[Implementation of a novel form of care for the early detection and prevention of emotional and behavioral problems in children in the pediatric setting: Qualitative interviews with pediatricians, practice staff and parents]. / Implementierung einer neuen Versorgungsform zur Früherkennung und Prävention emotionaler und Verhaltensauffälligkeiten bei Kindern im kinderärztlichen Setting: Qualitative Interviews mit Kinderärzt*innen, Praxispersonal und Sorgeberechtigten.

AIM OF THE STUDY: Evaluation of the implementation of a standardized screening using the Strengths and Difficulties Questionnaire (SDQ) as part of the routine pediatric health check-ups in the Dresden area (Germany) in order to detect emotional and behavioral problems (EBPs) in children early and allocate them to indicated preventive programs and/or to further counselling and treatment services. METHODS: 1.) Semi-structured interviews were performed with participating pediatricians (n=4), practice staff (n=4) and custodians of screened children (n=17) and subjected to content analysis regarding feasibility, advantages and disadvantages of the screening and the targeted allocation, as well as barriers and facilitators of using the screening and the preventive programs and further services. 2.) A self-developed questionnaire survey (descriptive analysis: means and frequencies) was conducted among pediatricians (n=34/99) to inquire about the implementation of the SDQ screening regarding feasibility, advantages, disadvantages and necessary conditions for a potential adoption of the screening to standard health services. RESULTS: In the interviews, the pediatricians and practice staff reported that the SDQ screening embedded in routine pediatric health check-ups was simple and could be carried out in a few minutes. The screening helped to identify and address possible EBPs in children and to recommend a targeted service. Apart from the expenditure of time, no disadvantages were mentioned. As expected, parent-related (e.g. fears, attitudes and trust in the pediatrician), child-related (does not want to reveal any information about him- or herself , attitude and motivation), service provider-related (presentation of services), organizational (necessary signatures, financing, waiting time) and service-related (duration, costs, venue, designation) factors influenced the families' use of the screening and further services. Interviewed custodians whose child participated in an indicated preventive program within the project (n=11) would recommend the SDQ screening and preventive program to other families. In the questionnaire survey 28/31 pediatricians "completely" or "rather" agreed on a 5-point Likert scale that the SDQ screening and targeted allocation should be included in standard pediatric care. DISCUSSION: The use of the SDQ, which is one of the most widely used and, despite its brevity, most valid screening instruments for the early detection of EBPs, in routine pediatric health check-ups and the targeted allocation of further health services represent a feasible approach to the early identification and clarification of EBPs in children as well as their allocation to indicated preventive services. CONCLUSION: An adoption of the novel form of care (SDQ screening and targeted allocation to indicated preventive programs and further services) to standard pediatric care unfolds its benefits if preventive and care services for EBPs in children are made available nationwide.

Essential Skills for Health Communication, Barriers, Facilitators and the Need for Training: Perceptions of Healthcare Professionals from Seven European Countries.

Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional's perception regarding health communication training's necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey in the framework of the H-Com project were utilized. The study included 691 healthcare professionals (physicians, nurses, students and allied health professionals) from seven European countries. Only 57% of participants had participated in health communication training, while 88.1% of them indicated a willingness to be trained in health communication. Nurses were more likely (OR = 1.84; 95% CI 1.16, 2.91) to have received such training, compared to physicians. Most examined communication skills, barriers and facilitators of effective communication, and perceived outcomes of successful communication were considered crucial for most participants, although physicians overall seemed to be less concerned. Most agreed perceived outcomes were improved professional-patient relations, patient and professional satisfaction, physical and psychological health amelioration and patients' trust. Nurses evaluated the importance of these communication skills and communication barriers, facilitators and outcomes higher than physicians. Physicians may underestimate the importance of communication skills more than nurses. Health communication should become an integral part of training for all health professionals.

Ultrafine and Fine Particles and Hospital Admissions in Central Europe. Results from the UFIREG Study.

