Evaluation of a Complex Intervention to Strengthen Participation-Centred Care for Children with Special Healthcare Needs: Protocol of the Stepped Wedge Cluster Randomised PART-CHILD Trial.

INTRODUCTION: Participation is an important dimension of healthy child development and is associated with higher self-rated health, educational attainment and civic engagement. Many children with special healthcare needs (SHCN) experience limited participation and are thus at risk for adverse health and developmental outcomes. Despite this, interventions that promote participation in healthcare are scarce. We therefore evaluate the effectiveness of a complex age- and condition-generic intervention that strengthens participation-centred care involving parents and their children with SHCN by, inter alia, assessing preferences, specifying participation goals and facilitating shared decision-making in care. METHODS AND ANALYSIS: In this study protocol we describe the design and procedures for an unblinded, stepped wedge, cluster randomised trial conducted in 15 German interdisciplinary healthcare facilities providing services for children aged 0-18 years with SHCN. Sites are randomised to five periods in which they switch from control to intervention condition in blocks of three. The intervention includes: (1) team training focused on participation-centred care, (2) introduction of a new software facilitating participation-focused documentation and (3) implementation support promoting the transfer of training content into routine care. Study sites deliver routine care while in the control condition. As primary outcome, the degree of perceived shared decision-making with parents (CollaboRATEpediatric parent scale), a potential antecedent of achieving participation goals in everyday life, is assessed on one randomly selected day per week during the entire study period, directly following care appointments. We aim to sample 70 parents per study site and period. Additionally, participation of children is assessed within a closed embedded cohort with three parent and patient surveys. Intervention effectiveness will be modelled with a marginal model for correlated binary outcomes using generalised estimation equations and complete cases. A comprehensive mixed-methods process evaluation complements the effectiveness analyses.

Modeling Obesity in Norway (The MOON Study): A Decision-Analytic Approach-Prevalence, Costs, and Years of Life Lost.

BACKGROUND: Limited knowledge exists on the expected long-term effects and cost-effectiveness of initiatives aiming to reduce the burden of obesity. AIM: To develop a Norwegian obesity-focused disease-simulation model: the MOON model. MATERIAL AND METHODS: We developed a Markov model and simulated a Norwegian birth cohort's movement between the health states "normal weight,""overweight,""obese 1,""obese 2," and "dead" using a lifetime perspective. Model input was estimated using longitudinal data from health surveys and real-world data (RWD) from local and national registers (N = 99,348). The model is deterministic and probabilistic and stratified by gender. Model validity was assessed by estimating the cohort's expected prevalence, health care costs, and mortality related to overweight and obesity. RESULTS: Throughout the cohort's life, the prevalence of overweight increased steadily and stabilized at 45% at 45 y of age. The number of obese 1 and 2 individuals peaked at age 75 y, when 44% of women and 35% of men were obese. The incremental costs per person associated with obesity was highest in older ages and, when accumulated over the lifetime, higher among women (€12,118, €9,495-€15,047) than men (€6,646, €5,252-€10,900). On average, obesity shortened the life expectancy of women/men in the whole cohort by 1.31/1.08 y. The life expectancy for normal-weight women/men at age 30 was 83.31/80.31. The life expectancy was reduced by 1.05/0.65 y if the individual was overweight, obese (2.87/2.71 y), or obese 2 (4.06/4.83 y). CONCLUSION: The high expected prevalence of obesity in the future will lead to substantial health care costs and large losses in life-years. This underscores the need to implement interventions to reduce the burden of obesity; the MOON model will enable economic evaluations for a wide range of interventions.

Assessing the Lifetime Cost-Effectiveness of Low-Protein Infant Formula as Early Obesity Prevention Strategy: The CHOP Randomized Trial.

BACKGROUND: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity. METHODS: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6-17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life. RESULTS: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion. CONCLUSIONS: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation.

The potential for long-term cost-effectiveness of obesity prevention interventions in the early years of life.

