Stefan Kohler

Can Motivational Interviewing in Emergency Care Reduce Alcohol Consumption in Young People? A Systematic Review and Meta-analysis

AIMSnWe investigate the effect of motivational interviewing (MI), delivered in a brief intervention during an emergency care contact, on the alcohol consumption of young people who screen positively for present or previous risky alcohol consumption.nnnMETHODSnMEDLINE, CINAHL, EMBASE, PsycARTICLES, PsycINFO, PSYNDEX and Scopus were searched for randomized controlled trials with adolescents or young adults that compared MI in an emergency care setting to control conditions and measured drinking outcomes.nnnRESULTSnSix trials with 1433 participants, aged 13-25 years, were included in the systematic review and meta-analysis. MI was never less efficacious than a control intervention. Two trials found significantly more reduction in one or more measures of alcohol consumption in the MI intervention group. One trial indicated that MI may be used most effectively in young people with high-volume alcohol consumption. Separate random effects meta-analyses were performed based on the highest impact that MI added on reducing the drinking frequency and the drinking quantity at any point in time during the different study periods. Their results were expressed as standardized mean differences (SMDs). The frequency of drinking alcohol decreased significantly more after MI than after control interventions (SMD ≤ -0.17, P ≤ 0.03). In addition, MI reduced the drinking quantity further than control interventions in a meta-analysis of the subset of trials that were implemented in the USA (SMD = -0.12, P = 0.04). Meta-analyses of the smallest mean differences between MI and control groups detected no differences in alcohol use (SMD ≤ 0.02, P ≥ 0.38).nnnCONCLUSIONnMI appears at least as effective and may possibly be more effective than other brief interventions in emergency care to reduce alcohol consumption in young people.

Smoke-Free Laws and Direct Democracy Initiatives on Smoking Bans in Germany: A Systematic Review and Quantitative Assessment

Background: Germany’s 16 states regulate smoking differently within health protection principles laid down in the federal law. All state smoke-free laws in Germany have undergone at least one change since taking effect. Methods: We systematically review federal and state laws regulating smoking, as well as petitions, popular initiatives and referenda that aimed at changing statutory smoking bans. Data generated through the systematic review were correlated with state smoking rates. Results: The protection from the dangers of secondhand smoke is the primary motive for smoking bans in Germany. The first smoke-free laws affecting smoking in pubs, restaurants and several other public places were introduced in 2007. In 2008, the Federal Constitutional Court of Germany ruled in a leading decision on the smoke-free laws of two states that some common smoking ban exemptions of the introduced smoke-free laws violate the basic right to freely exercise a profession and mandated revisions. All states but Bavaria and Saarland, whose smoking bans were more and less comprehensive than those judged by the constitutional court, respectively, needed to change the smoking ban exemptions to reconcile their smoke-free laws with the constitution. Direct democracy initiatives to change smoking bans were only successful in Bavaria in 2010, but a total of 15 initiatives by citizens’ or interest groups attempted to influence non-smokers protection legislation through direct democratic procedures. Early ratification of a smoking ban in a federal state correlates with a higher reduction in the smoking rate from 2005 to 2009 (Spearman’s ρ = 0.51, p = 0.04). Conclusions: The federal government structure and direct democratic participation in smoke-free legislation in Germany has produced a diversity of local smoking bans and exemptions.

Incomplete Information about Social Preferences Explains Equal Division and Delay in Bargaining

Two deviations of alternating-offer bargaining behavior from economic theory are observed together, yet have been studied separately. Players who could secure themselves a large surplus share if bargainers were purely self-interested incompletely exploit their advantage. Delay in agreement occurs even if all experimentally controlled information is common knowledge. This paper rationalizes both regularities coherently by modeling heterogeneous social preferences, either self-interest or envy, of one bargaining party as private information in a three period game of bargaining and preference screening and signaling.

Can internet access growth help reduce the global burden of noncommunicable diseases

Noncommunicable diseases, such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, are currently the leading causes of death in several regions of the world. The continuing fast increase in the global burden of noncommunicable diseases is accompanied by a speedy worldwide internet access growth. The worldwide number of internet users has doubled over the past five years. As the internet can make the access to information on a healthy lifestyle and disease prevention activities easier, internet access growth may help to promote good health. Against this background, I discuss the roles the internet and access to information can play in health promotion. I also present an open access web portal on local prevention and health promotion activities. It was initiated by two German states to link health information from disparate sources and to organize this information in a user-friendly way. The web portal focuses on reducing preventable lifestyle-related risk factors associated with noncommunicable diseases, including physical inactivity, unhealthy diet, tobacco use, and the harmful use of alcohol. This local initiative has the potential for scaling up and can serve as a blueprint for other areas that have or will acquire internet access.

Cost Effectiveness of Antiarrhythmic Medications in Patients Suffering from Atrial Fibrillation

Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1–2xa0% of the general population. Prevalence is highly related to age, with every fourth individual older than 40xa0years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50xa0years. This article presents AF-related cost-of-illness studies and reviews 19 cost–effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost–effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost–effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2–63.9xa0years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost–effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.

More fair play in an ultimatum game after resettlement in Zimbabwe: A field experiment and a structural model

Zimbabwean villagers of distinct background have resettled in government-organized land reforms for more than three decades. Against this backdrop, I assess the level of social cohesion in some of the newly established communities by estimating the average preferences for fairness in a structural model of bounded rationality. The estimations are based on behavioral data from an ultimatum game field experiment played by 234 randomly selected households in 6 traditional and 14 resettled villages almost two decades after resettlement. Equal or higher degrees of fairness are estimated in all resettlement schemes. In one, or arguably two, out of three distinct resettlement schemes studied, the resettled villagers exhibit significantly higher degrees of fairness ( ) and rationality ( ) than those who live in traditional villages. Overall, villagers appear similarly rational, but the attitude toward fairness is significantly stronger in resettled communities ( ). These findings are consistent with the idea of an increased need for cooperation required in recommencement.

Personalized medicine and global health

Abstract More and more new drug substances are personalized medicines. Their impact on population health is globally small because mortality from many major causes of death is not reduced. More than half of all deaths worldwide can be attributed to behavioral, environmental and occupational, or metabolic risks. Broad personalized medicine approaches, which collect and use information also to better target interventions on major health risks are needed to improve global population health.

Workplace health promotion of large and medium-sized businesses

Purpose – The purpose of this paper is to investigate the relationship between different areas of workplace health promotion (WHP) activities and predictors of the number of areas in which WHP activities are offered. Design/methodology/approach – A questionnaire with ten questions on WHP was mailed to the 478 largest businesses in Berlin and Brandenburg, Germany. The cross-sectional data from this survey are presented and explored using correlation and linear regression analyses. Findings – In total, 30 businesses, of which 90 percent offered WHP activities, participated in the survey. Businesses with WHP were, on average, active in 5.59 (SD=2.24) areas of health promotion. Offering an activity was positively correlated with offering an activity in at least one other area for all WHP areas except ergonomic workplace design (p < 0.05). Among businesses offering WHP, reporting that WHP would be strengthened with more support (−2.02, 95 percent CI: −4.04 to −0.01) and being a medium-sized business with an in...