[Costs of a guideline-based treatment of patients with chronic hepatitis C in the era of interferon-free treatment]. / Kosten einer leitliniengerechten Versorgung von Hepatitis-C-Patienten im Zeitalter Interferon-freier Therapien.

The treatment of chronic hepatitis C has considerably changed with the introduction of recent direct acting antivirals. These antivirals have sustained virologic response (SVR) rates above 90 % as well as reduced toxicity and treatment duration. Therefore, current German guidelines recommend these interferon-free regimens as first-choice treatment. Nevertheless, recent developments were accompanied by a significant increase in treatment costs, which led to extensive discussions on reasonable pharmaceutical prices. The aim of the current study was to analyze the average treatment costs and costs per patient cured for guideline treatment recommendations. Analyses were stratified according to genotype, treatment status (naive/experienced), and presence/absence of cirrhosis. Costs were separated in (1.) basic diagnostic procedures, (2.) monitoring, and (3.) pharmaceuticals. The calculation is based on a remuneration scheme in the statutory health insurance system. In treatment-naïve non-cirrhotic patients, the average cost is 41 766 €/SVR for the treatment with SOF/LDV calculated (PTV/r/OMV+DSV: 53 129 €/SVR). In treatment-naive cirrhotic patients, costs were 60 323 €/SVR (SOF/LDV+RBV) and 80 604 €/SVR (PTV/r/OMV+DSV+RBV). Treatment-experienced genotype 1 patients had average costs of 60 366 €/SVR for SOF/LDV treatment as well as 53 134 €/SVR for PTV/r/OMV+DSV±RBV treatment (cirrhotic patients: 62 208 €/SVR for SOF/LDV+RBV; 80 824 €/SVR for PTV/r/OMV+DSV+RBV). The average treatment costs per SVR in treatment-naive genotype 1 patients are comparable to previous standard of care treatments and lower in treatment-experienced patients. In other genotypes, treatment costs and costs per cure are significantly higher compared to previous standard of care. However, long-term modelling studies show that new regimens are cost-effective.

[Effectiveness and Cost-Effectiveness of Daily School Sport in the Primary School--Project: "fit for pisa"]. / Effektivität und Kosteneffektivität täglichen Schulsports in der Grundschule--das Projekt "fit für pisa".

The "fit for pisa" intervention implemented daily physical education at five primary schools in Göttingen. The results of the evaluation show an increase in physical activity among the students participating in the programme. At the same time sedentary behaviour, like watching television, decreased remarkably. In the long run the promotion of an active lifestyle had improved the body mass index. The study emphasises the need for government funding to implement the programme across the country.

[School Development by Using Health Management: Indicator Toolbox as Quality Assurance Instrument for Self-Evaluation in Schools]. / Schulentwicklung durch Gesundheitsmanagement: Kennzahlentoolbox als Qualitätssicherungsinstrument für Selbstevaluation an Schulen.

Organisational development is crucial to health promotion in schools. The intervention "Learning to Live Healthy" is a new school health promotion strategy designed to develop schools into healthy environments for all those who work and study there. The aim of the study "School Development by using Health Management" is to introduce the management instrument balanced scorecard and to develop an indicator toolbox. This allows schools to evaluate the achievement of objectives, the implementation level of the measures and the changes in their organisation regarding health management.

[Implementing daily physical education in primary school - potentials and barriers from the involved actor's point of view]. / Täglichen Schulsport in der Grundschule implementieren - Potenziale und Barrieren aus Sicht der beteiligten Akteure.

OBJECTIVE: The objective was to determine to what extent daily physical education can be implemented in primary schools, what barriers exist and how to overcome the mentioned barriers. Moreover, it was analysed to what extent daily physical education is accepted by teachers, external trainers, parents and students. METHODS: Semi-structured interviews with parents (n=7), teachers (n=5) and external trainers (n=6) of the intervention schools. The intervention students (n=44) were surveyed within focus groups. RESULTS: All surveyed groups appraised the implementation of daily school sports as successful. The cooperation between the schools and the sports club should be maintained during a comprehensive implementation of daily physical education. Besides an improved lessons quality teachers and external trainers reported an improved social behaviour of the children. Parents perceived positive effects on the child development. All groups believe that daily physical education increases the enjoyment of children in sports. As a certain barrier a lack of resources (e. g., facilities, equipment, financial resources) in the schools were mentioned. CONCLUSIONS: The cooperation between the schools and the sports club proved to be an applicable model to implement daily physical education. The combination of teachers and external trainers can contribute to a higher lesson quality. Considering the perceived potentials of daily physical education by all surveyed groups, a comprehensive implementation of systematic daily physical activity promotion in the primary school setting should be tapped more strongly in future.

[Health economic evaluation of health promotion - the example "fit for pisa"]. / Gesundheitsökonomische Evaluation der Gesundheitsförderung - am Beispiel "fit für pisa"

The increasing prevalence of risk factors associated with physical inactivity lead to an economic burden on society. The article uses the example of the prevention measure "fit for pisa" to investigate to what extent a full economic evaluation can provide a basis for decision-makers. The intervention integrated the daily physical education at 5 primary schools in Göttingen for the entire school term. The study is intended to provide information on short- and long-term potential savings. A process analysis identified the prevention performance from a societal perspective. Resource consumption was recorded in (partly) standardisedform and evaluated and also revealed the need for investment in sports halls with capacity to expand the programme to all primary schools in Göttingen. In the routine the implementation costs of half-day schools are 619 € per student year; for all-day schools 236 € per student year. The consideration of the short-term outcomes shows that TV viewing has decreased and physical activity has been strongly encouraged. The active life style promotion has shown an improvement on BMI in the medium-term. On the basis of a decision analytical model, a cost-benefit analysis of the program over the life course will be undertaken.

Integrating water resources management in eco-hydrological modelling.

In this paper the integration of water resources management with regard to reservoir management in an eco-hydrological model is described. The model was designed to simulate different reservoir management options, such as optimized hydropower production, irrigation intake from the reservoir or optimized provisioning downstream. The integrated model can be used to investigate the impacts of climate variability/change on discharge or to study possible adaptation strategies in terms of reservoir management. The study area, the Upper Niger Basin located in the West African Sahel, is characterized by a monsoon-type climate. Rainfall and discharge regime are subject to strong seasonality. Measured data from a reservoir are used to show that the reservoir model and the integrated management options can be used to simulate the regulation of this reservoir. The inflow into the reservoir and the discharge downstream of the reservoir are quite distinctive, which points out the importance of the inclusion of water resources management.

Integrating local and technical knowledge to support soil salinity monitoring in the Amudarya river basin.

The role of monitoring is changing due to the increasing awareness of complexity and uncertainty in environmental resources management. Monitoring systems are required to support critical reflection about the effectiveness of actions toward the achievement of management objectives. To this aim, monitoring should be based on a strong integrated and multi-scale approach. Monitoring costs could be prohibitive if the monitoring is only based on traditional scientific methods of measurements. To deal with these issues, the design of an innovative monitoring system should be based on the integration between different sources of knowledge and information. In this work the usability of local knowledge to support environmental monitoring is investigated. A multi-step participatory monitoring design process has been implemented aiming to design a program for soil salinity monitoring in the lower Amudarya river basin in Uzbekistan. Although there is an increasing awareness of the importance of stakeholders being involved in decision processes, the current socio-cultural and institutional context is not favourable to the participatory approach. The choice of method to be implemented in this work was influenced by such conditions. The analysis of the lessons learned from the experiences gained in this project revealed some important clues concerning the development of a locally-based monitoring program. These lessons can be subdivided according to three fundamental issues: the long term involvement of local community members in monitoring activities, the acceptance of locally-based monitoring systems by decision makers, and the reliability of monitoring information.