Verhältnisprävention nichtübertragbarer Krankheiten

Hintergrund: Seit 1800 hat sich in Deutschland und weltweit die Lebenserwartung bei Geburt mehr als verdoppelt. Das Potential verhältnispräventiver Ansätze, zur Vermeidung von Krankheit und vorzeitigen Tod beizutragen, ist auch heute noch nicht ausgeschöpft. Methodik: Mit einer systematischen Übersichtarbeit mit Meta-Analyse – einem Cochrane-Review – wurde die internationale Evidenz zur Wirksamkeit verhältnispräventiver Ansätze zur Reduktion des Süßgetränkekonsums gesammelt und ausgewertet. In mehreren Einzelprojekten wurde mit Methoden der qualitativen Inhaltsanalyse und unter Nutzung etablierter internationaler methodischer Rahmenwerke untersucht, inwieweit wissenschaftliche Empfehlungen zur Prävention nichtübertragbarer Krankheiten Eingang in den politischen Diskurs und die politische sowie gesellschaftliche Praxis in Deutschland gefunden haben. Durch Nutzung von Ansätzen der Co-Produktion von Evidenz wurde ein Beitrag zur Translation wissenschaftlicher Erkenntnisse in Politik und Praxis in Deutschland geleistet. Ergebnisse: Die verfügbare Evidenz zeigt, dass es skalierbare, effektive Maßnahmen zur Reduktion des Süßgetränkekonsums auf Bevölkerungsebene gibt, wobei die Zuverlässigkeit der Evidenz variabel ist und relevante Forschungslücken festzustellen sind. Wissenschaftliche Empfehlungen zur Prävention nichtübertragbarer Krankheiten finden zunehmend Eingang in Politik und Praxis in Deutschland, doch ist die Umsetzung weiterhin lückenhaft. Die Einbindung von Evidenznutzern in den Forschungsprozess kann helfen, die Translation von Forschungsergebnissen zu unterstützen. Schlussfolgerungen: Verhältnispräventive Ansätze können einen Beitrag zur Reduktion des Süßgetränkekonsums auf Bevölkerungsebene leisten. Vermehrte Anstrengungen sind nötig, um die Berücksichtigung wissenschaftlicher Erkenntnisse in der Politik und Praxis der Prävention in Deutschland zu fördern.Background: Life expectancy at birth has more than doubled since 1800 in Germany and worldwide. The potential of environmental approaches to prevention and health promotion has not yet been fully realized. Methods: A systematic review with meta-analysis – a Cochrane review – was conducted to synthesize the evidence regarding the effectiveness of environmental interventions to reduce the consumption of sugar-sweetened beverages. In several side-projects, qualitative content analysis and internationally established methodological frameworks were used to analyze to what extent scientific recommendations on the prevention of non-communicable diseases have entered the political discourse and societal practice in Germany. Co-production approaches were used to facilitate the translation of evidence into policy and practice in Germany. Results: The available evidence shows that scalable, effective interventions for reducing the consumption of sugar-sweetened beverages on a population level exist, but the certainty of evidence varies, and relevant research gaps remain. Scientific recommendations on the prevention of non-communicable diseases are increasingly taken into account in policy and practice in Germany, but implementation remains patchy. Engaging evidence users in the research process can help to translate evidence into policy and practice. Conclusions: Environmental interventions can contribute to reducing the consumption of sugar-sweetened beverages on a population level. Increased efforts are needed to promote the uptake of scientific evidence on effective policies for the prevention of non-communicable diseases in Germany

Quantifying changes in global health inequality: the Gini and Slope Inequality Indices applied to the Global Burden of Disease data, 1990-2017

Background The major shifts in the global burden of disease over the past decades are well documented, but how these shifts have affected global inequalities in health remains an underexplored topic. We applied comprehensive inequality measures to data from the Global Burden of Disease (GBD) study. Methods Between-country relative inequality was measured by the population-weighted Gini Index, between-country absolute inequality was calculated using the population-weighted Slope Inequality Index (SII). Both were applied to country-level GBD data on age-standardised disability-adjusted life years. Findings Absolute global health inequality measured by the SII fell notably between 1990 (0.68) and 2017 (0.42), mainly driven by a decrease of disease burden due to communicable, maternal, neonatal and nutritional diseases (CMNN). By contrast, relative inequality remained essentially unchanged from 0.21 to 0.19 (1990-2017), with a peak of 0.23 (2000-2008). The main driver for the increase of relative inequality 1990-2008 was the HIV epidemic in Sub-Saharan Africa. Relative inequality increased 1990-2017 within each of the three main cause groups: CMNNs; non-communicable diseases (NCDs); and injuries. Conclusions Despite considerable reductions in disease burden in 1990-2017 and absolute health inequality between countries, absolute and relative international health inequality remain high. The limited reduction of relative inequality has been largely due to shifts in disease burden from CMNNs and injuries to NCDs. If progress in the reduction of health inequalities is to be sustained beyond the global epidemiological transition, the fight against CMNNs and injuries must be joined by increased efforts for NCDs

Representation of social determinants of health in German medical education: protocol of a content analysis study

Introduction: Action on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO's Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health. Methods and analysis: We will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO's Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content. Ethics and dissemination: This study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal

