Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial)

Background: The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods: A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion: If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be propose

Reduction of (137)caesium contamination in wild boars by supplementing offered food with ammonium-iron-hexa-cyanoferrate

Objective: This replication study investigated whether the (137)caesium (Cs-137) contamination of wild boars could be relevantly reduced under field conditions by adding ammonium-iron-hexa-cyanoferrate (AFCF; Prussian blue) to the food. Material and methods: In 285 wild boars that had been shot in six Bavarian hunting territories during the season (November until May) between 01 November 2010 and 10 December 2011 Cs-137 contamination was analysed. Thirty-five animals originated from two hunting territories in which offered food had been supplemented with 1250 mg AFCF per kilogram food. Results: The control animals showed a mean Cs-137 contamination of 522 Bq/kg lean skeletal muscle meat. Direct (univariable) comparisons of the two experimental territories with the four control territories yielded a mean reduction in Cs-137 contamination due to Prussian bluefeeding by -211 Bq/kg (p < 0.001). Multivariable models that took potential confounders into account (age, weight, sex, hunting date, territory) estimated the effect to be -344 Bq/kg (p < 0.05). Conclusion and clinical relevance: This replication study confirmed the finding of Kienzle et al. (12) who described a statistically significant reduction in Cs-137 contamination by -380 Bq/kg due to the feeding of Prussian blue in other territories

Impact of the Introduction of the Social Long-Term Care Insurance in Germany on Financial Security Assessment in Case of Long-Term Care Need&ast;

The discussion concerning long-term care insurance in Germany barely exceeds the financial state of the social system. The view of the insured involved is largely ignored. This paper analyses the effect of the introduction of compulsory long-term care insurance in 1995 in Germany on the perception of financial security when needing long-term care. Using different regression techniques on a subset of the German Socio-Economic Panel (SOEP) data, we show that the introduction led to a general positive shift of the assessment. Furthermore, experience with long-term care had no significant effect before the introduction but a positive effect afterwards. Also, the perception of financial security is found to be increasing with income at both times with similar magnitudes.