Verhinderung sexueller Ausbeutung von Kindern im Kanton Zürich. Präventionsarbeit im ausserschulischen Bereich : eine Situations- und Bedarfsanalyse

Die 1989 ratifizierte Konvention über die Rechte des Kindes bietet eine klare normative Grundlage zum Schutz von Kindern vor Gewalt, Missbrauch und Ausbeutung. Trotz der Bemühungen zum Kindesschutz werden zahlreiche Kinder und Jugendliche Opfer sexueller Gewalt (WHO, 2017). Obwohl die Datenlage in der Schweiz kein vollständiges Bild ergibt, zeigen vorliegende repräsentative Studien wie die Optimus Studien 2012 und 2018 (Schmid, 2018), dass der sexuelle Missbrauch mit einem Anteil von 15,2% an den primären Formen der Kindeswohlgefährdung hoch ist. So ergab eine Hochrechnung anhand von 940 von Kinderschutzorganisationen dokumentierten Fällen, dass im Jahr 2016 19-31 von 10'000 Kindern Opfer sexueller Gewalt wurden (Schmid, 2018, S. 25). Eine wirksame Prävention von sexualisierter Gewalt ist dabei nur als Kombination unterschiedlicher Massnahmen möglich. Auf individueller Ebene sollen Kinder in ihrer psychosexuellen Entwicklung unterstützt und ermutigt werden, sich bei ungefragten Überschreitungen ihrer Körpergrenzen zu verteidigen. Allerdings können Kinder und Jugendliche nicht die Verantwortung tragen, sich vor sexuellen Übergriffen zu schützen. Es sind weitere Massnahmen wie die Prävention auf Ebene der Täterschaft und auf struktureller Ebene notwendig (Kinderschutz Schweiz, 2020). So bieten im ausserschulischen Bereich Vereine ein grosses Potential zur Prävention sexueller Ausbeutung bei Kindern und Jugendlichen. Allerdings erschweren es Hindernisse wie die Tabuisierung des Themas und die begrenzten Ressourcen der Vereine, spezifische Präventionsangebote zu entwickeln und selbständig zu implementieren. Hier sind professionelle Organisationen gefragt, die die Vereine bei der Präventionsarbeit mit spezifischen Angeboten, ihrem Wissen und ihren Fachkompetenzen unterstützen. Die Forschungsstelle Gesundheitswissenschaften der Zürcher Hochschule für Angewandte Wissenschaften (ZHAW) wurde deshalb vom Verein zur Verhinderung sexueller Ausbeutung von Kindern im Sport (VERSA), dem Zürcher Stadtverband für Sport (ZSS), dem Zürcher Kantonalverband für Sport (ZKS) und okaj zürich beauftragt, eine Situations- und Bedarfsanalyse durchzuführen, um einen Überblick über die aktuelle Situation im Bereich Prävention sexualisierter Gewalt im Kanton Zürich zu gewinnen und die Bedürfnisse und Bedarfe von Institutionen des Freizeitbereichs und Eltern zu erfassen. Zudem sollten Hinweise auf die Wirkung der bestehenden Präventionsangebote, wie der 2001 vom Zürcher Stadtverband für Sport gegründete «Verein zur Verhinderung sexueller Ausbeutung von Kindern im Sport» (VERSA) sowie Hinweise zur inhaltlichen und organisatorischen Weiterentwicklung der bestehenden Präventionsangebote gewonnen werden. Um die Aktivitäten und Kompetenzen von Institutionen des Freizeitbereichs im Kanton Zürich im Bereich der Prävention von sexuellen Übergriffen bei Kindern und Jugendlichen im Freizeitbereich zu erfassen sowie den Bedarf an Präventionsangeboten zu erheben, wurden sowohl Sportvereine, Jugendverbände und Institutionen der offenen Kinder- und Jugendarbeit als auch Eltern von Kindern, die in diesen Freizeitinstitutionen Mitglied sind, in einer Online-Umfrage im Zeitraum von Februar – April 2021 befragt. Im vorliegenden Schlussbericht wird aufgezeigt, wie die Prävention sexualisierter Gewalt von Sportvereinen, Jugendverbänden und Institutionen der offenen Kinder- und Jugendarbeit allgemein eingeschätzt wird, welche Präventionsmassnahmen sie bereits umsetzen und in welchen Bereichen noch Unterstützungsbedarf zur besseren Umsetzung der Prävention sexualisierter Gewalt besteht. Der Bericht liefert zudem Hinweise, wie ein kantonales Präventionsangebot aus Sicht der Vereine, Verbände und Institutionen optimalerweise gestaltet sein sollte

Development and internal validation of a prediction model for long-term opioid use-an analysis of insurance claims data.