BACKGROUND: Early childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost-effectiveness of interventions over time. OBJECTIVES: To estimate the long-term health benefits and health care cost-savings of reductions in BMI for the Australian population of children aged between 2 and 5 years. METHODS: A proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost-savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children. RESULTS: Results suggest significant potential for cost-effectiveness of obesity prevention interventions in preschool-aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z-score (-0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health-adjusted life years saved (95% uncertainty interval [UI], 30 283-42 945) and health care cost-savings of approximately $301 million (95% UI $234 million-$369 million) if modelled over the lifetime. CONCLUSIONS: Scenario results highlight the importance of obesity intervention in the early years of life.

Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity.

BACKGROUND: Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS: The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS: The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION: We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.

Biologicals and small molecules in psoriasis: A systematic review of economic evaluations.

Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder's interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.

German EstSmoke: estimating adult smoking-related costs and consequences of smoking cessation for Germany.

AIMS: We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. DESIGN: German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. SETTING: Germany. PARTICIPANTS: German population of prevalent current, never and ex-smokers in 2009. MEASUREMENT: Life-time cost and outcomes in current, never and ex-smokers. FINDINGS: If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. CONCLUSIONS: Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%.

Productivity loss due to overweight and obesity: a systematic review of indirect costs.

OBJECTIVE: The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. METHODS: A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. RESULTS: Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. CONCLUSION: The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.

Contextual influences on physical activity and eating habits -options for action on the community level.

BACKGROUND: This conceptual paper aims to illustrate the ways in which communities are able to advance health improvements on a population level. Outcome measures may include increased physical activity and healthier eating habits in particular, as well as an improved health-related quality of life and social cohesion as more generic outcomes. MAIN BODY: The paper begins by asking initial questions: Why did previous health-specific interventions only show moderate effects on an individual level and mixed effects on a population level? What is the added value of a community-based public health perspective compared to the traditional biomedical perspective when it comes to prevention? Why are we living the way we are living? Why do we eat what we eat? Why do we move the way we move? Subsequently, we illustrate the broad spectrum of contextual interventions available to communities. These can have geographical and technological as well as economic, political, normative and attitude-specific dimensions. It is shown that communities have a strong influence on health-related contexts and decision-making of adults, adolescents and children. In addition contextual characteristics, effects, mediators, moderators and consequences relevant for health can differ greatly between age groups. Both small-scale settings and overarching sectors possess physical, economic, political and sociocultural characteristics that can be proactively influenced by community decision-makers in the sense of a "health in all policies"-strategy. SHORT CONCLUSION: After presenting various interdisciplinary approaches to community-based health interventions, the manuscript closes with the following core message: Successful community-based health promotion strategies consist of multilevel - multicomponent interventions on the micro, meso and macro-level-environments.

Subjective social status and its relationship to health and health behavior: comparing two different scales in university students.

Background Little is known about the relationship between socioeconomic status (SES) and health in late adolescence. As it is difficult to measure SES in this age group directly, we used two subjective social status (SSS) scales with different reference groups for social comparison in the relatively homogeneous group of university students and analyzed the relationship with health and health behaviors. Methods We used two 10-rung ladders, a societal and a university one, to measure SSS in students (n = 689, 16-29 years). We compared the scales' ratings and analyzed relationships with sociodemographic factors, health outcomes and behaviors. Results On average, students rated their individual SSS higher on the university scale (6.87) than on the societal one (6.41). Regarding health outcomes and behaviors, we found similar results for both scales, while sociodemographic variables were more likely to be associated with the societal scale. Conclusion SSS seems to be a useful measure besides the objective SES. Our data suggest that both SSS scales are helpful in the framework of health inequality but differ slightly in what they measure. More detailed research may help to determine which scale is appropriate for individual study context.

DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status.

OBJECTIVE: The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). METHODS: Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. RESULTS: DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). CONCLUSIONS: The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups.

Why Early Prevention of Childhood Obesity Is More Than a Medical Concern: A Health Economic Approach.

