[Social acceptance of public breastfeeding over time: experiences and attitudes of the population and of breastfeeding mothers in 2016 and 2020]. / Die gesellschaftliche Akzeptanz von öffentlichem Stillen im zeitlichen Vergleich: Erfahrungen und Einstellungen der Bevölkerung und stillender Mütter 2016 und 2020.

BACKGROUND AND OBJECTIVE: Germany is only moderately breastfeeding-friendly, according to a systematic inventory from 2019. Based on a reference study, a survey on the acceptance of breastfeeding in public was conducted. The aim of the work is to capture perceptions and attitudes towards public breastfeeding in a periodic comparison. In addition, differences between the general population and mothers of young children as well as between mothers with different levels of education are considered. MATERIALS AND METHODS: In 2020, 1007 people aged 16 and older and 307 mothers with children up to 24 months were surveyed online about public breastfeeding. The results were compared with a previous survey from 2016. RESULTS: In 2020, a larger percentage of mothers breastfeed in public than in 2016; it is avoided less often. Mothers with lower levels of education are less likely to breastfeed, also in public, and more likely to report mixed reactions. Among the general population, acceptance of public breastfeeding has declined, for example, in gastronomy. About one in six (17%) explicitly rejects breastfeeding in public. Knowledge about the health effects of breastfeeding is lower among the general public than among mothers. As in 2016, knowledge about the positive effects of breastfeeding is associated with greater acceptance of public breastfeeding. CONCLUSIONS: The results underline the importance of measures, for example, to communicate knowledge to the population, show breastfeeding more frequently in mass media and through positive role models, and make the settings in which families live more breastfeeding-friendly. Measures should pay special attention to women with lower levels of education.

[Becoming breastfeeding friendly in Germany-an international research project to assess the readiness to scale up breastfeeding]. / Das internationale Forschungsvorhaben Becoming Breastfeeding Friendly. Untersuchung von Rahmenbedingungen zur Stillförderung.

Despite known positive effects for breastfed children and their mothers, only one third of children under four months of age are breastfed exclusively. In addition, an overview of structures, actors, and measures to promote breastfeeding in Germany is missing. In a two-year international research project entitled Becoming Breastfeeding Friendly (BBF), the current status of German breastfeeding support is systematically evaluated on the basis of the Breastfeeding Gear Model (BFGM) which was developed by the Yale School of Public Health. Therefore, committee members with expertise in the healthcare sector, science, policy, and communication evaluate 54 benchmarks of the eight relevant gears: advocacy, political will, legislation & policies, funding & resources, training & program delivery, promotion, research & evaluation, coordination, and goals & monitoring. Based on the identified strengths and needs, concrete calls to action for scaling up breastfeeding promotion are derived and prioritized. BBF started in September 2017 and is conducted in cooperation with the Yale School of Public Health by the Healthy Start - Young Family Network as well as the National Breastfeeding Committee as an initiative of the Federal Ministry of Nutrition and Agriculture. The project assesses the framework conditions for breastfeeding and thus makes a valuable contribution to the health promotion of mother and child and to breastfeeding protection in Germany.

A new telemonitoring system intended for chronic heart failure patients using mobile telephone technology--feasibility study.

BACKGROUND: Remote monitoring is one modality of structured care in chronic heart failure. The purpose of this study was to evaluate the feasibility of a new wireless telemonitoring system via a mobile phone network. METHODS: Portable home devices for electrocardiogram, blood pressure, body weight and self-assessment measurements were connected (via Bluetooth) to a personal digital assistant (PDA) that performs automated encrypted transmission via mobile phone. Two telemedical centres were set-up. RESULTS: 30 healthy volunteers were enrolled and followed for 26 days. A total of 4002 single measurements were taken, 133 ± 37 per person. No data was lost or incorrectly allocated. 880 of 937 (94%) of the ECG recordings had sufficient diagnostic quality for rhythm analysis and single beat measurements. 50 continuous ECG-streams (312 min) without disruption were performed. Total system availability was 96.6%, including that of the mobile phone network. CONCLUSIONS: Mobile phone technology is suitable for continuous and secure medical data transmission. To evaluate the clinical use in chronic heart failure patients, a large multicentre randomized controlled trial (ClinicalTrials.gov Identifier: NCT00543881) was started.

Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design.

AIMS: Remote patient management (telemonitoring) may help to detect early signs of cardiac decompensation, allowing optimization of and adherence to treatments in chronic heart failure (CHF). Two meta-analyses have suggested that telemedicine in CHF can reduce mortality by 30-35%. The aim of the TIM-HF study was to investigate the impact of telemedical management on mortality in ambulatory CHF patients. Methods CHF patients [New York Heart Association (NYHA) II/III, left ventricular ejection fraction (LVEF)≤35%] with a history of cardiac decompensation with hospitalization in the past or therapy with intravenous diuretics in the prior 24 months (no decompensation required if LVEF≤25%) were randomized 1:1 to an intervention group of daily remote device monitoring (electrocardiogram, blood pressure, body weight) coupled with medical telephone support or to usual care led by the patients' local physician. In the intervention group, 24/7 physician-led medical support was provided by two central telemedical centres. A clinical event committee blinded to treatment allocation assessed cause of death and reason for hospitalization. The primary endpoint was total mortality. The first secondary endpoint was a composite of cardiovascular mortality or hospitalization due to heart failure. Other secondary endpoints included cardiovascular mortality, all-cause and cause-specific hospitalizations (all time to first event) as well as days lost due to heart failure hospitalization or cardiovascular death (in % of follow-up time), and changes in quality of life and NYHA class. Overall, 710 CHF patients were recruited. The mean follow-up was 21.5±7.2 months, with a minimum of 12 months. Perspective The study will provide important prospective outcome data on the impact of telemedical management in patients with CHF.