The use of implementation strategies for the distribution of guidelines on CVD can be convincingly effective on physician adherence, regardless whether based on a unimodal or multimodal design. Three distinct strategies should be well considered in such an attempt: organizational changes in the primary care team, patient education and provider education.

CWP is defined by the criteria of the American College of Rheumatology (ACR--strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

verweight and obesity are a growing global public health problem (1). Epidemiological analyses have projected that overweight will be one of the top 4 global causes of preventable years of life lost in the future, besides hypertension, diabetes, and smoking (2). Already in 2007, the social costs of overweight amounted to 16 billion Pound Sterling in the United Kingdom (corresponding to 1% of their gross national product), with a strong upward trend. According to guideline recommendations on the prevention of myocardial infarction, stroke, and diabetes, physicians should offer lifestyle interventions to their overweight patients (3, 4). The 13 th nutrition report of the German Nutrition Society (DGE, Deutsche Gesellschaft für Ernährung e. V.) highlights the need to stop this obesity epidemic in Germany and calls for urgent action (5).According to the World Health Organization (WHO), in 2016 worldwide 39% of adults were overweight with a body mass index (BMI) of ≥ 25 kg/m 2 , while 11% of men and 15% of women were obese with a BMI of ≥ 30 kg/m 2 (6). The prevalence of obesity is high in Germany. Of the adult population, 54% have a BMI of ≥ 25 kg/m 2 and 18% of >30 kg/m 2 (7). In the United States, prevalence rates are even higher, with 36% of the population being obese (8).For weight-loss interventions to be successful, people need to be aware of the fact that they are overweight; without this awareness, a behavioral change is unlikely to happen (9-11). The agreement between self-perception and measured weight status has already been evaluated in numerous studies on a variety of populations; however, an aggregation of these data for the general adult population is missing.The aim of this review is to organize the available data from studies on weight perception in adults, to identify areas that need to be addressed in future research, and to provide summarized answers to the following questions:• How often is the self-perceived BMI categorization accurate?• Is misclassification based on overestimation or underestimation?• What groups of persons show good weight selfperception and what groups do not? SummaryBackground: Overweight and obesity are an increasingly serious public health problem in Western societies, including Germany. The tendency of overweight and obese people not to classify themselves as such limits the efficacy of information on the health risks of these conditions and lessens the motivation to change behavior accordingly. In this article, we summarize the available study data on the selfperception of weight class. We present and discuss the differences between selfreported body-mass index (BMI) category and the actual category of the BMI when it is calculated from the individual's measured height and weight.Methods: We systematically searched the Medline, EMBASE, and Cochrane Library databases in August 2017 for pertinent publications. The study protocol was published in the PROSPERO register (CRD42017064230). Meta-analyses were calculable for a number of subgroup analyses.Results: A total of 50 st...

Zusammenfassung Haus?rzte und spezialisierte Fach?rzte sind in der ambulanten Versorgung ?Gatekeeper? zu rehabilitativen Leistungen. Gefragt wird daher nach Einflussfaktoren und Optimierungsm?glichkeiten der Zugangsprozesse zu medizinischer Rehabilitation bei Tr?gerschaft der Deutschen Rentenversicherung. Zur Beantwortung wurden insgesamt 4 Fokusgruppen- und 51 Experteninterviews mit niedergelassenen ?rzten und sozialmedizinischen Gutachtern in Mitteldeutschland (Sachsen, Sachsen-Anhalt, Th?ringen) durchgef?hrt und inhaltsanalytisch sowie auf Basis der grounded theory ausgewertet. Die Ergebnisse zeigen ein eher intuitives Vorgehen bei der Erkennung potenziellen Rehabilitationsbedarfs. Allgemein?rzte haben psychosoziale Aspekte wesentlich im Blick ? Rheumatologen fokussieren st?rker somatische. Die Erkennung von Rehabilitationsbedarf wird durch ung?nstige Verhaltensweisen von ?rzten (u.?a. Informationsdefizite) als auch Patienten (u.?a. Pr?sentismus) erschwert. In den ?rztlichen Befundberichten werden die Auswirkungen bestehender Erkrankungen auf die Erwerbsf?higkeit h?ufig nicht klar aufgezeigt. Gutachter berichten so oftmals von unvollst?ndigen Befundberichten sowie von undifferenzierten und ?ICF-fernen? Darstellungen. Wahrgenommene Divergenzen zwischen Rehabilitationsbedarf und Reha-Bewilligung sowie intransparente Bewilligungskriterien bzw. Ablehnungsgr?nde f?hren zur Entmutigung der befragten ?rzte. Mangelnde R?ckmeldung seitens des Kostentr?gers zu Pr?fkriterien und -ergebnis verhindert nach Meinung der Befragten Lerneffekte hinsichtlich einer optimaleren Antragsgestaltung. Insgesamt l?sst sich ein mehrdimensionales Bedingungsgef?ge von Problemdimensionen nachzeichnen, worauf aufbauend unterschiedliche M?glichkeiten der Optimierung vorgestellt werden.

BackgroundStudies show that endangered work ability (EWA) can be maintained or restored through medical rehabilitation (MR). For patients, general practitioners (GP) represent an important point of access to MR in outpatient care. However, many different barriers and shortcomings hinder GPs in both timely detection of the need for MR and the recognition of its potentials for their EWA-patients. These are necessary if GPs are to adequately inform patients about MR options and successfully support applications for MR. This study describes the evaluation of a continuing medical education (CME) module designed to improve rehabilitation-related practical performance of GPs regarding a) subjective satisfaction of GPs with the CME module, b) stability of attitudes and knowledge over time regarding rehabilitation, and c) subjective and objective changes in MR-related competencies needed to support MR applications.MethodsThis study is an open, non-randomised, pre-post-intervention study. The intervention involves a CME module for GPs (n = 1365) in the German state of Saxony-Anhalt on the topic of medical rehabilitation in connection with the federal German pension fund (Deutsche Rentenversicherung). The module will be initially held as regularly scheduled meetings in moderated GP quality circles (QC), and then offered as a written self-study unit. At the end it will be evaluated by the GPs. The study’s primary focus is on the organizational practice as measured by the number of approved MR applications supported by medical reports submitted by the participating GPs in the 6 months before and 6 months after the CME module. Other study aims involve measuring self-perceived competencies of GPs, as well as their attitudes towards and knowledge of rehabilitation (both upon completing the CME and 6 months later). In addition, the level of satisfaction with the CME module will be analysed among participating GPs and QC moderators (as CME facilitators).DiscussionImplementing targeted CME on complex topics such as those involving barriers is possible, even promising, when using QCs and their moderators. Of particular importance is how aware moderating physicians are of the relevance of MR need detection and access.Ethics and disseminationThe ethics committee of the Martin-Luther-Universität Halle-Wittenberg has registered this study under the number 2014–13. The study will be reported on in peer-reviewed journals and at national and international conferences. The results will be available to current and future initiatives aiming to improve detection of MR need and making MR accessible to EWEC patients needing such support to minimize the effects of chronic disease on their livess.Trial registration numberGerman Clinical Trials Register (ID number DRKS00006188) and WHO International Clinical Trials Registry Platform, Universal Trial Number (UTN) U1111–1158-8334.