BACKGROUND: Childhood overweight and obesity are a non-deniable health concern with increasing economic attention. SUMMARY: International studies provide robust evidence about substantial lifetime excess costs due to childhood obesity, thereby underscoring the urgent need to implement potent obesity prevention programs in early childhood. Fortunately, this is happening more and more, as evidenced by the increase in well-conducted interventions. Nevertheless, an important piece of the puzzle is often missing, that is, health economic evaluations. There are 3 main reasons for this: an insufficient number of economic approaches which consider the complexity of childhood obesity, a lack of (significant) long-term effect sizes of an intervention, and inadequate planning of health economic evaluations in the design phase of an intervention. Key Messages: It is advisable to involve health economists during the design phase of an intervention. Equally necessary is the development of a tailored toolbox for efficient data acquisition.

Behandlungspräferenzen für Biologika bei Psoriasis: erfahrene Patienten legen Wert auf Nachhaltigkeit.

HINTERGRUND UND ZIELE: Die Therapiezufriedenheit kann durch die Berücksichtigung von Patientenpräferenzen in der gemeinsamen Entscheidungsfindung verbessert werden. Kürzlich untersuchten wir Patientenpräferenzen für Eigenschaften von Biologika und fanden starke Präferenzen für Sicherheit und Wirksamkeit. Die vorliegende Studie hatte das Ziel, Auswirkungen von Therapieerfahrung auf diese Präferenzen zu erheben. PATIENTEN UND METHODEN: Präferenzen für Ergebnis- (Wahrscheinlichkeit einer 50%igen und 90%igen Verbesserung, Zeit bis zum Ansprechen, Nachhaltigkeit des Erfolgs, Wahrscheinlichkeit von leichten und schweren Nebenwirkungen und Wahrscheinlichkeit eines ACR-20-Ansprechens) und Prozesseigenschaften (Behandlungsort, Behandlungshäufigkeit, Zeitaufwand und Applikationsweise) wurden bei 200 Teilnehmern mit mittelschwerer bis schwerer Psoriasis mit Hilfe von Conjoint-Analyse ermittelt. Der Einfluss aktueller und früherer Therapien, der Krankheitsdauer und der Behandlungszufriedenheit auf die "Relative Importance Scores" wurde durch Varianz-analysen, Post-hoc-Tests und multivariate Regressionen bestimmt. ERGEBNISSE: Teilnehmer, die aktuell eine topische Therapie (p = 0,02) oder eine Phototherapie (p = 0,032) erhielten, hielten den Zeitaufwand der Behandlung für wichtiger als andere. Diejenigen, denen zuvor traditionelle Systemtherapien (p = 0,028) oder Biologika (p = 0,044) verordnet worden waren, legten mehr Wert auf die Nachhaltigkeit als andere. Diese Eigenschaft gewann mit steigender Anzahl zuvor verabreichter systemischer Therapien (p = 0,045) und längerer Krankheitsdauer (p = 0,018) an Bedeutung. FAZIT: Patientenpräferenzen für Biologika variieren abhängig von der Therapieerfahrung und Krankheitsdauer. Diese Aspekte sollten bei der gemeinsamen Entscheidungsfindung berücksichtigt werden.

Treatment preferences for biologicals in psoriasis: experienced patients appreciate sustainability.

BACKGROUND AND OBJECTIVES: Treatment satisfaction can be improved by integrating patients' preferences into shared decision-making. We recently investigated patients' preferences for attributes of biologicals, and showed high preferences for safety and efficacy. The objective of the present study was to assess the impact of treatment experience on these preferences. PATIENTS AND METHODS: Preferences for outcome (probability of 50 % and 90 % improvement, time until response, sustainability of success, probability of mild and severe adverse events, probability of ACR 20 response) and process attributes (treatment location, frequency, duration, and delivery method) were analyzed in 200 participants with moderate-to-severe psoriasis using conjoint analysis. The impact of current and previous therapies, disease duration, and treatment satisfaction on 'Relative Importance Scores' was determined by analysis of variance, post hoc tests, and multivariate regression. RESULTS: Participants presently on topical therapy (p = 0.02) or phototherapy (p = 0.032) placed more importance on treatment duration than others. Individuals who had previously been given traditional systemic agents (p = 0.028) or biologicals (p = 0.044) favored sustainability more than others. With an increasing number of systemic agents ever received (p = 0.045) and longer disease duration (p = 0.018), the latter attribute became increasingly important. CONCLUSIONS: Patients' preferences for biologicals vary in correlation with treatment experience and disease duration, aspects to be addressed in the context of shared decision-making.