In the United States, a public-health crisis of opioid overuse has been observed, and in Europe, prescriptions of opioids are strongly increasing over time. The objective was to develop and validate a multivariable prognostic model to be used at the beginning of an opioid prescription episode, aiming to identify individual patients at high risk for long-term opioid use based on routinely collected data. Predictors including demographics, comorbid diseases, comedication, morphine dose at episode initiation, and prescription practice were collected. The primary outcome was long-term opioid use, defined as opioid use of either >90 days duration and ≥10 claims or >120 days, independent of the number of claims. Traditional generalized linear statistical regression models and machine learning approaches were applied. The area under the curve, calibration plots, and the scaled Brier score assessed model performance. More than four hundred thousand opioid episodes were included. The final risk prediction model had an area under the curve of 0.927 (95% confidence interval 0.924-0.931) in the validation set, and this model had a scaled Brier score of 48.5%. Using a threshold of 10% predicted probability to identify patients at high risk, the overall accuracy of this risk prediction model was 81.6% (95% confidence interval 81.2% to 82.0%). Our study demonstrated that long-term opioid use can be predicted at the initiation of an opioid prescription episode, with satisfactory accuracy using data routinely collected at a large health insurance company. Traditional statistical methods resulted in higher discriminative ability and similarly good calibration as compared with machine learning approaches

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers.

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18-65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = -0.27; 95% CI: -0.54 to -0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18-65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = -0.27; 95% CI: -0.54 to -0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646 . Keywords: Absenteeism; Ergonomics; Exercise; Health promotion; Presenteeis

No evidence for an effect of the first COVID-19 lockdown on neck pain and neck disability among Swiss office workers

Introduction: During March and April 2020, the COVID-19 pandemic forced around50 % of employees of Switzerland into a working from home setting. Working from home appears to have considerably changed the work experience of office workers. Newspapers reported an increase in non-specific neck pain as a negative consequence of working from home. Therefore, the main driver for this abstract was to confirm these observations with higher levels of evidence. Purpose of the study: The aim of this analysis was to investigate the effect of the first COVID-19 lockdown on neck pain. We hypothesised that the COVID-19 lockdown would increase neck pain. Methods: This longitudinal analysis is based on control group data from an ongoing stepped-wedge cluster randomised controlled trial. Office workers from two Swiss organisations, aged 18-65 years, were included. Baseline data collected in January 2020 before the COVID-19 pandemic were compared with follow-up data collected during the fourth and fifth week of the first lockdown in April 2020. Neck pain was assessed with a measure of intensity (numeric rating scale NRS from 0 = no pain to 10 = maximum pain), frequency (number of days within the last 28 days), and disability (neck disability index from 0 % = no disability to 100 % = maximum disability). Paired Wilcoxon signed rank tests were performed for statistical analysis as the normality assumption was not met. Results: Data from 76 participants were analysed. The mean age was 42.7 years (ranging from 21.8 to 62.7) at baseline and fifty-four participants (71.1 %) were female. At baseline, the meanintensity of neck pain was NRS 2.3 (± 1.9), mean frequency of neck pain 4.5 / 28 days (± 8.3), and mean neck disability 11.7 % (± 10.0). At follow-up, the mean intensity of neck pain was NRS 2.2 (± 2.2), mean frequency of neck pain 6.8 / 28 days (± 7.4), and mean neck disability 11.1 % (± 10.9). We found no evidence for a difference in the intensity of neck pain (estimate = 2.59*10-5, 95 % CI from -0.50 to 0.50, p-value = 0.607), frequency of neck pain (estimate = 3.26*10-5, 95 % CI from -2.00 to 2.50, p-value = 0.964), or neck disability index (estimate = 4.43*10-6, 95 % CI from -2.00 to 3.00, p-value = 0.794) between both measurement time points. Conclusion: The first COVID-19 lockdown did not result in a difference of neck pain among our sample of office workers, neither in intensity nor in frequency nor in disability. Therefore, our hypothesis and the findings of the newspapers could not be confirmed. A higher number of work breaks taken as well as improved working times and work-life balance may have contributed to this result. To enable more comprehensive statements, further dimensions of pain (i.e., duration) and the effect of psychosocial factors (i.e., mental health) would need to be investigated