Growth cone response to ephrin gradients produced by microfluidic networks

A microfluidic network (μFN) etched into a silicon wafer was used to deliver protein solutions containing different concentrations of the axonal guidance molecule ephrinA5 onto a silicone stamp. In a subsequent microcontact printing (μCP) step, the protein was transferred onto a polystyrene culture dish. In this way, stepwise substrate-bound concentration gradients of ephrinA5 were fabricated spanning a total distance of 320 μm. We tested the response of chick retinal ganglion cell (RGC) axons, which are guided in vivo by ephrin gradients, to these in vitro gradients. Temporal, but not nasal axons stop at a distinct zone in the gradient, which is covered with a certain surface density of substrate-bound ephrinA5. Within the temporal RGC population, all axons respond uniformly to the gradients tested. The position of the stop zone depends on the slope of the gradient with axons growing further into the gradient in shallow gradients than in steep gradients. However, axons stop at lower ephrinA5 concentrations in shallow gradients than in steep gradients, indicating that the growth cone can adjust its sensitivity during the detection of a concentration gradient of ephrinA5

Ephrin-A/EphA specific co-adaptation as a novel mechanism in topographic axon guidance

Genetic hardwiring during brain development provides computational architectures for innate neuronal processing. Thus, the paradigmatic chick retinotectal projection, due to its neighborhood preserving, topographic organization, establishes millions of parallel channels for incremental visual field analysis. Retinal axons receive targeting information from quantitative guidance cue gradients. Surprisingly, novel adaptation assays demonstrate that retinal growth cones robustly adapt towards ephrin-A/EphA forward and reverse signals, which provide the major mapping cues. Computational modeling suggests that topographic accuracy and adaptability, though seemingly incompatible, could be reconciled by a novel mechanism of coupled adaptation of signaling channels. Experimentally, we find such ‘co-adaptation’ in retinal growth cones specifically for ephrin-A/EphA signaling. Co-adaptation involves trafficking of unliganded sensors between the surface membrane and recycling endosomes, and is presumably triggered by changes in the lipid composition of membrane microdomains. We propose that co-adaptative desensitization eventually relies on guidance sensor translocation into cis-signaling endosomes to outbalance repulsive trans-signaling

Multifunctional Wing Motor Control of Song and Flight

Multifunctional motor systems produce distinct output patterns that are dependent on behavioral context, posing a challenge to underlying neuronal control. Flies use their wings for flight and the production of a patterned acoustic signal, the male courtship song, employing in both cases a small set of wing muscles and corresponding motor neurons. We took first steps toward elucidating the neuronal control mechanisms of this multifunctional motor system by live imaging of muscle ensemble activity patterns during song and flight, and we established the functional role of a comprehensive set of wing muscle motor neurons by silencing experiments. Song and flight rely on distinct configurations of neuromuscular activity, with most, but not all, flight muscles and their corresponding motor neurons contributing to song and shaping its acoustic parameters. The two behaviors are exclusive, and the neuronal command for flight overrides the command for song. The neuromodulator octopamine is a candidate for selectively stabilizing flight, but not song motor patterns

Investigation wettability of carbon components with the polyurethane binder of resistive composites

The research paper deals with influence wettability of carbon components with the polyurethane binder of resistive composites. We have revealed that the polyurethane lacquer wets up to 25 wt. % of C-1 and GE-3 particles, which results in their uniform distribution over the entire volume of the binder and homogeneity of RCMs. Zero wetting of the same weight percentage is observed in the case of K-163 carbon black, which gives rise to caking and distortion of homogeneity of the composite coating after its formation and its further cracking after heat treatment. The wetting capacity of K-163 carbon black in the polyurethane lacquer is improved using a DISPERBYK-2155 dispersing agent in the amount of 10 wt. % with respect to the binder. The resulting experimental data indicate that C-1 particles exhibit the best wettability, hence their adhesion strength with the binder would be higher than that of GE-3 graphite element and K-163 carbon black

Environmental Interventions to Reduce the Consumption of Sugar-Sweetened Beverages: Abridged Cochrane Systematic Review

BACKGROUND Regular consumption of sugar-sweetened beverages (SSB) can increase the risk for obesity, type 2 diabetes, cardiovascular disease, and dental caries. Interventions that alter the physical or social environment in which individuals make beverage choices have been proposed to reduce the consumption of SSB. METHODS We included randomised controlled, non-randomised controlled, and interrupted time series studies on environmental interventions, with or without behavioural co-interventions, implemented in real-world settings, lasting at least 12 weeks, and including at least 40 individuals. Studies on the taxation of SSB were not included, as these are subject of a separate Cochrane review. We used standard Cochrane methods for data extraction, risk of bias assessment, and evidence grading and synthesis. Searches were updated to January 24, 2018. RESULTS We identified 14,488 unique records and assessed 1,030 full texts for eligibility. We included 58 studies comprising a total of 1,180,096 participants and a median length of follow-up of 10 months. We found moderate-certainty evidence for consistent associations with decreases in SSB consumption or sales for the following interventions: traffic light labelling, price increases on SSB, in-store promotion of healthier beverages in supermarkets, government food benefit programs with incentives for purchasing fruits and vegetables and restrictions on SSB purchases, multi-component community campaigns focused on SSB, and interventions improving the availability of low-calorie beverages in the home environment. For the remaining interventions we found low- to very-low-certainty evidence for associations showing varying degrees of consistency. CONCLUSIONS With observed benefits outweighing observed harms, we suggest that environmental interventions to reduce the consumption of SSB be considered as part of a wider set of measures to improve population-level nutrition. Implementation should be accompanied by evaluations using appropriate methods. Future studies should examine population-level effects of interventions suitable for large-scale implementation, and interventions and settings not yet studied thoroughly

Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review

Objectives: To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. Design: Rapid systematic review. Participants: Humans with viral respiratory infections, exposed to systemic NSAIDs. Primary outcomes: Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. Results: We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution