Contextual influences on physical activity and eating habits -options for action on the community level

Background: This conceptual paper aims to illustrate the ways in which communities are able to advance health improvements on a population level. Outcome measures may include increased physical activity and healthier eating habits in particular, as well as an improved health-related quality of life and social cohesion as more generic outcomes. Main body: The paper begins by asking initial questions: Why did previous health-specific interventions only show moderate effects on an individual level and mixed effects on a population level? What is the added value of a community-based public health perspective compared to the traditional biomedical perspective when it comes to prevention? Why are we living the way we are living? Why do we eat what we eat? Why do we move the way we move? Subsequently, we illustrate the broad spectrum of contextual interventions available to communities. These can have geographical and technological as well as economic, political, normative and attitude-specific dimensions. It is shown that communities have a strong influence on health-related contexts and decision-making of adults, adolescents and children. In addition contextual characteristics, effects, mediators, moderators and consequences relevant for health can differ greatly between age groups. Both small-scale settings and overarching sectors possess physical, economic, political and sociocultural characteristics that can be proactively influenced by community decision-makers in the sense of a “health in all policies”-strategy. Short conclusion: After presenting various interdisciplinary approaches to community-based health interventions, the manuscript closes with the following core message: Successful community-based health promotion strategies consist of multilevel – multicomponent interventions on the micro, meso and macro-level-environments

Identification of starting points to promote health and wellbeing at the community level – a qualitative study

Background: As health is influenced by the social, economic and environmental conditions in which individuals live, local communities are an ideal setting to promote health and wellbeing. However, up to now various health promotion interventions at the community level have had limited success, perhaps related to an incomplete understanding of local contexts and priorities. We therefore aimed to develop a broader and deeper understanding of topics or issues that were most salient to residents of a South-West German community by exploring their perceptions of needs, challenges, barriers and existing resources related to health and well-being. Methods: As an initial step of a multi-year community-based participatory research project, we conducted semi-structured interviews with key informants (n = 30) from various community settings (e.g., child care, elderly care, businesses, non-profit organizations, village councils, and local government). The terms “health” and “wellbeing” were included in the stem of each question in the semi-structured interview guide to enable a focus on related perceived needs, challenges, barriers and existing resources. Interviews were audiotaped, transcribed verbatim and analyzed using qualitative content analysis techniques. Results: Themes emerging from our interviews appeared to center primarily in three distinct areas: natural resources and built environment, access to services, and social cohesion including subthemes on the importance of social engagement and volunteerism, sense of community, and shared identity. Conclusions: That health and wellbeing were not identified explicitly as a priority by key informants suggests that these should not be presented as the primary focus of a community-wide initiative. Instead themes with a higher priority should be addressed in ways that can lead to better health and wellbeing as a secondary goal

Negative Regulation of Bone Formation by the Transmembrane Wnt Antagonist Kremen-2

Wnt signalling is a key pathway controlling bone formation in mice and humans. One of the regulators of this pathway is Dkk1, which antagonizes Wnt signalling through the formation of a ternary complex with the transmembrane receptors Krm1/2 and Lrp5/6, thereby blocking the induction of Wnt signalling by the latter ones. Here we show that Kremen-2 (Krm2) is predominantly expressed in bone, and that its osteoblast-specific over-expression in transgenic mice (Col1a1-Krm2) results in severe osteoporosis. Histomorphometric analysis revealed that osteoblast maturation and bone formation are disturbed in Col1a1-Krm2 mice, whereas bone resorption is increased. In line with these findings, primary osteoblasts derived from Col1a1-Krm2 mice display a cell-autonomous differentiation defect, impaired canonical Wnt signalling and decreased production of the osteoclast inhibitory factor Opg. To determine whether the observed effects of Krm2 on bone remodeling are physiologically relevant, we analyzed the skeletal phenotype of 24 weeks old Krm2-deficient mice and observed high bone mass caused by a more than three-fold increase in bone formation. Taken together, these data identify Krm2 as a regulator of bone remodeling and raise the possibility that antagonizing KRM2 might prove beneficial in patients with bone loss disorders

HEGPOL: Randomized, placebo controlled, multicenter, double-blind clinical trial to investigate hepatoprotective effects of glycine in the postoperative phase of liver transplantation [ISRCTN69350312]

BACKGROUND: Kupffer cell-dependent ischemia / reperfusion (I/R) injury after liver transplantation is still of high clinical relevance, as it is strongly associated with primary dysfunction and primary nonfunction of the graft. Glycine, a non-toxic, non-essential amino acid has been conclusively shown in various experiments to prevent both activation of Kupffer cells and reperfusion injury. Based on both experimental and preliminary clinical data this study protocol was designed to further evaluate the early effect of glycine after liver transplantation. METHODS / DESIGN: A prospective double-blinded randomized placebo-controlled multicenter study with two parallel groups in a total of 130 liver transplant recipients was designed to assess the effect of multiple intravenous doses of glycine after transplantation. Primary endpoints in hierarchical order are: peak levels of both aspartat-amino-transaminase (AST) and alanine-amino-transaminase (ALT) as surrogates for the progression of liver related injury, as well as both graft and patient survival up to 2 years after transplantation. Furthermore, the effect of glycine on cyclosporine A-induced nephrotoxicity is evaluated. DISCUSSION: The ongoing clinical trial represents an advanced element of the research chain, along which a scientific hypothesis has to go by, in order to reach the highest level of evidence; a randomized, prospective, controlled double-blinded clinical trial. If the data of this ongoing research project confirm prior findings, glycine would improve the general outcome after liver transplantation