Development and validation of a prognostic model for the early identification of COVID-19 patients at risk of developing common long COVID symptoms

Background: The coronavirus disease 2019 (COVID-19) pandemic demands reliable prognostic models for estimating the risk of long COVID. We developed and validated a prediction model to estimate the probability of known common long COVID symptoms at least 60 days after acute COVID-19. Methods: The prognostic model was built based on data from a multicentre prospective Swiss cohort study. Included were adult patients diagnosed with COVID-19 between February and December 2020 and treated as outpatients, at ward or intensive/intermediate care unit. Perceived long-term health impairments, including reduced exercise tolerance/reduced resilience, shortness of breath and/or tiredness (REST), were assessed after a follow-up time between 60 and 425 days. The data set was split into a derivation and a geographical validation cohort. Predictors were selected out of twelve candidate predictors based on three methods, namely the augmented backward elimination (ABE) method, the adaptive best-subset selection (ABESS) method and model-based recursive partitioning (MBRP) approach. Model performance was assessed with the scaled Brier score, concordance c statistic and calibration plot. The final prognostic model was determined based on best model performance. Results: In total, 2799 patients were included in the analysis, of which 1588 patients were in the derivation cohort and 1211 patients in the validation cohort. The REST prevalence was similar between the cohorts with 21.6% (n = 343) in the derivation cohort and 22.1% (n = 268) in the validation cohort. The same predictors were selected with the ABE and ABESS approach. The final prognostic model was based on the ABE and ABESS selected predictors. The corresponding scaled Brier score in the validation cohort was 18.74%, model discrimination was 0.78 (95% CI: 0.75 to 0.81), calibration slope was 0.92 (95% CI: 0.78 to 1.06) and calibration intercept was -0.06 (95% CI: -0.22 to 0.09). Conclusion: The proposed model was validated to identify COVID-19-infected patients at high risk for REST symptoms. Before implementing the prognostic model in daily clinical practice, the conduct of an impact study is recommended. Keywords: Clinical prediction model; Long COVID; Prognostic factors; Stratified medicin

Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020

Background: Women are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown. Aim: We assessed the impact of sex and gender on PASC in a Swiss population. Method: Our multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection.ResultsAmong those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41-1.79; p < 0.001) and a score summarising gendered sociocultural variables (RR = 1.05; 95% CI: 1.03-1.07; p < 0.001) were significantly associated with PASC. Following multivariable adjustment, biological female sex (RR = 0.96; 95% CI: 0.74-1.25; p = 0.763) was outperformed by feminine gender-related factors such as a higher stress level (RR = 1.04; 95% CI: 1.01-1.06; p = 0.003), lower education (RR = 1.16; 95% CI: 1.03-1.30; p = 0.011), being female and living alone (RR = 1.91; 95% CI: 1.29-2.83; p = 0.001) or being male and earning the highest income in the household (RR = 0.76; 95% CI: 0.60-0.97; p = 0.030). Conclusion: Specific sociocultural parameters that differ in prevalence between women and men, or imply a unique risk for women, are predictors of PASC and may explain, at least in part, the higher incidence of PASC in women. Once patients are hospitalised during acute infection, sex differences in PASC are no longer evident

Towards a comprehensive safety evaluation of cycling infrastructure including objective and subjective measures

Cycling infrastructure has been implemented worldwide to promote bicycle use and to minimize injury risk. A comprehensive evaluation of such infrastructure is required to assess its success. In terms of safety, assessments ideally focus on both objective and subjective parameters. This study explores the application of a combined objective-subjective safety assessment approach in a pre-post analysis of a left-turning bicycle box in Zurich, Switzerland. A computer-based video technology was used to objectively measure passing distance between bicycles turning left and continuing motor vehicles passing on the right. In an in-situ survey perceived safety while crossing the intersection and a photo-based assessment of the intersection were collected as indicators of subjective safety. Median passing distance between bicycles and motor vehicles did not significantly change after the implementation of the bicycle box, but the shortest distances were increased. Perceived safety while crossing the intersection was significantly higher after marking the bicycle box, which is consistent with safety expectations expressed based on photos with and without left-turning box. Gender and general perception of traffic safety within the city are significant determinants of expected and perceived intersection safety. Women expect greater safety gains from the left-turning box (photo based), but its effect on perceived safety when actually crossing the intersection does not differ between genders. While the applied video technology is not yet practice-ready, it shows great potential to complement cycling safety evaluations, in combination with self-reported perceived safety indicators

