Klassifikationsmodelle in der Gesundheitsförderung und Prävention: Möglichkeiten und Grenzen für die Konzeption und Evaluation von Projekten und Programmen

Zusammenfassung: Hintergrund: Um die komplexe Planung und Evaluation von Projekten und Programmen im Gesundheitsbereich zu unterstützen, kommen heute v.a. im angelsächsischen Raum unterschiedliche Klassifikationsmodelle zum Einsatz. In diesem Artikel geht es um eine kritische Prüfung von 2 Klassifikationsmodellen, die derzeit in diversen Institutionen der Schweiz angewendet werden. Methode: Das Ergebnismodell von Gesundheitsförderung Schweiz sowie das "Program-Logic-Modell" von Sue Funnell werden als 2 Typen von Klassifikationsmodellen verglichen und auf ihre Einsatzmöglichkeiten in der Planungs- und Evaluationsphase von Gesundheitsprojekten untersucht. Dazu verdeutlichen wir die vielfältigen Implikationen von Klassifikationssystemen im Gesundheitsbereich und zeigen anhand von 2 Fallstudien die Problematiken bei der praktischen Umsetzung der Modelle. Ergebnisse: Die Modelle basieren auf unterschiedlichen, impliziten Annahmen und unterscheiden sich im Strukturierungsgrad der Kategorien sowie im Grad der Explizierung von Kausalitäten. Bei der Nutzung der Modelle ergeben sich dadurch spezifische Vor- und Nachteile. Schlussfolgerungen: Unter Berücksichtigung ihrer Grenzen und inhärenten Logik sind Klassifikationsmodelle nützliche Instrumente, um die Komplexität in der Planung und Evaluation von Gesundheitsprojekten zu reduzieren. Darüber hinaus erzwingen sie einen Austausch der Stakeholder über Gesundheitsvorstellungen und Ziele im Gesundheitsbereic

Evidence for repetitive load in the trapezius muscle during a tapping task

Many studies describe the trapezius muscle activation pattern during repetitive key-tapping focusing on continuous activation. The objectives of this study were to determine whether the upper trapezius is phasically active during supported key tapping, whether this activity is cross-correlated with forearm muscle activity, and whether trapezius activity depends on key characteristic. Thirteen subjects (29.7±11.4years) were tested. Surface EMG of the finger's extensor and flexor and of the trapezius muscles, as well as the key on-off signal was recorded while the subject performed a 2-min session of key tapping at 4Hz. The linear envelopes obtained were cut into single tapping cycles extending from one onset to the next onset signal and subsequently time-normalized. Effect size between mean range and maximal standard deviation was calculated to determine as to whether a burst of trapezius muscle activation was present. Cross-correlation was used to determine the time-lag of the activity bursts between forearm and trapezius muscles. For each person the mean and standard deviation of the cross-correlations coefficient between forearm muscles and trapezius were determined. Results showed a burst of activation in the trapezius muscle during most of the tapping cycles. The calculated effect size was ≥0.5 in 67% of the cases. Cross-correlation factors between forearm and trapezius muscle activity were between 0.75 and 0.98 for both extensor and flexor muscles. The cross-correlated phasic trapezius activity did not depend on key characteristics. Trapezius muscle was dynamically active during key tapping; its activity was clearly correlated with forearm muscles' activit

Correlates of short- and long-term absence due to musculoskeletal disorders

Background Musculoskeletal disorders (MSD) are a common cause of disability and absence from work. There is no consistent evidence in the literature regarding predictors for short- and long-term absences due to these disorders. Aims To investigate work-related factors influencing short- and long-term absences due to MSD in German-speaking countries. Methods The study is based on data from the Fourth European Working Conditions Survey. The study population included 2849 workers in German-speaking countries who participated in face-to-face interviews. Logistic regression models were used to determine the associations between possible risk factors and the occurrence of short- or long-term absence due to MSD. Results A tiring or painful working position was positively correlated with short- and long-term absenteeism due to MSD, whereas the freedom to decide when to take holidays was negatively associated with this phenomenon. Some psychosocial factors, such as the ability to apply one's own ideas at work, the ability to choose or change the speed or rate of work and the emotional demands of the job, had contradictory impacts on short- and long-term absenteeism due to MSD. Conclusions The results of this investigation show that it is important to distinguish between predictors of short- and long-term absenteeism due to MS

