High protein intake along with paternal part-time employment is associated with higher body fat mass among girls from South China.

PURPOSE: Protein intake has been suggested to be associated with body composition among western children. Our aim was to determine whether protein intake is associated with body composition among Chinese children and to investigate whether parental socioeconomic status modifies these associations. METHODS: Cross-sectional data were collected from the baseline survey of an ongoing population-based prospective open cohort study conducted in 2013. In this survey, 2039 children in South China were recruited using cluster random sampling. Information of 1704 children (47% girls), aged 7-12 years from three primary schools (42 classes), on diet and anthropometry was included finally. Their daily protein intake was obtained by 3-day 24-h dietary recalls. Skinfold thickness, body height, and weight were measured to calculate percent body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI). Parental characteristics were collected by questionnaires. RESULTS: Among girls, protein intake was positively associated with %BF and FMI [estimate (SE) for %BF: 0.007 (0.003), p = 0.04; for FMI: 0.092 (0.002), p = 0.03], adjusted for pubertal stage, breast-feeding, maternal overweight, carbohydrate intake, energy intake, and physical activity level. Furthermore, there was interaction between paternal occupation and the relations of dietary protein with %BF and FMI (p for interaction ≤ 0.04). None of the associations between protein intake and %BF, FMI, or FFMI was found among boys. CONCLUSIONS: Our data indicate that school-aged girls, but not boys, living in South China with higher dietary protein intake might have higher body fat mass, which could be modified by paternal occupation.

Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial.

BACKGROUND: Patients often seek other patients' experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people's health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients' Experiences) aims to provide scientifically based online information on people's experiences with health and illness to fulfill patients' needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. OBJECTIVE: The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. METHODS: In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks. RESULTS: The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. CONCLUSIONS: The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users' motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients' perceived effects of using such a website. TRIAL REGISTRATION: Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi).

Sedentary Behavior Is Independently Related to Fat Mass among Children and Adolescents in South China.

We aim to explore the independent associations of sedentary behaviors (SB) with body mass distribution among Chinese children. Data on the screen-based sedentary time (television viewing and computer use) and doing homework, physical activities and dietary intake of 1586 Chinese children (50.3% girls) aged 7-15 years were obtained through validated questionnaires. Skin-fold thickness, body height, and weight were measured to calculate percent body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI). Parental characteristics were collected by questionnaires. Among girls, time of SB (screen time or doing homework) was positively related to %BF, FMI, and FFMI (p < 0.03) after adjusting for maternal overweight, the average annual income of family, moderate-to-vigorous physical activity energy expenditure, and energy intake: Girls in the highest tertile of screen time/homework had 16.7%/23.3% higher relative FMI and 2.9%/2.9% higher relative FFMI than girls in the lowest tertile. Among boys, screen time was positively associated with FFMI (p < 0.003), but not related to %BF and FMI (p > 0.09), while time of doing homework was positively related to %BF and FMI (p = 0.03). Sedentary behaviors might be positively and independently related to fat mass among Chinese children, and were more pronounced in girls.

Changes in water and sugar-containing beverage consumption and body weight outcomes in children.

An intervention study showed that promoting water consumption in schoolchildren prevented overweight, but a mechanism linking water consumption to overweight was not substantiated. We investigated whether increased water consumption replaced sugar-containing beverages and whether changes in water or sugar-containing beverages influenced body weight outcomes. In a secondary analysis of the intervention study in Germany, we analysed combined longitudinal data from the intervention and control groups. Body weight and height were measured and beverage consumption was self-reported by a 24-h recall questionnaire at the beginning and end of the school year 2006/2007. The effect of a change in water consumption on change in sugar-containing beverage (soft drinks and juices) consumption, change in BMI (kg/m2) and prevalence of overweight and obesity at follow-up was analysed using regression analyses. Of 3220 enroled children, 1987 children (mean age 8·3 (sd 0·7) years) from thirty-two schools were analysed. Increased water consumption by 1 glass/d was associated with a reduced consumption of sugar-containing beverages by 0·12 glasses/d (95 % CI -0·16, -0·08) but was not associated with changes in BMI (P=0·63). Increased consumption of sugar-containing beverages by 1 glass/d was associated with an increased BMI by 0·02 (95 % CI 0·00, 0·03) kg/m2 and increased prevalence of obesity (OR 1·22; 95 % CI 1·04, 1·44) but not with overweight (P=0·83). In conclusion, an increase in water consumption can replace sugar-containing beverages. As sugar-containing beverages were associated with weight gain, this replacement might explain the prevention of obesity through the promotion of water consumption.

Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city.

This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Niño birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient = 0.59; p < 0.001; 19.35 and 13.50 µg/L, respectively). Arsenic concentrations were above detection limit (3.30 µg/L) in 17.9% of maternal and 34.6% of cord blood samples. They were not associated (Fischer's p = 0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient = 0.15; p < 0.03; 9.00 and 8.62 µg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining.

Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial.

OBJECTIVE: We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease. METHOD: Secondary analysis of a randomized controlled trial: In 2002-2004, 8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6months during the 3-year follow-up. RESULTS: In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7% in the intervention and 21.5% in the control group. Prevalence decreased in both groups to 16.6% vs. 19.5%, 15.3% vs. 16.8%, and 14.2% vs. 15.6% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group×time: P=0.005). The effect was largest after 6 and 12months [odds ratios (95% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24months. CONCLUSION: A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time. TRIAL REGISTRATION: ClinicalTrials.gov (www.clinicaltrials.gov): NCT00379249.

European accreditation and the future public health workforce.

BACKGROUND: In 2011 the Agency for Public Health Education Accreditation (APHEA) was initially launched focusing on Master level (second cycle) education. METHODS: Between 2012 and 2013 the Association of Schools of Public Health in the European Region, APHEA and partner schools conducted a study on the compliance of Master level programmes of public health to the accreditation criteria. A web-based survey of second cycle programmes of public health across 29 countries was conducted using the APHEA criteria. The 29 countries were categorized into four regions: Northern, Southern, Central and Eastern and Western. We applied a Chi square test to identify regional differences with regard to the compliance of the programmes to the criteria. RESULTS: Data from 51 out of 71 schools contacted were analyzed. The compliance to the two themes of student and faculty exchange and quality management were lowest for programmes of public health throughout the EHEA. There were significant differences in the compliance between the regions with higher compliance in the Northern European region. CONCLUSIONS: Student and faculty exchange and quality management are essential for schools and programmes of public health to improve the quality of their education through expanding international knowledge and the pertinence of skills taught within European and national contexts. The results show that there are intrinsic issues with exchange and quality management as well as the role of national accreditation agencies in defining public health education for the future workforce.

Association between sudden infant death syndrome and diphtheria-tetanus-pertussis immunisation: an ecological study.

BACKGROUND: Sudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States. The objective of this study was to analyse the association between diphtheria-tetanus-pertussis (DTP) immunisation and SIDS over time. METHODS: The Centers for Disease Control and Prevention provided the number of cases of SIDS and live births per year (1968-2009), allowing the calculation of SIDS mortality rates. Immunisation coverage was based on (1) the United States Immunization Survey (1968-1985), (2) the National Health Interview Survey (1991-1993), and (3) the National Immunization Survey (1994-2009). We used sleep position data from the National Infant Sleep Position Survey. To determine the time points at which significant changes occurred and to estimate the annual percentage change in mortality rates, we performed joinpoint regression analyses. We fitted a Poisson regression model to determine the association between SIDS mortality rates and DTP immunisation coverage (1975-2009). RESULTS: SIDS mortality rates increased significantly from 1968 to 1971 (+27% annually), from 1971 to 1974 (+47%), and from 1974 to 1979 (+3%). They decreased from 1979 to 1991 (-1%) and from 1991 to 2001 (-8%). After 2001, mortality rates remained constant. DTP immunisation coverage was inversely associated with SIDS mortality rates. We observed an incidence rate ratio of 0.92 (95% confidence interval: 0.87 to 0.97) per 10% increase in DTP immunisation coverage after adjusting for infant sleep position. CONCLUSIONS: Increased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS.

Association between water consumption and body weight outcomes in children and adolescents: a systematic review.

OBJECTIVE: Water is recommended to replace sugar-containing beverages for prevention of childhood obesity. Because this recommendation is not evidence-based yet, the existing evidence on the association between water consumption and body weight outcomes was summarized. METHODS: In a systematic review, studies were retrieved from four electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane) and further search methods. Studies including children aged 2-19 years on the association between water consumption and any body weight-related outcome were eligible. RESULTS: Out of 3,023 retrieved records, 13 studies were included: four longitudinal and nine cross-sectional studies. One cross-sectional analysis in one longitudinal study was additionally included, resulting in ten cross-sectional analyses. One non-randomized controlled study and two observational longitudinal studies showed that increased water consumption reduced the risk of overweight or body mass index. Another observational longitudinal study did not indicate this association. Six cross-sectional analyses found a direct association between water consumption and at least one body weight outcome. Four cross-sectional analyses did not show any association. CONCLUSIONS: On the cross-sectional level, higher water consumption seems to be associated with higher weight status. In contrast, longitudinal studies suggest a weight-reducing effect of water consumption, but evidence for a causal association is still low.