Associations Between Supportive Leadership Behavior and the Costs of Absenteeism and Presenteeism: An Epidemiological and Economic Approach.

OBJECTIVE: This study investigates associations between supportive leadership behavior (SLB) and presenteeism/absenteeism, and estimates related costs. METHODS: Cross-sectional data from a German industrial sample (n = 17,060) assessing SLB and presenteeism/absenteeism were used. Adjusted interval regressions were performed. The study population was split into tertiles with respect to SLB, and minimum and maximum costs for each tertile were estimated on the basis of national industry averages. RESULTS: Low SLB was associated with higher presenteeism [-0.31, 95% confidence interval (95% CI) -0.33 to -0.28)] and absenteeism (-0.36, 95% CI -0.40 to -0.32). Compared with high SLB, the costs of low SLB for absenteeism are between 534.54 and 1675.16 Euro higher per person and year. For presenteeism, this difference ranges between 63.76 and 433.7 Euro. CONCLUSIONS: SLB has the potential to reduce absenteeism, presenteeism, and associated costs. To contribute to workforce health, productivity, and efficiency, SLB merits being fostered by corporate policy.

Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations.

Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.

[Parental Social Status and other determinants of quality of life and behavioral problems: An analysis of German preterm births between 1987-2004]. / Elterlicher Sozialstatus und andere Determinanten von Lebensqualität und Verhaltensauffälligkeiten : Eine Analyse deutscher Frühgeborener der Jahrgänge 1987-2004.

BACKGROUND: Knowledge of the factors affecting the development of preterm children in Germany is limited. We analysed the prevalence of preterm birth in Germany using the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 and assessed factors associated with quality of life (QOL) and behavioural development in preterm children (< 37 weeks' gestational age). METHODS: Data were weighted and preterm prevalence was calculated by socioeconomic status (SES) and year of birth for 1,106 preterm children. Using linear regression models, the relationship between sociodemographic, pre- and perinatal, lifestyle, and contextual determinants on the one hand, and the QOL (KINDL® parent questionnaire) and behavioural problems (the total problem behaviour scale, the Strengths and Difficulties Questionnaire [SDQ]) on the other was calculated. RESULTS: Prevalence of preterm birth (mean 7.5 %) was higher in families with low compared with high SES (8.4 versus 7.0 %). In the final regression models, preterm children with high SES had higher QOL scores (+ 3.3 KINDL points, p = 0.024) compared with children with low SES, and adolescents (aged 14-17 years) had a higher QOL than children aged 7-13 years. All other variables (contextual, pre- and perinatal) were not related to QOL. In contrast, there were many determinants of behavioural development in preterms: the SDQ total score was lower in girls, children with older mothers, those from high SES and those with a high level of physical activity. However, both very low birth weight (< 1,500 g) and birth at > 34 weeks' gestation were associated with a higher SDQ total score. CONCLUSION: Given its high prevalence, preterm birth is a relevant public health issue in Germany. While SES may be the most important determinant of QOL in preterms, determinants of behavioural problems are the same as those in term children and also encompass perinatal factors.

Lifetime indirect cost of childhood overweight and obesity: A decision analytic model.