Evaluation of a prediction tool for asthetic gas and oxygen concentration available for the „Perseus-A500®“ anesthesia system developed by Draeger (Lubeck, Germany)

Die Narkose mit volatilen Anästhetika ist ein häufig praktiziertes Verfahren der Allgemeinanästhesie. Wegen ihrer Vorteile werden oftmals Niedrigflussnarkosen durchgeführt. Aufgrund des hohen Rückatemanteils verändern sich hierbei nach Änderung der Frischgaseinstellungen die Gaskonzentrationen nur mit größerer zeitlicher Latenz. Bislang gibt es noch kein im klinischen Alltag eingesetztes Verfahren, welches eine zuverlässige Vorhersage der Sauerstoff- und der Narkosegaskonzentration in einem halbgeschlossenen Narkosekreisteil ermöglicht. Die Firma Dräger (Lübeck, Deutschland) entwickelte, basierend auf pharmakologischen und physiologischen Modellen, eine Software, welche die in- und exspiratorischen Narkosegaskonzentrationen sowie die inspiratorische Sauerstoffkonzentration für die nächsten 20 Minuten vorhersagen kann. Das Ziel der Studie besteht darin, die Vorhersagefunktion des Narkosegerätes „Perseus-A500®“ (Firma Dräger, Lübeck, Deutschland) für die Sauerstoff- und Narkosegaskonzentration unter kontrollierten, klinischen Bedingungen zu evaluieren. Die Erkenntnisse dieser Pilotstudie sollen zudem als Grundlage für die Durchführung weiterer Studien dienen. In dieser Studie konnte gezeigt werden, dass die Software im Narkosegerät „Perseus-A500®“ (Firma Dräger, Lübeck, Deutschland) die Konzentrationen von Sevofluran und Desfluran sowie die Sauerstoffkonzentration mit einer angemessenen Genauigkeit über einen Zeitraum von 20 Minuten voraussagen kann. Swinhoe et al. definierten in ihrer Studie zur Evaluation eines „target-controlled infusion“-Systems (TCI-Systems) Kriterien für eine akzeptierbare Vorhersagegenauigkeit (Swinhoe et al., 1998). Die Vorhersage ist klinisch akzeptabel, wenn der MDPE kleiner als 10-20% ist und der MDAPE zwischen 20-40% liegt. Die Ergebnisse unserer Studie befinden sich innerhalb dieser Grenzen. Die Vorhersagegenauigkeit der inspiratorischen Sauerstoffkonzentration war schlechter als die der Narkosegaskonzentrationen. Ursächlich hierfür könnte die verhältnismäßig einfache Formel nach Arndt zur Berechnung der Sauerstoffverbrauches sein, die als Grundlage für das Vorhersagemodell der inspiratorischen Sauerstoffkonzentration dient.Inhalational anesthetics are commonly used for the induction of general anesthesia. Low-flow anesthesia is often performed because of numerous advantages. Due to the significant proportion of rebreathing during low-flow anesthesia, gas concentrations change quite slowly after changing the fresh gas settings. There is currently no reliable prediction tool of anesthetic gas and oxygen concentrations in a semi-closed circuit for everyday clinical practice. Based on pharmacological and physiological models, Draeger (Lubeck, Germany) developed a software tool which is able to predict and visualize anesthetic gas and oxygen concentrations over the next 20 minutes. The aim of this study is to evaluate the prediction function of the software tool available for the „Perseus-A500®“ anesthesia system developed by Draeger (Lubeck, Germany) under controlled clinical conditions. Furthermore the findings of this pilot study will serve as a basis for further studies. In this study it is shown that the software tool available for the ‘‘Perseus-A500®’’ (Draeger, Lubeck Germany) can predict the concentrations of anesthetic gas as well as the oxygen concentration with a reasonable accuracy over a period of 20 minutes. Swinhoe et al. defined criteria for acceptable prediction accuracy in their study for the evaluation of a target-controlled infusion (TCI) system. The prediction is clinically acceptable if the MDPE is less than 10-20% and the MDAPE is between 20- 40% (Swinhoe et al., 1998). The results of our study are within these limits. The predictive performance of the software tool with inspiratory oxygen concentration was worse than that of the anesthetic gas concentrations. The reason could be the model used for the prediction of oxygen concentration that is based on a comparatively simple formula by Arndt to calculate oxygen consumption

