besides setting up steering committees and health circles, goals and action measures are defined and operationalized using a participatory quality development and evaluation approach. The intervention focuses on project organization instruments to implement organizational change processes in schools, develop these processes in a goal-oriented, systematic and sustainable manner, and improve the quality of education in schools by means of health interventions. It uses the BSC as a supportive strategic management tool. The BSC provides the basis for the definition and prioritization of goals at the participating schools and facilitates the measurement of health promotion activities in schools. Structured telephone interviews were conducted for a post-workshop evaluation of methodology for the implementation process of the BSC.ResultsA preliminary evaluation of the implementation process revealed a fundamental need to integrate the Lower Saxon Policy Framework for School Quality. Therefore, the School-BSC no longer evaluates schools from four perspectives, but rather from six, pursuant to the Policy Framework. The health specialists expect the School-BSC to promote goal-oriented and structured work and transparency within schools. Considering the participatory approach, two health specialists were enlisted to optimize the training concept.ConclusionsEvaluation of the School-BSC in schools makes it possible to assess its suitability as a management and evaluation instrument in these organizations. Newly developed school programs largely dispelled the initial reservations of the health specialists. The School-BSC is viewed as a useful tool for the creation of organizational structures and transparency and for the facilitation of work. This study provides information useful for enhancing management-related interventions.

Die Lebensphase Adoleszenz und junge Erwachsene – gesellschaftliche und altersspezifische Herausforderungen zur Förderung der Gesundheit

»Die Jugend von heute liebt den Luxus, hat schlechte Manieren und verachtet die Autoritat. Sie widersprechen ihren Eltern, legen die Beine ubereinander und tyrannisieren ihre Lehrer.« Diese Worte von Sokrates konnten auch aus diesem Jahrhundert stammen. Handelt es sich dabei um eine allgemeingultige Charakterisierung der Jugendphase oder um eine uberspitzte Formulierung von Klischees, die mit dieser Lebensphase verbunden sind? Das folgende Kapitel versucht, diese und weitere Fragen zu beantworten. Zunachst stellt Kapitel 2.1 als Einleitung allgemein die Phase der Adoleszenz und jungen Erwachsenen vor: Wie ist Jugend definiert, welche gesellschaftlichen Entwicklungen wirken auf diese Lebensphase ein und welche gesundheitlichen Risiken und Chancen umfasst diese Lebensphase? Kapitel 2.2 beschreibt die Lebensphase mit ihren Veranderungen. Kann von »der Jugend« uberhaupt gesprochen werden? Was gilt fur die Zielgruppe der Jugendlichen allgemein? Wie wirken sich gesellschaftliche Veranderungen auf Jugendliche aus? Warum zeigen Jugendliche riskante Verhaltensweisen? Ein Interview in Kapitel 2.3 mit Prof. Keupp, dem Vorsitzenden der Kommission fur den Kinder- und Jugendbericht der Bundesregierung, fragt nach den Chancen und Grenzen der Pravention und Gesundheitsforderung in dieser Altersgruppe. Abschliesend stellt der Beitrag in Kapitel 2.4 europaische Strategien zur Forderung der Gesundheit von Kindern und Jugendlichen vor.

Gesundheit, gesundheitliche Beeinträchtigungen und Ansätze der Prävention in der Lebensphase Adoleszenz und junges Erwachsenenalter

Bis in die 1990er Jahre lagen nur vereinzelt reprasentative Studien zu gesundheitsbezogenen Themen vor (z. B. Drogenaffinitatsstudie der Bundeszentrale fur gesundheitliche Aufklarung). Erst in den vergangenen beiden Jahrzehnten wurden Studien in Deutschland durchgefuhrt, die umfassende Informationen zur Gesundheit und zum Gesundheitsverhalten von Jugendlichen erhoben haben (z. B. Schulerbefragung des Kriminologischen Forschungsinstituts Niedersachsen). Der Kinder- und Jugendgesundheitssurvey des Robert Koch-Instituts ermoglicht erstmals die Verknupfung vielfaltiger Informationen und bildet damit eine konjunkte Datenbasis. Die aufgefuhrten nationalen und internationalen Studien und Surveys (siehe Infobox Relevante Studien) sowie weitere systematische Erhebungen und ausgewahlte Einzelstudien stellen die Datengrundlage fur die nachfolgende Betrachtung dar. Im Mittelpunkt stehen dabei gesundheitsrelevante Verhaltensweisen, zentrale Bereiche der Gesundheit im Jugendalter sowie Ansatze der Pravention.

Ernährung und Bewegung

Das vorliegende Kapitel zeigt zunachst auf, welche Uberlegungen fur eine effektive Planung und Umsetzung praventiver ernahrungs- und bewegungsorientierter Masnahmen erforderlich sind (▸ Kap. 10.1). Im Anschluss stellen die zwei folgenden Beitrage detailliert ernahrungs- und bewegungsbedingte Praventionsmoglichkeiten zur Vermeidung von Beeintrachtigungen und Erkrankungen des Muskel-Skelett-Systems dar (▸ Kap. 10.2 bzw. ▸ Kap. 10.3). Fur erfolgreiche Praventionsmasnahmen ist jedoch nicht nur das Wissen um eine gesundheitsforderliche Ernahrung und korperliche Aktivitat bei den unterschiedlichen Bevolkerungsgruppen von Bedeutung. Ebenfalls berucksichtigt werden muss das Wissen um Moglichkeiten der Motivation, den individuellen Lebensstil gesundheitsforderlicher zu gestalten. Dies zeigt ▸ Kap. 10.4 anhand eines theoretischen Modells am Beispiel der korperlichen Aktivitat auf. Nachfolgend verdeutlichen zwei Praxisprojekte, eines in der Schule (▸ Kap. 10.5) und eines im Kindergarten (▸ Kap. 10.6), wie Kinder und Jugendliche zu vermehrter korperlicher Aktivitat angeregt werden konnen.