OBJECTIVE: To estimate the indirect lifetime cost of childhood overweight and obesity for Germany. METHODS: The lifetime cohort model consisted of two parts: (a) Model I used data from the German Interview and Examination Survey for Children on prevalence of BMI categories during childhood to evaluate BMI trajectories before the age of 18; and (b) Model II estimated lifetime excess indirect cost based on the history of childhood BMI. Indirect costs were defined as the opportunity cost of lost productivity due to mortality and morbidity and were identified through a systematic literature review. RESULTS: Our analysis showed that the majority of children with overweight and obesity remained in the same BMI category during their adult life, resulting in significant indirect lifetime costs. We estimated that overweight and obesity during childhood resulted in an excess lifetime cost per person of €4,209 (men) and €2,445 (women). For the current prevalent German population, the excess lifetime cost was €145 billion. CONCLUSIONS: Our study showed that childhood obesity results in significant economic burden on the society. Therefore, cost-effective strategies targeted at reducing the prevalence of obesity during the early years of life can significantly reduce both healthcare and nonhealthcare costs over the lifetime.

Patient Preferences for Biologicals in Psoriasis: Top Priority of Safety for Cardiovascular Patients.

Patients with psoriasis are often affected by comorbidities, which largely influence treatment decisions. Here we performed conjoint analysis to assess the impact of comorbidities on preferences of patients with moderate-to-severe psoriasis for outcome (probability of 50% and 90% improvement, time until response, sustainability of success, probability of mild and severe adverse events (AE), probability of ACR 20 response) and process attributes (treatment location, frequency, duration and delivery method) of biologicals. The influence of comorbidities on Relative Importance Scores (RIS) was determined with analysis of variance and multivariate regression. Among the 200 participants completing the study, 22.5% suffered from psoriatic arthritis, 31.5% from arterial hypertension, 15% from cardiovascular disease (myocardial infarction, stroke, coronary artery disease, and/or arterial occlusive disease), 14.5% from diabetes, 11% from hyperlipidemia, 26% from chronic bronchitis or asthma and 12.5% from depression. Participants with psoriatic arthritis attached greater importance to ACR 20 response (RIS = 10.3 vs. 5.0, p<0.001; ß = 0.278, p<0.001) and sustainability (RIS = 5.8 vs. 5.0, p = 0.032) but less value to time until response (RIS = 3.4 vs. 4.8, p = 0.045) than those without arthritis. Participants with arterial hypertension were particularly interested in a low risk of mild AE (RIS 9.7 vs. 12.1; p = 0.033) and a short treatment duration (RIS = 8.0 vs. 9.6, p = 0.002). Those with cardiovascular disease worried more about mild AE (RIS = 12.8 vs. 10, p = 0.027; ß = 0.170, p = 0.027) and severe AE (RIS = 23.2 vs. 16.2, p = 0.001; ß = 0.203, p = 0.007) but cared less about time until response (ß = -0.189, p = 0.013), treatment location (ß = -0.153, p = 0.049), frequency (ß = -0.20, p = 0.008) and delivery method (ß = -0.175, p = 0.023) than others. Patients' concerns should be addressed in-depth when prescribing biologicals to comorbid patients, keeping in mind that TNF antagonists may favourably influence cardiovascular risk.

Beyond Food Promotion: A Systematic Review on the Influence of the Food Industry on Obesity-Related Dietary Behaviour among Children.

An increased consumption of energy-dense, nutrient-poor food and beverages as a result of a changing obesogenic environment contributes substantially to the increasing prevalence of childhood overweight and obesity. This paper reviews the nature and extent of food industry influences which expose children to commercial influences and thus might affect unhealthy dietary behaviour and finally contributes to obesity. A systematic search of nine electronic databases (including PubMed, PsycINFO, EconLit) and reference lists of original studies and reviews using key search terms identified 1900 articles. Of these only thirty-six articles met the inclusion and quality criteria. A narrative synthesis of the reviewed studies revealed six key obesogenic environments by which the food industry possibly influences obesity-related dietary behaviours in young children. These were schools, retailers, mass media "television", mass media "internet", home and promotional campaigns. Identifying these obesogenic environments is critical for monitoring and controlling the food industry, the development of effective environmental-level interventions to prevent childhood overweight and obesity and to identify knowledge gaps to be addressed in future research to support informed decisions of policy makers.