Relationship of objective street quality attributes with youth physical activity: findings from the Healthy Communities Study.

BACKGROUND: Residential environments may significantly influence youth physical activity (PA). However, few studies have examined detailed street quality attributes via observational audits in relation to context-specific PA among youth. OBJECTIVES: The objective of this study was to explore whether the overall quality of street environments, as well as specific attributes, was associated with neighbourhood-based and street-based PA within a national sample of youth in the Healthy Communities Study. METHODS: Data were collected from 4616 youth from 130 communities across the USA. Youth PA in the neighbourhood and on the participant's street was captured using 7-d recall interviews. Windshield survey observational audits documented five street quality variables: burned, boarded up or abandoned residential units, litter, overall condition of residences, street type and presence of sidewalks in good condition. RESULTS: Youth with no litter on their street reported significantly lower neighbourhood-based PA and youth living on a side street, cul-de-sac, dead-end or one-way street reported greater neighbourhood-based PA. No significant associations were detected for the overall street quality index or with street-based PA. CONCLUSIONS: Specific street quality attributes may be associated with youth PA. Further research and collaboration between diverse disciplines and agencies should focus on understanding and improving street quality to promote youth PA and health.

[Objective Criteria in the Medicinal Therapy for Type II Diabetes: An Analysis of the Patients' Perspective with Analytic Hierarchy Process and Best-Worst Scaling]. / Zielkriterien der medikamentösen Therapie des Diabetes Typ II: Eine Analyse der Patientenperspektive mit Analytic Hierarchy Process und Best-Worst Scaling.

BACKGROUND: The patient's perspective with regard to decision criteria of alternative treatment options has hardly been analysed. The objective of any intervention in health-care is to increase the patient's benefit. OBJECTIVE: This study aimed to analyse the patient-relevant decision criteria in the medicinal therapy of type II diabetes. The characteristics of a drug therapy that are relevant for the choice of the patients should be revealed. METHOD: An explorative qualitative study (N=15) in combination with a quantitative survey (in total N=388) using Analytic Hierarchy Process and Best-Worst Scaling aimed at the determination of the importance of patient-relevant decision criteria. RESULTS: The quantitative AHP- and BWS survey resulted in a clear dominance of the attribute "HbA1c level" and its optimal settings, for both with oral anti-diabetics treated patients (OAD) and insulin-treated patients. In the group of the OAD patients both methods independently showed the same ranking of the following 3 ranks: "delay of insulin therapy" (rank 2), "occurrence of hypoglycaemia" (rank 3) and "weight changes" (rank 4). For insulin patients "the occurrence of hypoglycaemia" follows in the AHP on the second rank and in the BWS on the 3(rd) rank. Compared to OAD patients, the relevance of the target criterion "weight changes" decreases in the group of the insulin patients in the AHP on the last rank (rank 7) and in the BWS on the second last rank (rank 6). CONCLUSION: For the first time the methods of AHP and BWS were combined to assess how patients weight between different characteristics of the treatment in type II diabetes and which influence those criteria of therapy have on the patient's benefit. Both patient groups show differences in the horizon of experience and thus in the ranking of the decision criteria.

[Patients' Priorities in the Treatment of Neuroendocrine Tumours: An Analytical Hierarchy Process]. / Die Patientenperspektive in der Behandlung von Neuroendokrinen Tumoren: Eine Analyse mittels Analytic Hierarchy Process.

Background: Neuroendocrine tumours (NET) are relatively rare, usually slow-growing malignant tumours. So far there are no data on the patient preferences/priorities regarding the therapy for NET. This empirical study aimed at the elicitation of patient priorities in the drug treatment of NET. Method: Qualitative patient interviews (N=9) were conducted. To elicit the patient's perspective regarding various treatment aspects of NET a self-administered questionnaire using the Analytical Hierarchy Process (AHP) was developed. The data collection was carried out using paper questionnaires supported by an item response system in a group discussion. To evaluate the patient-relevant outcomes, the eigenvector method was applied. Results: N=24 patients, experts and relatives participated in the AHP survey. In the AHP all respondents had clear priorities for all considered attributes. The attribute "overall survival" was the most significant feature of a drug therapy for all respondents. As in the qualitative interviews, "efficacy attributes" dominated the side effects in the AHP as well. The evaluation of all participants thus showed the attributes "overall survival" (Wglobal:0.418), "progression-free survival" (Wglobal:0.172) and "response to treatment" (Wglobal:0.161) to be most relevant. "Occurrence of abdominal pain" (Wglobal:0.051) was ranked sixth, with "tiredness/fatigue" and "risk of a hypoglycaemia" (Wglobal:0.034) in a shared seventh place. Conclusion: The results thus provide evidence about how much influence a treatment capacity has on therapeutic decisions. Using the AHP major aspects of drug therapy from the perspective of those affected were captured, and positive and negative therapeutic properties could be related against each other. Based on the assessment of the patient's perspective further investigation must elicit patient preferences for NET drug therapy. In the context of a discrete choice experiment or another choice-based method of preference measurement, the results obtained here can be validated and the therapeutic features weighted according to their preferability.

