Vom Wissen zum Handeln – Grundlagen des Wissenstransfers

Ziel des vorliegenden Knowledge Flow Paper ist es, den Begriff des Wissenstransfers in spezifischer Weise zugänglich zu machen und die wichtigsten Methoden und Instrumente zur Anwendung innerhalb des Zentrums darzulegen. Besondere Herausforderung ist hierbei, das Spannungsverhältnis zwischen gesellschaftlichem Verfügbarmachen von Lösungen und Kontexten und der Vermittlung von Wissen aus dem (natur-)wissenschaftlichen Zentrum in den gesellschaftlichen Handlungsbereich (Politik, Wirtschaft, Umweltorganisationen etc.) zu verbinden. Somit soll das Paper einen ersten Einstieg in das Thema Wissenstransfer/Transferforschung ermöglichen und dessen Potentiale für BiKF erörtern.The knowledge transfer approach has gained a lot of attention in the political, scientific and public context, as it deals with questions about the use and transfer of scientific knowledge. The paper at hand is giving a first overview of the subject of knowledge transfer and it’s potential for BiKF. It is the aim to explain what exactly lies behind the concept of knowl-edge transfer and to state the most important methods and instruments for use within the centre. It serves as a starting point for a more comprehensive integration of internal and external transfer of knowledge within each project areas of BiKF to adress environmental, political and social problems associated with climate change and biodiversity. This Knowledge Flow Paper is based on the document of Thomas Höhne concerning the current state of transfer research for the Institute for Social-Ecological Research

Multimorbidity of communicable and non-communicable diseases in low- and middle-income countries: A systematic review

OBJECTIVE: The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs). METHODS: PubMed, Cochrane, and Embase databases were searched from 1(st) January 2000 to 31(st) July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453). RESULTS: Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19–2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25–1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities. CONCLUSION: The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted

Risk factor clustering in men and women with CHD in the Southern Cone of Latin America

Background Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD). The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin America. Methods We analyzed cross-sectional data from the 634 participants aged 35–74 with CHD from the community-based CESCAS Study. We calculated the prevalence for counts of cardiometabolic (hypertension, dyslipidemia, obesity, diabetes) and lifestyle (current smoking, unhealthy diet, low physical activity, excessive alcohol consumption) RF. Differences in RF number between men and women were tested with age-adjusted Poisson regression. We identified the most common RF combinations among participants with ≥4 RF. We performed a subgroup analysis by educational level. Results The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Obesity, central obesity, diabetes and low physical activity were more common in women, while excessive alcohol consumption and unhealthy diet were more common in men. Close to 85% of women and 81.5% of men presented with ≥4 RF. Women presented with a higher number of overall (relative risk (RR) 1.05, 95% CI 1.02–1.08) and cardiometabolic RF (1.17, 1.09–1.25). These sex differences were found in participants with primary education (RR women overall RF 1.08, 1.00–1.15, cardiometabolic RF 1.23, 1.09–1.39), but were diluted in those with higher educational attainment. The most common RF combination was hypertension/dyslipidemia/obesity/unhealthy diet. Conclusion Overall, women showed a higher burden of multiple cardiovascular RF. Sex differences persisted in participants with low educational attainment, and women with low educational level had the highest RF burden

A Global Perspective on Cardiovascular Risk Factors by Educational Level in CHD Patients: Surf Chd Ii

