Do diabetes and depressed mood affect associations between obesity and quality of life in postmenopause? Results of the KORA-F3 Augsburg population study

<p>Abstract</p> <p>Background</p> <p>To assess associations of obesity with health-related quality of life (HRQL) in postmenopausal women, and whether depressed mood and diabetes moderate these associations.</p> <p>Methods</p> <p>Survey of 983 postmenopausal women aged 35-74, general population, Augsburg region/Germany, 2004/2005. Body weight/height and waist/hip circumference were assessed anthropometrically and classified via BMI ≥ 30 as obese, and WHR ≥ 0.85 as abdominally obese (vs. not). Depressed mood was assessed by the Depression and Exhaustion-(DEEX-)scale, diabetes and postmenopausal status by self-report/medication, and HRQL by the SF-12.</p> <p>Results</p> <p>General linear models revealed negative associations of obesity and abdominal obesity with physical but not mental HRQL. Both forms of excess weight were associated with diabetes but not depressed mood. Moderation depended on the HRQL-domain in question. In non-diabetic women, depressed mood was found to amplify obesity-associated impairment in physical HRQL (mean "obese"-"non-obese" difference given depressed mood: -6.4, p < .001; among those without depressed mood: -2.5, p = .003). Reduced mental HRQL tended to be associated with obesity in diabetic women (mean "obese"-"non-obese" difference: -4.5, p = .073), independent of depressed mood. No interactions pertained to abdominal obesity.</p> <p>Conclusions</p> <p>In postmenopausal women, depressed mood may amplify the negative impact of obesity on physical HRQL, while diabetes may be a precondition for some degree of obesity-related impairments in mental HRQL.</p

Policy, competence and participation: empirical evidence for a multilevel health promotion model

This paper uses data from a European health promotion evaluation study (MAREPS) to empirically test some fundamental assumptions of health promotion theory. Analysis shows that both the competence of individual actors and the opportunities provided for by health-promoting policies are significant predictors of participation in health promotion action. It also demonstrates effects of health promotion values on such action. Moreover, people's perception of their own political efficacy, e.g. their influence on community decisions that effect their health, turns out to be a significant predictor of self-rated health. In conclusion, the paper encourages further research to investigate the effectiveness of health-promoting policy strategies within a multilevel health promotion framework. As the present results indicate, effective health-promoting policies may create opportunities that enable individuals and communities to increase control over the determinants of health, and thereby improve their healt

Probleme der Stichprobenziehung und -konstruktion bei Telefon-Surveys

'Es werden Probleme hinsichtlich folgender Zielsetzungen bei Stichprobenplänen für Telefon-Surveys diskutiert: (1) Ziehnung von regional begrenzten Stichproben (Bundesländer, Regierungsbezirke, Landkreise); (2) Berücksichtigung nicht-gelisteter Telefonnummern durch die Verwendung von 'Randomized-Last-Digit' - (RLD-) Nummern. Mögliche Lösungen werden am konkreten Beispiel der Ziehung einer Zufallsstichprobe für den Freistaat Sachsen erörtert.' (Autorenreferat)'This article focuses on the problems associated with pursuing: (1) selection of regionally restricted random samples (states -Bundesländer-, administrative districts -Regierungsbezirke, Landkreise-); (2) consideration of unlisted telephone numbers using 'randomized last digit'- (RLD-) numbers. Also discussed are some possible solutions to these problems are suggested by an actual random sample selection for the State of Saxony.' (author's abstract)

Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway

Purpose To explore relationships of socio-demographic variables, health behaviours, environmental characteristics and personal factors, with physical and mental health variables in persons with morbid obesity, and to compare their health-related quality of life (HRQoL) scores with scores from the general population. Methods A cross-sectional correlation study design was used. Data were collected by self-reported questionnaire from adult patients within the first 2 days of commencement of a mandatory educational course. Of 185 course attendees, 142 (76.8%) volunteered to participate in the study. Valid responses on all items were recorded for 128 participants. HRQoL was measured with the Short Form 12v2 from which physical (PCS) and mental component summary (MCS) scores were computed. Other standardized instruments measured regular physical activity, social support, self-esteem, sense of coherence, self-efficacy and coping style. Results Respondents scored lower on all the HRQoL subdomains compared with norms. Linear regression analyses showed that personal factors that included self-esteem, self-efficacy, sense of coherence and coping style explained 3.6% of the variance in PCS scores and 41.6% in MCS scores. Conclusion Personal factors such as self-esteem, sense of coherence and a high approaching coping style are strongly related to mental health in obese persons