"We talk it over"--mixed-method study of interdisciplinary collaborations in private practice among urologists and oncologists in Germany.

BACKGROUND: Utilisation of multidisciplinary teams is considered the best approach to care and treatment for cancer patients. However, the multidisciplinary approach has mainly focused on inpatient care rather than routine outpatient care. The situation in private practice care and outpatient care is gradually changing. We aimed to 1), investigate interdisciplinary cooperations in the care of tumor patients among urologists and oncologists in the community setting, 2), establish an estimate of the prevalence of cooperation among oncologists and organ-specific providers in community settings in Germany and 3), characterise existing cooperations among oncologists and urologists. METHODS: We conducted simultaneously a cross-sectional survey with private practice urologists (n=1,925) and a qualitative study consisting of semi-structured interviews with urologists and oncologists (n=42), primarily with private practices, who had indicated cooperation the care of urological tumor patients. RESULTS: Most of the participants (66%) treated their own tumor patients. When physicians referred patients, they did so for co- and subsequent treatments (43%). Most cooperating urologists were satisfied with the partnership and appreciated the competency of their partners. Qualitative interviews revealed two types of collaboration in the community setting: formal and informal. Collaborations were usually ongoing with many physicians and depended equally on both patient preference and diagnosis. CONCLUSION: Joint patient treatment requires clear delineation of roles and responsibilities and simple means of communication. Formal frameworks should allow for incorporation of patients' critical role in collaboration decisions in treatment and care.

Primary prevention in general practice - views of German general practitioners: a mixed-methods study.

BACKGROUND: Policy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners' (GPs) attitudes toward primary prevention. METHODS: Mixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention. RESULTS: Most respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs' health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of "health policing". GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions. CONCLUSIONS: The mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.

Longitudinal association between body mass index and health-related quality of life.

OBJECTIVE: Health-related quality of life (HRQoL) is an important outcome in individuals with a high risk for cardiovascular diseases. We investigated the association of HRQoL and body mass index (BMI) as an indicator for obesity. DESIGN: Secondary longitudinal analysis of the ORBITAL study, an intervention study which included high-risk cardiovascular primary care patients with hypercholesterolemia and an indication for statin therapy. METHODS: HRQoL was determined with the generic Short Form (SF)-12 health status instrument. Body weight and height were assessed at baseline and at months 6, 12, 18, 24, 30, and 36. We used a linear and a linear mixed-effects regression model to investigate the association between BMI and SF-12 summary scores at baseline as well as between change in BMI and SF-12 summary scores over 3 years. We adjusted for age, sex, smoking status, and in the longitudinal analysis also for the study arm and its interaction term with time. RESULTS: Of the 7640 participants who completed the baseline questionnaire, 6726 participants (mean age: 61 years) were analyzed. The baseline BMI was inversely associated with physical and mental SF-12 summary scores (ß [95% CI] per 1 kg/m2: -0.36 [-0.41; -0.30] and -0.05 [-0.11; -0.00], respectively). A significant association between the change in BMI and physical SF-12 summary scores over time was only present in women (-0.18 [-0.27; -0.09]) and only in obese participants (-0.19 [-0.29; -0.10]). A change in BMI was directly associated with mental SF-12 summary scores (0.12 [0.06; 0.19]) in the total population. CONCLUSION: Increases in BMI were associated with decreases in physical HRQoL, particularly in obese individuals and in women. In contrast, the mental HRQoL seemed to increase with increasing BMI over time. Thus, body weight management with respect to the HRQoL should be evaluated differentially by sex and body weight status. TRIAL REGISTRATION: ClinicalTrials.gov NCT00379249.

Association between water consumption and body weight outcomes: a systematic review.

