1,721,071 research outputs found
Prevention of cardiovascular disease from an epidemiological and social medicine perspective
No full textDie vorliegende Arbeit befasst sich unter Verwendung verschiedener
epidemiologischer Methoden einerseits mit Fragestellungen der Epidemiologie
und Gesundheitsökonomie kardiovaskulärer Erkrankungen und Risikofaktoren sowie
andererseits mit der Effektivität und Kosteneffektivität von Strategien zur
nichtmedikamentösen Prävention kardiovaskulärer Erkrankungen. Die Ergebnisse
zeigen, dass die deutliche Reduktion der altersstandardisierten KHK Mortalität
zwischen 1980 und 2007 in Deutschland keineswegs einheitlich war sondern ein
komplexes Bild widerspiegelt, mit erheblichen Unterschieden in Abhängigkeit
von Geschlecht, Alter, sozioökonomischen und regionalen Faktoren. im Vergleich
zu anderen Industrienationen fallen um mehrere Jahre verzögerte Trends mit
vergleichsweise geringer Reduktion der Sterblichkeit auf. Gegenteilige Trends,
wie sie in den USA und Großbritannien beobachtet wurden, finden sich hingegen
nicht. Vor dem Hintergrund der nachgewiesenen hohen Prävalenz kardiovaskulärer
Risikofaktoren bereits bei Jungendlichen und der deutlichen altersabhängigen
Zunahme ist jedoch absehbar, dass sich zukünftige Trends der Sterblichkeit in
Deutschland vergleichbar mit den bereits jetzt zu beobachtenden weniger
positiven Trends in den USA und Großbritannien entwickeln könnten. Die
vorliegenden Ergebnisse machen darüber hinaus auch die gesamtgesellschaftliche
Bedeutung kardiovaskulärer Risikofaktoren und Erkrankungen deutlich. In Europa
betrugen die mit Adipositas assoziierten Gesundheitsausgaben gemessen am
Bruttoinlandsprodukt bis zu 0,6%, allein in Deutschland mehr als 10 Milliarden
Euro. Studien zu den Gesundheitsausgaben für kardiovaskuläre Erkrankungen
bezifferten diese in Deutschland auf etwa 53 Milliarden Euro, was fast einem
Drittel der Ausgaben der gesamten Europäischen Union entspricht. Verschiedene
individuelle nichtmedikamentöse Strategien zur Primär- und Sekundärprävention
kardiovaskulärer Erkrankungen wurden im Rahmen der vorliegenden Arbeit
bezüglich ihrer Effektivität und Kosteneffektivität beurteilt. Dabei zeigte
sich, dass die vielfach empfohlenen Instrumente zur Risikostratifikation
gesunder Personen, sogenannte Risikoscores, gegenwärtig nur sehr begrenzt von
niedergelassenen Ärzten eingesetzt werden und dass erhebliche inhaltliche und
strukturelle Barrieren bestehen. Unter anderem die fehlende Verknüpfung der
Ergebnisse von Risikoscores mit individualisierten Empfehlungen zu
intensivierter Lebensstilmodifikation stellt sich als Hemmnis dar. Das
nichtmedikamentöse Präventionsstrategien wirksam und langfristig zu
Veränderungen des Gesundheitsverhaltens und verbesserter Gesundheit im Rahmen
der Primär- und Sekundärprävention beitragen, konnte jedoch mittels zweier
Metaanalysen in der vorliegenden Arbeit nachgewiesen werden, ebenso wie die
Kosteneffektivität dieser Strategien. Trotz der positiven Entwicklung der
Vergangenheit und der nachgewiesenen Effektivität und Kosteneffektivität
individueller nichtmedikamentöser Strategien, machen die Erkenntnisse der
vorliegenden Arbeiten einerseits die erhebliche individuelle und
gesamtgesellschaftliche Bedeutung kardiovaskulärer Erkrankungen deutlich und
legen weiterhin die Vermutung nahe, dass individuelle Präventionsstrategien
auf Bevölkerungsebene nicht ausreichend umsetzbar und wirksam sein werden, um
die positiven Trends kardiovaskulärer Erkrankungen nachhaltig fortsetzen zu
können. Auch die Reduktion der bestehenden sozialen Ungleichverteilungen durch
derartige individuelle Strategien ist unwahrscheinlich. Ergänzend zur
Ausweitung individueller nichtmedikamentöser Präventionsstrategien, scheint
daher insbesondere eine erhebliche Stärkung bevölkerungsweiter Ansätze
notwendig, wie sie jüngst unter anderem auch vom National Institute for Health
and Clinical Excellence in Großbritannien empfohlen wurden. Die bestehende