RATIONALE: Evidence of short-term effects of ultrafine particles (UFP) on health is still inconsistent and few multicenter studies have been conducted so far especially in Europe. OBJECTIVES: Within the UFIREG project, we investigated the short-term effects of UFP and fine particulate matter (particulate matter with an aerodynamic diameter less than 2.5 µm [PM2.5]) on daily cause-specific hospital admissions in five Central and Eastern European cities using harmonized protocols for measurements and analyses. METHODS: Daily counts of cause-specific hospital admissions focusing on cardiovascular and respiratory diseases were obtained for Augsburg and Dresden (Germany), 2011-2012; Chernivtsi (Ukraine), 2013 to March 2014; and Ljubljana (Slovenia) and Prague (Czech Republic), 2012-2013. Air pollution and meteorologic data were measured at fixed monitoring sites in all cities. We analyzed city-specific associations using confounder-adjusted Poisson regression models and pooled the city-specific effect estimates using metaanalysis methods. MEASUREMENTS AND MAIN RESULTS: A 2,750 particles/cm3 increase (average interquartile range across all cities) in the 6-day average of UFP indicated a delayed and prolonged increase in the pooled relative risk of respiratory hospital admissions (3.4% [95% confidence interval, -1.7 to 8.8%]). We also found increases in the pooled relative risk of cardiovascular (exposure average of lag 2-5, 1.8% [0.1-3.4%]) and respiratory (6-d average exposure, 7.5% [4.9-10.2%]) admissions per 12.4 µg/m3 increase (average interquartile range) in PM2.5. CONCLUSIONS: Our findings indicated delayed and prolonged effects of UFP exposure on respiratory hospital admissions in Central and Eastern Europe. Cardiovascular and respiratory hospital admissions increased in association with an increase in PM2.5. Further multicenter studies are needed using harmonized UFP measurements to draw definite conclusions on health effects of UFP.

Associations between ultrafine and fine particles and mortality in five central European cities - Results from the UFIREG study.

BACKGROUND: Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results. OBJECTIVES: The main objective of the UFIREG project was to investigate the short-term associations between UFP and fine particulate matter (PM)<2.5µm (PM2.5) and daily (cause-specific) mortality in five European Cities. We also examined the effects of PM<10µm (PM10) and coarse particles (PM2.5-10). METHODS: UFP (20-100nm), PM and meteorological data were measured in Dresden and Augsburg (Germany), Prague (Czech Republic), Ljubljana (Slovenia) and Chernivtsi (Ukraine). Daily counts of natural and cardio-respiratory mortality were collected for all five cities. Depending on data availability, the following study periods were chosen: Augsburg and Dresden 2011-2012, Ljubljana and Prague 2012-2013, Chernivtsi 2013-March 2014. The associations between air pollutants and health outcomes were assessed using confounder-adjusted Poisson regression models examining single (lag 0-lag 5) and cumulative lags (lag 0-1, lag 2-5, and lag 0-5). City-specific estimates were pooled using meta-analyses methods. RESULTS: Results indicated a delayed and prolonged association between UFP and respiratory mortality (9.9% [95%-confidence interval: -6.3%; 28.8%] increase in association with a 6-day average increase of 2750particles/cm(3) (average interquartile range across all cities)). Cardiovascular mortality increased by 3.0% [-2.7%; 9.1%] and 4.1% [0.4%; 8.0%] in association with a 12.4µg/m(3) and 4.7µg/m(3) increase in the PM2.5- and PM2.5-10-averages of lag 2-5. CONCLUSIONS: We observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.

Challenges in finding and measuring behavioural determinants of childhood obesity in Europe.

AIM: Childhood obesity is an important concern for child health. However, despite widespread concern about the increase in childhood obesity, its causes are not monitored systematically in Europe. In 2007, the Scientific Platform Project on Lifestyle Determinants of Obesity identified routine data sources nationally available in European countries to measure childhood obesity. This work was revisited in 2014 to monitor any progress made. SUBJECT AND METHODS: In 2007, a literature review and project discussion resulted in a list of desirable indicators that could be collected in Europe to describe child populations at risk of overweight and obesity. Participants from EU member states, the EEA, Croatia, Macedonia and Turkey set out to discover which countries collected these indicators. Eight years later, a literature search sought to establish if the surveillance of children's nutrition and physical activity behaviour had changed. RESULTS: In 2007, no countries collected all variables for all ages, leading to major gaps in knowledge. A literature search carried out in 2014 suggests that this is unchanged. There remains inconsistency of data surveillance in Europe, and disagreement on which age groups to collect data from or how to define obesity and overweight. CONCLUSION: There is a lack of consistent data collection on upstream influences on obesity. The true causes of the childhood obesity epidemic remain undiscovered, and the ability of research to identify effective prevention and treatment methods is compromised.