BACKGROUND: Drinking water is often applied as a dietary means for weight loss and overweight/obesity prevention, but no evidence-based recommendation exists for this indication. OBJECTIVE: We summarized the existing evidence on the association between water consumption and body weight outcomes in adults of any body weight status. DESIGN: In a systematic review, we retrieved studies from 4 electronic databases (MEDLINE, EMBASE, CINAHL, and COCHRANE), cross-references by PubMed functions and hand-searching, and experts' recommendations. Any type of study including adults aged >18 y that reported the association between daily water consumption and any weight-related outcome, such as body weight, body mass index, or body weight classifications, was eligible. RESULTS: Of 4963 retrieved records, 11 original studies and 2 systematic reviews were included. In participants dieting for weight loss or maintenance, a randomized controlled trial, a nonrandomized controlled trial, and an observational longitudinal study showed that increased water consumption, in addition to a program for weight loss or maintenance, reduced body weight after 3-12 mo compared with such a program alone. In mixed-weight populations not primarily dieting for weight loss or maintenance, 2 short-term randomized trials showed no effect of water consumption on body weight; 6 cross-sectional studies showed inconsistent results. CONCLUSIONS: Studies of individuals dieting for weight loss or maintenance suggest a weight-reducing effect of increased water consumption, whereas studies in general mixed-weight populations yielded inconsistent results. The evidence for this association is still low, mostly because of the lack of good-quality studies. This trial was registered at www.crd.york.ac.uk/Prospero as CRD42012002585.

Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis.

BACKGROUND Physical activity (PA) is considered a cornerstone of diabetes mellitus management to prevent complications, but conclusive evidence is lacking. METHODS This prospective cohort study and meta-analysis of existing studies investigated the association between PA and mortality in individuals with diabetes. In the EPIC study (European Prospective Investigation Into Cancer and Nutrition), a cohort was defined of 5859 individuals with diabetes at baseline. Associations of leisure-time and total PA and walking with cardiovascular disease (CVD) and total mortality were studied using multivariable Cox proportional hazards regression models. Fixed- and random-effects meta-analyses of prospective studies published up to December 2010 were pooled with inverse variance weighting. RESULTS In the prospective analysis, total PA was associated with lower risk of CVD and total mortality. Compared with physically inactive persons, the lowest mortality risk was observed in moderately active persons: hazard ratios were 0.62 (95% CI, 0.49-0.78) for total mortality and 0.51 (95% CI, 0.32-0.81) for CVD mortality. Leisure-time PA was associated with lower total mortality risk, and walking was associated with lower CVD mortality risk. In the meta-analysis, the pooled random-effects hazard ratio from 5 studies for high vs low total PA and all-cause mortality was 0.60 (95% CI, 0.49-0.73). CONCLUSIONS Higher levels of PA were associated with lower mortality risk in individuals with diabetes. Even those undertaking moderate amounts of activity were at appreciably lower risk for early death compared with inactive persons. These findings provide empirical evidence supporting the widely shared view that persons with diabetes should engage in regular PA.

Immigrational background affects the effectiveness of a school-based overweight prevention program promoting water consumption.

We tested whether a simple overweight prevention program promoting water consumption in elementary schools is equally effective in children with an immigrational background (MIG) and in those without (non-MIG). Thus, a secondary analysis of a controlled cluster trial, lasting one school year, was conducted. Thirty-two elementary schools located in low socioeconomic districts in two German cities were included. Of the 2,950 school children analyzed, 1,306 were MIG children. Water fountains were installed in the schools of the intervention group (IG) and teachers held lessons to promote water consumption. Control schools (control group (CG)) did not receive any intervention. Before and after intervention, body weight and height was measured. Overweight was defined by age- and sex-specific BMI cutoffs that are linked to an adult BMI of 25 kg/m(2). Beverage consumption was assessed in questionnaires. Modification of intervention effects by immigrational background was tested by interaction terms. The immigrational background modified the intervention effect on prevalence and remission of overweight (interaction term: P = 0.03 and P = 0.02), but not on the incidence of overweight (P = 0.06). After intervention, the risk of being overweight was reduced in the IG compared to the CG among non-MIG (odds ratio = 0.51, 95% confidence interval (CI): 0.31-0.83), but not among MIG children (odds ratio = 1.02, 95% CI: 0.63-1.65). After intervention, water consumption significantly increased in the IG equally among both, non-MIG and MIG, by ~1 glass/day. A simple school-based intervention promoting water consumption prevented overweight in non-MIG children, but failed in MIG children. Different beverage consumption, among other lifestyle factors, may account for this effect but scientific discussion remains open.

Relative validity of a self-completion 24 h recall questionnaire to assess beverage consumption among schoolchildren aged 7 to 9 years.