[Patients' preferences in the medicamentous treatment of diabetes mellitus type 2: A systematic classification and meta-comparison of patient preference studies]. / Patientenpräferenzen in der medikamentösen Therapie von Diabetes Mellitus Typ 2 : Systematische Klassifizierung und Metavergleich der Patientenpräferenzstudien.

OBJECTIVE: Diabetes Mellitus is one of the most expensive common diseases. Because of the great socio-economic importance of this indication, it seems necessary to consider the expectations and needs of all patients with regard to treatment characteristics. To evaluate patient preferences stated-preference methods are increasingly used. The aim was to analyze and compare the available evidence from patient preference studies regarding the treatment characteristics and to display which target criteria in the medicinal treatment of diabetes mellitus type 2 are most important from the patients view. METHODS: A literature review in PubMed was conducted to identify stated preference studies in the indication of diabetes and show which properties of a treatment are relevant to the patient's benefit. By means of level difference calculation and a subsequent normalization uniform weights for the attributes of the studies were determined. Based on a final ranking the key criteria according to their value proposition from the perspective of affected populations are demonstrated. RESULTS: N = 13 studies could be included in the analysis. By calculating the level difference and performing a normalization it was possible to obtain a uniform representation of all attributes of N = 7 studies. The preference studies show that the control of blood sugar, side effects (such as hypoglycemia, nausea and stomach discomfort or weight changes), long-term complications and the mode of administration represent the most common patient-relevant outcomes in diabetes therapy. In five of the 13 DCE studies the blood glucose control achieved the highest ranking within the relative importance score in the treatment of diabetes mellitus. In two studies, the side effects hypoglycemia and weight changes occupied the first rank. Furthermore, in two other studies, the side effects of nausea/upset stomach and in one study the type of application determined as the primary outcome measure. CONCLUSIONS: The use of stated preference methods in health economics aims to reflect the benefit assessments of therapy features from patient's or expert perspective. So far it is unclear how this evidence is documented in benefit assessment of medical interventions and how the findings will be made available to decision-makers. Based on the findings of this review the evidence of patient preferences in diabetes treatment is synthesized. The results show the relative importance based on a derived ranking score of the used patient-relevant endpoints. The ranking allows the comparison of the results of the identified preference studies.

Use of Reston foam in liposuction.

Use of Reston foam along with a pressure garment after liposuction results in three salutary effects: less waviness in the skin surface, a more comfortable recovery, and less blood loss and ecchymoses. Free fat cells are thought to be redistributed evenly by the pressure of the foam plus the pressure garment. The result is a smoother skin surface with less waviness. Reston foam is also comfortable under the pressure garment and there is less immediate postoperative tenderness. In addition, the use of the foam, in conjunction with the pressure garment, results in less postoperative bleeding and bruising. Consequently, there is also a decrease in the amount of postoperative fall in hematocrit. Since there is less of a drop in hematocrit and hemoglobin, there is also less postoperative anemia. The mechanism involved in the reduction in blood loss is thought to be a combination of overcoming capillary pressure and stabilization of the skin and subsurface blood vessels.

Breast reduction in the male-to-female transsexual.

An interesting case of reduction mammaplasty in a male-to-female transsexual is presented using a combination of conventional resection and implant change surgery. The associated changes of advanced silicone mastitis provided some unique physical characteristics and technical challenge. This case report illustrates key breast surgery principles and documents the first reduction mammaplasty in a male.