BACKGROUND: Clinical guidelines recommend lifestyle modifications and medication use to control cardiovascular risk factors in coronary heart disease (CHD) patients. However, risk factor control remains challenging especially in patients with lower educational level. OBJECTIVE: To assess inequalities by educational level in the secondary prevention of CHD in the Survey of Risk Factors in Coronary Heart Disease (SURF CHD II). METHODS: SURF CHD II is a cross-sectional clinical audit on secondary prevention of CHD, conducted during routine clinical visits in 29 countries. The easy-to-perform design of the survey facilitates its implementation in settings with limited resources. We reported risk factor recording, attainment of guideline-defined risk factor targets, and treatment in CHD patients. Differences by educational level in target attainment and treatment were assessed with logistic regression stratified for high- (HIC), upper middle- (UMIC), and lower middle-income (LMIC) countries. RESULTS: SURF CHD II included 13,884 patients from 2019 to 2022, of which 25.0% were female and 18.6% had achieved only primary school level. Risk factor recording ranged from 22.2% for waist circumference to 95.6% for smoking status, and target attainment from 15.9% for waist circumference to 78.7% for smoking. Most patients used cardioprotective medications and 50.5% attended cardiac rehabilitation.Patients with secondary or tertiary education were more likely to meet targets for smoking, LDL cholesterol and physical activity in HICs and LMICs; for physical activity and triglycerides in UMICs; but less likely to meet targets for blood pressure in HICs and LDL <1.4mmol/L in UMICs. Higher education was positively associated with medication use and cardiac rehabilitation participation. CONCLUSION: CHD patients generally have poor attainment of risk factor targets, but patients with a higher educational level are generally more likely to participate in cardiac rehabilitation, use medication, and meet targets. MAIN MESSAGES: Target attainment and participation in cardiac rehabilitation are poor in CHD patients globally.Patients with higher education are more likely to meet risk factor targets, showing health inequities in secondary prevention of CHD.The association between education and risk factor target attainment and treatment varies with country income level

Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease (CVD). The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology (ESC). Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate. Azerbaijan is a country in the South Caucasus, a region at a very high risk for CVD. AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku (Azerbaijan). METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021. Information on demographics, risk factors, physical and laboratory data, and medications was collected using a standard questionnaire in consecutive patients aged ≥ 18 years with established CHD during outpatient visits. Data from 687 patients (mean age 59.6 ± 9.58 years; 24.9% female) were included in the study. RESULTS Only 15.1% of participants were involved in cardiac rehabilitation programs. The rate of uncontrolled risk factors was high: Systolic blood pressure (BP) (SBP) (54.6%), low-density lipoprotein cholesterol (LDL-C) (86.8%), diabetes mellitus (DM) (60.6%), as well as overweight (66.6%) and obesity (25%). In addition, significant differences in the prevalence and control of some risk factors [smoking, body mass index (BMI), waist circumference, blood glucose (BG), and SBP] between female and male participants were found. The cardiovascular health index score (CHIS) was calculated from the six risk factors: Non- or ex-smoker, BMI < 25 kg/m2, moderate/vigorous physical activity, controlled BP (< 140/90 mmHg; 140/80 mmHg for patients with DM), controlled LDL-C (< 70 mg/dL), and controlled BG (glycohemoglobin < 7% or BG < 126 mg/dL). Good, intermediate, and poor categories of CHIS were identified in 6%, 58.3%, and 35.7% of patients, respectively (without statistical differences between female and male patients). CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and, in particular, the control rate of BP, are insufficient. Given the fact that patients with different comorbid pathologies are at a very high risk, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at a high risk for CVD. A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors

A Multi-Dimensional Sustainable Diet Index (SDI) for Ghanaian Adults Under Transition: The RODAM Study

The sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. Methods: We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25–70 years). For the SDI construct (0–16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. Results: The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. Conclusion: The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.Projekt DEAL - The European Commission - 7th Framework Programme (Grant Number: 278901). Deutscher Akademischer Austauschdienst German Academic Exchange Service (Grant number: 57507442). Intramural Research Program of the National Human Genome Research Institute of the National Institutes of Health (NIH) through the Center for Research on Genomics and Global Health (CRGGH). National Institute of Diabetes and Digestive and Kidney Diseases and the Office of the Director at the NIH (Z01HG200362)

Das Millennium ecosystem assessment als Diskursarena im Diskursfeld "Klimabedingte Veränderungen der Biodiversität"