Evaluation of Whole Genome Sequencing and an Insertion Site Characterization Method for Molecular Characterization of GM Maize

Molecular characterization of genetically modified (GM) crops has traditionally been accomplished through a combination of Southern blot, polymerase chain reaction (PCR), and Sanger sequencing analyses. This characterization generates critical information that is used in downstream safety assessment of GM crops and development of GM detection methods.Next generation sequencing (NGS) technologies, such as whole genome sequencing (WGS), have shown the potential to replace some or all of these techniques for molecular characterization of GM crops. This paper describes the characterization of two GM maize events using NGS for WGS in combination with an insertion site characterization (ISC) method.  The sensitivity of the method is also compared to that of Southern blot analysis through detection of small insert fragments. Our results demonstrate that WGS is at least as sensitive as Southern blot analysis for determining the insert copy number, presence or absence unintended insertions, and for characterization of small fragment insertions.These results support the conclusion that WGS along with an appropriate insertion site characterization method are a suitable alternative to Southern blot analyses for molecular characterization of GM maize.https://doi.org/10.21423/jrs-v06n01p001 (DOI assigned 1/24/2019

Immunosuppressive Therapy for Patients With Myelodysplastic Syndrome : a Prospective Randomized Multicenter Phase III Trial Comparing Antithymocyte Globulin Plus Cyclosporine With Best Supportive Care--SAKK 33/99

PURPOSE Immunosuppressive treatment is reported to improve cytopenia in some patients with myelodysplastic syndrome (MDS). Combined antithymocyte globulin (ATG) and cyclosporine (CSA) is most effective in patients with immune-mediated marrow failure. PATIENTS AND METHODS This trial was designed to assess the impact of immunosuppression on hematopoiesis, transfusion requirements, transformation, and survival in patients with MDS randomly assigned to 15 mg/kg of horse ATG for 5 days and oral CSA for 180 days (ATG+CSA) or best supportive care (BSC), stratified by treatment center and International Prognostic Scoring System (IPSS) risk score. Primary end point was best hematologic response at 6 months. Eligible patients had an Eastern Cooperative Oncology Group performance status of 2 and transfusion dependency of less than 2 years in duration. Results Between 2000 and 2006, 45 patients received ATG+CSA (median age, 62 years; range, 23 to 75 years; 56% men) and 43 patients received BSC (median age, 65 years; range, 24 to 76 years; 81% men). IPSS score was low, intermediate-1, intermediate-2, high, and not evaluable in eight, 24, seven, one, and five patients on ATG+CSA, respectively, and eight, 25, five, zero, and five patients on BSC, respectively. Refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB) -I, RAEB-II, and hypoplastic disease were present in 21, six, nine, zero, and nine patients on ATG+CSA, respectively, and 18, eight, 11, two, and four patients on BSC, respectively. By month 6, 13 of 45 patients on ATG+CSA had a hematologic response compared with four of 43 patients on BSC (P = .0156). Two-year transformation-free survival (TFS) rates were 46% (95% CI, 28% to 62%) and 55% (95% CI, 34% to 70%) for ATG+CSA and BSC patients, respectively (P = .730), whereas overall survival (OS) estimates were 49% (95% CI, 31% to 66%) and 63% (95% CI, 42% to 78%), respectively (P = .828). CONCLUSION This open-lab randomized phase III trial demonstrates that ATG+CSA treatment seems to be associated with hematologic response in a subset of patients without apparent impact on TFS and OS

Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective

(1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pandemic-related problems likely determine this decisional dilemma for patients and can characterize vulnerable groups with special susceptibility for decisional problems and related consequences. (2) Methods: Cross-sectional data from the OnCoVID questionnaire study were used involving 540 patients from 11 participating institutions covering all major regions in Germany. Participants were actively involved in clinical treatment in oncology or psychiatry during the COVID-19 pandemic. Questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, perception of consequences for patients) and very basic demographic data (age, gender, stage of treatment and educational background). Decision uncertainties and distress were operationalized using equidistant five-point scales. Data analysis was performed using descriptive and various multivariate approaches. (3) Results: A total of 11.5% of all patients described intensive uncertainty in their clinical decisions that was significantly correlated with anxiety, depression, loneliness and stress. Younger and female patients and those of higher educational status and treatment stage had the highest values for these stressors (p p = 0.021) considered the additional risk of COVID-19 infections as very important for their disease-related decisions. Regression analysis identified determinants for patients at risk of a decisional dilemma, including information availability, educational level, age group and requirement of treatment decision making. (4) Conclusions: In patients, the COVID-19 pandemic induced specific decisional uncertainty and distress accompanied by intensified stress and psychological disturbances. Determinants of specific vulnerability were related to female sex, younger age, education level, disease stages and perception of pandemic-related treatment modifications, whereas availability of sufficient pandemic-related information prevented these problems. The most important decisional criteria for patients under these conditions were expected side effects/complications and treatment responses

Differences in Stakeholders’ Perception of the Impact of COVID-19 on Clinical Care and Decision-Making

Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making