Protecting children and youth from sexual violence : prevention in out-of-school settings

Background: The Convention on the Rights of the Child, which was ratified in 1989, provides a clear normative foundation for the protection of children from violence, abuse and exploitation. However, despite efforts to protect children, many children and adolescents become victims of sexual violence. Representative studies such as the Optimus studies 2012 and 2018 (Schmid, 2018) show that sexual abuse is high in Switzerland, accounting for 15.2% of the primary forms of child welfare endangerment. Sports as well as youth and leisure clubs offer great potential for the prevention of sexual violence against children and adolescents. However, little is known about their current prevention practices and parents’ perspectives. Methods: To assess the competences and actual implementation of measures in the area of prevention of sexual violence against children and adolescents as well as the need for prevention services of institutions in the out-of-school sector of the canton of Zurich, an online-survey was conducted among representatives of sports clubs (n = 324), youth associations (n = 33), open child and youth work (n = 42) and parents of children and adolescents who are members of one of these clubs or associations (n = 580) between February 9th and April 13th 2021. Results: Sports clubs, youth associations, open child and youth work as well as parents consider the prevention of sexual violence to be a very relevant topic and participants rated their competences in finding, understanding, assessing and applying relevant information about this topic as rather high or high. However, the current implementation of prevention measures in the participating organizations shows that there is are still barriers to implementation, space for improvement in prevention work and a need for support in developing and implementing prevention measures among the organizations. Conclusions: The high degree of agreement in the assessments of the current situation and the postulated need for the prevention of sexual violence between the sports clubs, the youth associations and open child and youth work indicate a great potential for closer cooperation and synergies. In a next step, it should be clarified how improvements in prevention can be jointly developed and implemented

The Effect of Three Foot Types on the Achilles Tendon Lever Arm

Category: Hindfoot Introduction/Purpose: During locomotion, propulsion of the body is created by the force of the triceps surae complex as it is transmitted to the metatarsal heads. The amount and pattern of the resulting propulsion force highly depends on the moment arm of the Achilles tendon. To our knowledge, no data exists on how and to which extent position and morphology of the foot affects the moment arm of the Achilles tendon. The aim of this study was 1) to develop a method to determine the Achilles tendon moment arm, and 2) to calculate the Achilles tendon moment arm with the foot in different degrees of dorsi- and plantarflexion for 3 foot types (normal arched foot, pes planus, and pes cavus). Methods: 99 study participants with a healthy ankle joint (males, 40; females, 59; mean age 49 [range, 14 – 78] years) were included. Participants’ foot type was classified as a normal arched foot (n = 33), as pes planus (n = 33), or as pes cavus (n = 33) based on the calcaneal inclination angle (CI) (Figure 1). Besides the foot type, the foot length (FL), the calcaneal insertion of the Achilles tendon (ATI), the angle (a) between the line (L) connecting ATI with the center of rotation of the ankle (COR) and the horizontal line (L’) were measured on the lateral radiographs. The interrater reliabilities of measuring a on radiographs and on MRIs were compared. The lever arm of the Achilles tendon (L’calculated) was calculated as following (foot and tibia were regarded as two rigid segments; the influences of other muscles were neglected): L’calculated = cos(a - plantarflexion)*L Results: The interrater reliability of a was higher on radiographs (ICC = 0.84, [0.73 – 0.91]) than on MRIs (ICC = 0.61, [0.27 – 0.81]). The ICC comparing a measured on MRIs and radiographs was 0.63 [0.50-0.74]. There was no difference in FL between the three foot types (p = 0.199). However, the average a was significantly different (normal arched foot 31°, pes planus 24°, pes cavus 36°, p = 0.021), resulting in a statistically significant shorter Achilles tendon lever arm for pes cavus than for pes planus (p < 0.0001) and normal arched feet (p = 0.006) in neutral position. The maximum lever arm for the three different foot types was reached at different degrees of plantarflexion (Figure 2). Conclusion: The assessment of the Achilles tendon lever arm using radiographs is reliable. The foot configuration determines the lever arm of the Achilles tendon for a given flexion position of the foot. It also determines the plantarflexion position where the Achilles tendon reaches the maximum of its lever arm. This has to be taken into consideration when planning surgeries that change a or L, as they may also result in changes of plantarflexion power