Evidenz spricht dafür, dass die zusätzliche Ausweitung bevölkerungsweiter
Strategien in erheblich größerem Umfang zu Reduktionen der Prävalenz
modifizierbarer Risikofaktoren, der Inzidenz kardiovaskulärer Erkrankungen und
sozialer Ungleichheiten beitragen können.The present work investigates epidemiological and health economic aspects of
cardiovascular diseases and risk factors, as well as the effectiveness and
cost-effectiveness of non-pharmacological preventive strategies. Findings show
that the marked reducation in coronary heart disease (CHD) mortality in
Germany between 1980 and 2007 was by no means uniform but presents a complex
picture, with substantial variations between men and women, different age
groups, socioeconomic and regional factors. Compared to other industrialized
counters, the decline in CHD mortality was smaller and delayed by many years.
Increases in CHD mortality in certain population subgroups, as identified in
the US and the UK, were not observed. In view of the high prevalence of
cardiovascular risk factors in German youths and their substantial increase
with age, it seems possible, however, that similar developments will also be
observed in Germany in the future. Present findings also highlight the major
societal implications of cardiovascular risk factors and diseases. For
instance, expenditures of up to 0.6% of the gross domestic product are
attributable to obesity in Europe. In Germany alone, this equals more than 10
billion Euros. Expenditures attributable to cardiovascular diseases in Germany
are estimated at about 53 billion Euros, reflecting nearly one third of the
health care expenditures for cardiovascular disease in the entire European
Union. Regarding the effectiveness and cost-effectiveness of different
individual non-pharmacological primary- and secondary preventive strategies it
was found, that widely recommended risk stratification tools, so called risk
scores, are currently underutilized by general practitioners due to
substantial factual and structural barriers. Among other barriers, the missing
link between risk score results and individualised lifestyle recommendations
was emphasized by physicians. There is, however, evidence for the
effectiveness, cost-effectiveness and sustainability of such lifestyle
interventions in the primary- and secondary prevention of cardiovascular
disease, as was highlighted in two systematic reviews and meta-analyses.
Despite positive trends in cardiovascular mortality and proven effectiveness
and cost-effectiveness of individual non-pharmacological strategies, the
present findings suggest, that on a population bases, individual strategies
may not be practical and sufficiently effective. A continuation of the
positive mortality trends in the future is therefore questionable. Also, a
reduction in existing social inequalities through individual strategies seems
unlikely. A strengthening of population based strategies is therefore
warranted in addition to the more widespread dissemination of individual
preventive strategies. Recently published recommendations of the National
Institute for Health and Clinical Excellence had a similar emphasize. The
existing evidence suggests, that this additional strengthening of population
based strategies can, to a greater extent, lead to reductions in risk factor
prevalence, cardiovascular disease incidence, and social inequalities
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Associations of physical activity levels and screen time with oral glucose tolerance test profiles in Singaporean women of reproductive age actively trying to conceive: the S-PRESTO study
No full textAssociation of physical activity and sedentary behaviour during pregnancy with gestational diabetes mellitus among Asian women in Singapore
No full textSocio-demographic and maternal predictors of adherence to 24-hour movement guidelines in Singaporean children
No full textAppropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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