Das Gesprächsführungspraktikum im 2. Studienjahr des Modellstudiengangs HannibaL: Eine Evaluation mittels Selbsteinschätzungen der Studierenden [The communication skills course for second year medical students at Hannover Medical School: An evaluation study based on students' self-assessments]

[english] In the model medical curriculum HannibaL at Hannover Medical School (MHH, Hannover, Germany), communication skills in taking case histories and disclosing diagnoses (breaking bad news) are assessed through an objective structured clinical examination (OSCE). This is part of the examinations which at the MHH represent the equivalent to the First Part of the Medical Examinations. The second year doctor-patient communication course preparing for these examinations was evaluated during the 2009/10 academic year.Using questionnaires specific to the learning objectives, learning needs were assessed, pre-post comparisons of self-assessed competencies were performed and key teaching methods were evaluated (5-point Likert scales, “5”=fully agree). At T0 (start of the course) 267 students participated (response rate: 93.7%), of which 180 filled out the T1 questionnaire during the last session of the course (67.4%). Within-subject analyses of variance and paired t-tests were conducted.The highest learning needs were found for the “to show how”-items regarding history taking and disclosing diagnoses (M=4.4). The T1-T0 comparisons showed the greatest improvements for history taking (“to know how”: mean difference = +1.7, “to show how”: +1.8, p&lt;.0001 as with all tests) and the “to know how”-item regarding the disclosure of diagnoses (+1.6), followed by the “to show how”-items on disclosing a diagnosis (+1.4), shared decision making (+1.2), self-assessing one’s own strengths/weaknesses (+1.0) and confidently approaching new patients (+0.7). Students with T0 values of 1 or 2 on the respective scales improved on average by 2.2 points across all items, students with the value of 3 by 1.1, and from 4 or 5 by 0.1. Methodically, the use of simulated patients was rated the most helpful (M=4.8, 87% with the scale value 5).This doctor-patient communication course is associated with substantial improvements regarding all key learning objectives. Regarding methods, the deployed simulated patients (2-4 per 10-student-course group in 3 of the 7 course sessions, respectively) were rated the most helpful. The present evaluation calls for both further development of the doctor-patient communication curriculum at the MHH and joint activities across medical schools, which are discussed at the end of the paper. [german] Im MHH-Modellstudiengang HannibaL werden Gesprächsführungskompetenzen für Anamneseerhebung und Diagnosemitteilung durch eine Objective Structured Clinical Examination (OSCE) geprüft, die Teil der dem Ersten Abschnitt der Ärztlichen Prüfung äquivalenten Prüfungen sind. Das vorbereitende Gesprächsführungspraktikum im 2. Studienjahr wurde 2009/10 evaluiert.Mittels lernzielspezifischer Fragebogen wurden der Lernbedarf erhoben, Vorher-Nachher-Vergleiche der selbsteingeschätzten Kompetenzen durchgeführt und zentrale Lehrmethoden bewertet (5-Punkt-Likertskalen, „5“=hohe Ausprägung). Zu T0 (Beginn des Praktikums) nahmen 267 Studierende teil (Teilnahmerate: 93,7%), von denen 180 den T1-Fragebogen beim letzten Praktikumstermin ausfüllten (67,4%). Es wurden Varianzanalysen mit Messwiederholungsfaktor und T-Tests für verbundene Stichproben durchgeführt. Die höchsten Lernbedarfe zeigten sich bei den „to show how“-Items zu Anamneseerhebung und Diagnosemitteilung (M=4,4). Die T1-T0-Vergleiche zeigten die größten Verbesserungen bei den anamnesespezifischen Items („to know how“: Mittelwertsdifferenz=+1,7, „to show how“:+1,8, p&lt;.0001 wie bei allen Tests) und beim „to know how“-Item zur Diagnosemitteilung (+1,6), gefolgt von der Umsetzung einer Diagnosemitteilung (+1,4), partizipativer Entscheidungsfindung (+1,2), der Einschätzung eigener Stärken/Schwächen (+1,0) und dem sicheren Zugehen auf neue Patienten (+0,7). Studierende mit T0-Werten von „1“ oder „2“ auf den jeweiligen Skalen verbesserten sich über alle Items im Mittel um 2,2 Punkte, solche mit „3“ um 1,1, und mit „4“ oder „5“ um 0,1. Methodisch wurde der Einsatz der Simulationspatienten am hilfreichsten bewertet (M=4,8; 87% mit dem Wert „5“).Das Gesprächsführungspraktikum ist bezüglich aller zentralen Lernziele mit deutlichen Lernfortschritten assoziiert. Methodisch wird vor allem der Einsatz von Simulationspatienten (pro Praktikumsgruppe mit 10 Studierenden zu 3 von 7 Terminen mit jeweils 2-4 Simulationspatienten) am besten bewertet. Die Evaluation spricht für einen weiteren Ausbau des Gesprächsführungscurriculums an der MHH und von hochschul-/fakultätsübergreifenden Aktivitäten, die abschließend diskutiert werden