12PLECTIN GALACTOSIDE-BINDING SOLUBLE 3 BINDING PROTEIN (LGALS3BP) IS A CANCER-ASSOCIATED LIGAND FOR INHIBITORY SIGLECS

Tumor cells subvert the control of the immune system by downregulation of their antigenicity and production of an immunosuppressive microenvironment including the upregulation and engagement of inhibitory receptors on immune cells. Therapeutic strategies have demonstrated that the immune system can be reactivated and control established cancers by blocking inhibitory receptors on immune cells such CTLA-4 and PD1. While such activation of the immune system is successful in some patients, many patients still show cancer progression after some time. Thus, the definition of new targetable immunomodulatory pathways is needed to improve the outcome in those patients. Recent evidence suggests that sialic acid dependent ligands on tumor cells can engage inhibitory sialic acid binding immunoglobulin-like lectins (Siglecs) on NK cells and cells of the myelomonocytic lineage and thereby facilitate evasion of immune-mediated killing. Moreover, the presence of a natural variant of Siglec-9 with reduced binding capacity to sialic acid dependent ligands in patients with non-small cell lung cancer improved the two year survival in a retrospective multivariate analysis. Here we identify a novel cancer-associated ligand for immuno-inhibitory Siglecs by affinity chromatography and subsequent proteomic analysis. LectinGalactoside-Binding Soluble 3 Binding Protein (LGALS3BP) bound to various inhibitory Siglecs including Siglec-5, Siglec-9 and Siglec-10 with high affinity. LGALS3BP was previously found to be upregulated in various carcinomas such as breast, colorectal, prostate and lung cancer and linked to advanced stage and poor prognosis. The exact function during cancer progression, however, was not yet defined. Our findings provide a novel insight into how LGALS3BP could promote immune evasion by inhibiting immune cell activation through engagement of Siglecs and defines LGALS3BP-Siglec interactions as potential novel target to interfere with cancer progression and reactivate the immune system against carcinomas. Disclosure: All authors have declared no conflicts of interes

Relationship between perceived exertion and mean power frequency of the EMG signal from the upper trapezius muscle during isometric shoulder elevation

The aim of the study was to investigate the relationship between a fatigue-induced increase of perceived exertion in the neck with a decrease of mean power frequency (MPF) in the surface electromyography (sEMG) signal during repeated shoulder elevation endurance tasks. About Thirty-two healthy women (age range 20-62) performed two maximum 6-min shoulder elevation endurance tasks at 30% of their maximal voluntary contraction (MVC) level, separated by a rest of 6min. During these exercises, perceived exertion was estimated using the Borg scale (range 0-10), whereas the MPF of the sEMG signal from the upper trapezius was simultaneously detected. Linear regression analysis was applied over time for each trial and subject for both MPF and Borg scale rating values. The MPF was normalized by the intercept of the linear regression analysis. The resulting slopes of normalized mean power frequency (nMPF) and Borg scale rating were correlated with each other by linear regression for both trials. In order to investigate the individual behavior of fatigue effects between trials, Δ trial 2-trial 1 slopes of nMPF and Borg scale ratings were calculated for each subject. These slopes of nMPF and Borg scale ratings were correlated with each other as well by linear regression. The increase of Borg scale ratings, as well as the decrease of nMPF, were significantly higher in trial 2 than trial 1 (P<0.01). The results show a linear correlation between slopes of nMPF and Borg scale ratings for both trials 1 and 2 (r=0.76, P<0.01). Trial-to-trial slopes (Δ trial 2-trial 1) of nMPF and Borg scale rating, were also significantly correlated (r=0.68, P<0.05). Thus, the individually sensed increase of perceived exertion in the neck during trial 2 was accompanied by a simultaneously higher detected decrease of nMPF. These findings indicate a close relationship between subjective perception of exertion in the neck and objectively assessed muscle fatigue of the upper trapeziu

Health technology assessment in Switzerland

OBJECTIVES AND METHODS: To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA). RESULTS: In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office "of Social Security" to the one for "Public Health." The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs. CONCLUSIONS: Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public healt

Health technology assessment in Switzerland

OBJECTIVES AND METHODS: To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA). RESULTS: In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office "of Social Security" to the one for "Public Health." The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs. CONCLUSIONS: Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public health

Effects of COVID-19 Lockdown on Melanoma Diagnosis in Switzerland: Increased Tumor Thickness in Elderly Females and Shift towards Stage IV Melanoma during Lockdown.

At the early stages of the COVID-19 outbreak in 2020, Switzerland was among the countries with the highest number of SARS-CoV2-infections per capita in the world. Lockdowns had a remarkable impact on primary care access and resulted in postponed cancer screenings. The aim of this study was to investigate the effects of the COVID-19 lockdown on the diagnosis of melanomas and stage of melanomas at diagnosis. In this retrospective, exploratory cohort study, 1240 patients with a new diagnosis of melanoma were analyzed at five tertiary care hospitals in German-speaking Switzerland over a period of two years and three months. We compared the pre-lockdown (01/FEB/19-15/MAR/20, n = 655) with the lockdown (16/MAR/20-22/JUN/20, n = 148) and post-lockdown period (23/JUN/20-30/APR/21, n = 437) by evaluating patients' demographics and prognostic features using Breslow thickness, ulceration, subtype, and stages. We observed a short-term, two-week rise in melanoma diagnoses after the major lift of social lockdown restrictions. The difference of mean Breslow thicknesses was significantly greater in older females during the lockdown compared to the pre-lockdown (1.9 ± 1.3 mm, p = 0.03) and post-lockdown period (1.9 ± 1.3 mm, p = 0.048). Thickness increase was driven by nodular melanomas (2.9 ± 1.3 mm, p = 0.0021; resp. 2.6 ± 1.3 mm, p = 0.008). A proportional rise of advanced melanomas was observed during lockdown (p = 0.047). The findings provide clinically relevant insights into lockdown-related gender- and age-dependent effects on melanoma diagnosis. Our data highlight a stable course in new melanomas with a lower-than-expected increase in the post-lockdown period. The lockdown period led to a greater thickness in elderly women driven by nodular melanomas and a proportional shift towards stage IV melanoma. We intend to raise awareness for individual cancer care in future pandemic management strategies