Der vorliegende Materialienband entstand im Rahmen der problemorientierten Diskursfeldanalyse zu „Klimabedingten Veränderungen der Biodiversität“. Ziel dabei ist es, prioritäre Themen und zentrale Akteure systematisch darzustellen, sowie Konfliktlinien und zukünftige Handlungsbedarfe innerhalb des Themenfeldes zu identifizieren. Das Millennium Ecosystem Assessment bildet dabei eine zentrale Diskursarena im Diskursfeld. Im Zentrum der Analyse des Millennium Ecosystem Assessments stehen wissenschaftlich beeinflusste Positionen und die Frage nach deren gesellschaftlicher Nutzung. Es ist von wissenschaftlicher Seite unumstritten, dass die Auswirkungen des Klimawandels bereits heute die Biodiversität auf unterschiedliche Art und Weise stark beeinflussen. Der vorliegende Bericht analysiert daher den Diskurs zum Themenfeld klimabedingte Biodiversitätsveränderungen auf wissenschaftlicher Basis. Dabei werden zunächst kurz die Vorgeschichte und die zentralen Inhalte des Millennium Ecosystem Assessment skizziert. Die Darlegung und Diskussion übergreifender Themenfelder ermöglicht die Festlegung prioritärer Diskursstränge innerhalb der Diskursarena. Diese umfassen sowohl ökosystemare Aspekte als auch wirtschaftliche Handlungsfelder und forscherliche Herausforderungen. In einem weiteren Arbeitsschritt werden umstrittene Wirkungszusammenhänge sowie wissenschaftliche Forschungsbedarfe und gesellschaftliche Handlungsbedarfe erörtert.The study on hand evolved in connection with the problem orientated discourse field analysis concerning “Climatically caused changes of biological diversity”. The aim is to systematically present prior topics and main stakeholders as well as lines of conflict and future requirements for action within this discourse field. In this context the Millennium Ecosystem Assessment constitutes a major discourse arena. The central point of analysing the Millennium Ecosystem Assessment comprises scientifically influenced positions and the question of how society can profit from them. It is scientifically undisputed that the effects of climate change are already strongly influencing biological diversity in one way or another. Thus, the report on hand is analysing on a scientific basis the discourse field taking place in the context of climatically caused changes of biological diversity. In a first step the genesis and main issues of the Millennium Ecosystem Assessment are being outlined. The presentation and analysis of comprehensive thematic fields allows a definition of prior topics within the field of discourse. These comprise ecosystematic aspects as well as economic fields of action and scientific challenges. In a following step undisputed cause-effect-relationships, needs for research as well as societal requirements for action are debated

Multimorbidity of non-communicable diseases in low-income and middle-income countries : a systematic review and meta-analysis

INTRODUCTION: Multimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs. METHODS: We conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs. RESULTS: The systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%–81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions. CONCLUSION: Multimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time. PROSPERO REGISTRATION NUMBER: CRD42019133453

Multimorbidity Among Migrant and Non-Migrant Ghanaians: The RODAM Study

Objectives: Multimorbidity is a growing public health concern due to the increasing burden of non-communicable diseases, yet information about multimorbidity in low- and middle-income countries and migrant populations is scarce. We aimed to investigate the distribution and patterns of multimorbidity in rural and urban areas in Ghana and Ghanaian migrants in Europe. Methods: The RODAM cross-sectional study included 4,833 participants. Multimorbidity was defined as presence of multiple non-communicable chronic conditions. Patterns were determined from frequent combination of conditions. Prevalence ratios were estimated by logistic regression. Results: Prevalence of multimorbidity was higher in women and in urban Ghana and Europe. We observed a cardiometabolic pattern in all sites as well as circulatory-musculoskeletal and metabolic-musculoskeletal combinations in Ghana. Multimorbidity prevalence ratios were higher in Europe (men 1.47, 95% CI 1.34–1.59, women 1.18, 1.10–1.26) and urban Ghana (men 1.46, 1.31–1.59, women 1.27, 1.19–1.34). Conclusion: Distribution and patterns of multimorbidity differed by sex and site. With a higher burden of multimorbidity in urban areas, prevention strategies should focus on forestalling its increase in rapidly growing rural areas