OBJECTIVE: Drinking habits in children are associated with diet quality, but validated assessment tools for large-scale studies in young children are lacking. Therefore, we validated a self-completion 24 h recall questionnaire (RQ) focusing on beverage consumption with a 24 h weighed record (WR). DESIGN: Thirty-five voluntary participants from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study cohort aged 7-9 years completed the RQ. The illustrated RQ required ticking the number of glasses of seven beverage categories consumed in five time intervals in the previous 24 h. As a reference, parents completed weighed records of their child's diet. Agreement between the RQ and WR was tested by classification into consumers and non-consumers (kappa coefficients, kappa), by the children's ability to estimate the exact beverage and total volume consumed (Wilcoxon signed-rank test, Spearman rank correlation), and by ranking children according to reported beverage volumes. RESULTS: The RQ and WR showed a good level of agreement for classifying participants into consumers and non-consumers of the single beverage categories (kappa values between 0.78 and 0.94). Correlation coefficients for the volume of the single categories ranged between 0.81 and 0.91. The total beverage volume was overestimated in the RQ, on average, by 114 ml (P = 0.015). Agreement in ranking into tertiles by beverage volume was moderate to good for juice/soft drinks (kappa = 0.44), milk (kappa = 0.57) and water (kappa = 0.70), but fair for the total beverage volume (kappa = 0.23). CONCLUSIONS: Our self-completion 24 h RQ could estimate the consumption of several beverage categories among young children at the group level, but quantification of total beverage volume was flawed.

Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial.

OBJECTIVE: The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school. METHODS: The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007). RESULTS: Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean +/- SD: 8.3 +/- 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent. CONCLUSION: Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.

A simple dietary intervention in the school setting decreased incidence of overweight in children.

OBJECTIVE: The study analyzed the effect of a combined environmental and educational intervention solely promoting water consumption on the incidence of overweight among school children. METHODS: 2,950 second and third graders of 32 elementary schools in socially deprived neighborhoods of two German cities participated in a randomized controlled intervention trial (August 2006-June 2007). In intervention schools (N = 17), water fountains were installed, each child received a water bottle, and teachers performed classroom lessons to promote water consumption. Control schools (N = 15) did not receive any intervention. Body heights and weights were measured at baseline and follow-up to assess the incidence and remission of overweight and obesity during follow-up. The water flow of the fountains was measured regularly during follow-up. Children's beverage consumption was self-reported in 24-hour recall questionnaires before and after intervention. RESULTS: After the intervention, the incidence of overweight was significantly lower in the intervention group (3.8%) than in the control group (6.0%, p = 0.018). Remission of overweight and obesity did not differ between the groups. Measured water flow of the fountains indicated a sustained use. CONCLUSION: A simple dietary intervention with the sole focus on the promotion of drinking water effectively reduced the incidence of overweight among school children.

Comparison of sirolimus and everolimus in their effects on blood lipid profiles and haematological parameters in heart transplant recipients.

The mTOR (mammalian target of rapamycin) inhibitors sirolimus (SRL) and everolimus (EVL) are potent immunosuppressive agents, which allow reducing the dose of the nephrotoxic calcineurin inhibitors cyclosporin and tacrolimus (TAC) in solid organ transplant recipients. However, there is evidence that mTOR inhibitors may lead to myelosuppression and dyslipidemia/hyperlipidemia. We therefore performed a retrospective analysis in heart transplant recipients with renal insufficiency, who received 3.0 mg/d SRL (SRL group; n = 28) or 1.5 mg/d EVL (EVL group; n = 27) each in combination with a reduced TAC dose for at least one yr. Fewer cardiac rejections, but a similar rate of infections occurred in the EVL group compared with the SRL group indicating that the administered EVL dose resulted in a potent immunosuppression. Serum triglyceride and total cholesterol concentrations rose significantly in the SRL group but not in the EVL group. In the SRL group only, the frequency of statin use increased significantly during follow-up. The EVL group showed a significant rise in HDL cholesterol levels during follow-up. There was a slight transient fall in haemoglobin concentrations in the SRL group but not in the EVL group. Leucocyte counts fell significantly in both study groups. However, no cases of leucopenia and also no cases of thrombopenia occurred. In summary, we could demonstrate that in heart transplant recipients with renal insufficiency the introduction of 1.5 mg/d EVL in combination with a reduced TAC dose is effective in preventing cardiac rejections and has less adverse effects on lipid metabolism than the usually prescribed SRL dose, whereas both therapy regimens are not associated with major haematological side-effects.