Objective: Evaluation of the implementation process of a kindergarten-based intervention ('TigerKids') to promote a healthy lifestyle. Design: Questionnaire survey among kindergarten teachers about programme implementation and acceptance. Setting: Kindergartens in Bavaria, Germany. Methods: Two hundred and fifteen kindergartens were included; 96.3 % returned informative questionnaires. 'TigerKids' is a multi-approach behavioural intervention programme to increase physical activity level and to promote healthy eating in preschool children. Project elements and materials are designed for kindergarten teachers, children, and their parents. The main outcome measures of the study are implementation, acceptance, and estimated effectiveness of the intervention programme. Results: The elements for promoting healthy lifestyle were implemented regularly in the participating kindergartens: 94.2 % used the drinking station daily, 75.8 % prepared the magic fruit plate daily, and 63.3 % carried out the activity programme at least two times per week. The educators reported that the children ate more fruits and vegetables, drank more non-sugared beverages, and were more active. The designed materials and elements for the children, the educators, and the parents were also evaluated positively by the kindergarten teachers. Conclusion: The 'TigerKids' programme is a suitable instrument for health promotion in the kindergarten setting.
A woman with relapsing-remitting multiple sclerosis (MS) was treated with oral azathioprine (AZA) for 4 years and subsequently switched to interferon-β1a. Five years later, leukopenia developed and resolved after interferon was discontinued; MS treatment was changed to copolymer-1. Recurrent pancytopenia subsequently led to diagnosis of myelodysplastic syndrome (MDS) with deletion of the long arm of chromosome 5 (MDS 5q–). Within several months, unusually rapid for this subtype, MDS progressed to secondary acute myeloid leukemia. While AZA is the probable cause for the chromosomal deletion and MDS, combined or sequential immunomodulatory therapies may permit clonal expansion of malignant hematopoietic progenitors.
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