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

<p>Abstract</p> <p>Background</p> <p>Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany.</p> <p>Methods</p> <p>Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999–2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for.</p> <p>Results</p> <p>Overall, being dissatisfied with one’s body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one’s body weight were associated with the highest socioeconomic index group (OR = 2.3, 95% CI: 1.4–3.8), middle and high educational level (OR = 1.6, 95% CI: 1.1–2.3, and OR = 1.9, 95% CI: 1.3–3.7), high income (OR = 1.8, 95% CI: 1.2–2.7), and middle and high occupational status (both OR = 1.8, 95% CI: 1.2–2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR = 1.6, 95% CI: 1.1–2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR = 3.7, 95% CI: 1.8–7.5) and in those with a high educational level (OR = 2.3, 95% CI: 1.3–4.1), high income (OR = 2.6, 95% CI: 1.4–4.7), and middle and high occupational status (both OR = 2.2, 95% CI: 1.3–3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR = 3.6, 95% CI: 1.0–12.8).</p> <p>Conclusions</p> <p>In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.</p

Comparing different data sources by examining the associations between surrounding greenspace and children's weight status

Background: Studies on the association between surrounding greenspace and being overweight in childhood show inconsistent results, possibly because they differ widely in their definition and measurement of surrounding greenspace. Our aim was to evaluate whether the association of greenspace with being overweight depends on the measurement of greenspace in different data sources. Methods: Based on data from the school entry examinations of 22,678 children in the city of Hannover, Germany, from 2010 to 14, the association between greenspace availability and overweight was examined. Three different sources of greenspace availability were derived for a set of 51 areas of the city: The Normalized Difference Vegetation Index (NDVI), the OpenStreetMap (OSM) dataset, and the European Urban Atlas (UA) dataset. Agreement between the indicators on the quantity of greenspace coverage was compared. The association with children's BMI z-score, including potential interaction terms, was assessed using multilevel regression analysis. Results: Greenspace availability per district area derived by NDVI was on average 42%, by OSM 29% and UA 22%, with OSM and UA being strongly correlated. Only the greenspace availability derived by NDVI showed an association with children's BMI z-score: The higher the greenspace availability was, the lower the BMI. The trend of association was higher for boys and migrant children than for girls and non-migrants and was restricted to the highest levels of greenspace availability. Conclusions: Associations of greenspace with children's weight status depend on the greenspace measurement chosen. Surrounding greenspace was measured more comprehensively by NDVI. Data sources based on land use categories such as UA and OSM may be less suitable to reflect surrounding greenspace relevant for health outcomes. Potential mechanisms warrant further analysis and investigation