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Background: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes., Methods: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources., Results: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups., Discussion and Conclusions: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Competing Interests: Die Autoren geben an, dass kein Interessenskonflikt besteht.

Background: Internationally, a variety of definitions for public health interventions (PHI) exist. In the German-speaking countries, however, a definition is still outstanding. Therefore, the aim of this study was to derive consensus criteria for the definition of PHI from the expert perspective of science and practice., Methods: A Delphi survey with two online rounds was conducted from December 2022 to February 2023. Six criteria were formulated by a working group and posed for consensus: 1) the intention of the intervention, 2) potential conflicts of interest of the initiators of the intervention, 3) primary vs. secondary/tertiary prevention, 4) costs, 5) targeting, and 6) the reach of the intervention. In both Delphi rounds, experts from academia and practice were recruited through relevant networks and associations throughout the German-speaking world. The judgments were asked about standardized rating scales with the possibility of open justification., Results: In the first Delphi round, n = 52 and in the second round n = 43 experts from research, care and administration/management in health care participated. Consensus was reached on four of the six criteria after the second Delphi round: the intention of the intervention, possible conflicts of interest of the initiators of the intervention, primary vs. secondary/tertiary prevention, and the scope of the intervention. From the perspective of the experts interviewed, these are the criteria that distinguish PHI., Discussion and Conclusion: Based on the consensus criteria, PHI can be defined more concretely. Thus, the results contribute to a better inter- and transdisciplinary understanding. Ideally, the criteria will make it easier to assign interventions to the public health sector in the future, even if a precise examination will be necessary in individual cases, among other things because the experts disagreed on the criteria of costs and how to address the target group., (Copyright © 2023. Published by Elsevier GmbH.)

Background: In 2018, IDx-DR was approved as a method to determine the degree of diabetic retinopathy (DR) using artificial intelligence (AI) by the FDA., Methods: We integrated IDx-DR into the consultation at a diabetology focus clinic and report the agreement between IDx-DR and fundoscopy as well as IDx-DR and ophthalmological image assessment and the influence of different camera systems., Results: Adequate image quality in miosis was achieved more frequently with the Topcon camera (n = 456; NW400, Topcon Medical Systems, Oakland, NJ, USA) compared with the Zeiss camera (n = 47; Zeiss VISUCAM 500, Carl Zeiss Meditec AG, Jena, Germany). Overall, IDx-DR analysis in miosis was possible in approximately 60% of the patients. All patients in whom IDx-DR analysis in miosis was not possible could be assessed by fundoscopy with dilated pupils. Within the group of images that could be evaluated, there was agreement between IDx-DR and ophthalmic fundoscopy in approximately 55%, overestimation of severity by IDx-DR in approximately 40% and underestimation in approximately 4%. The sensitivity (specificity) for detecting severe retinopathy requiring treatment was 95.7% (89.1%) for cases with fundus images that could be evaluated and 65.2% (66.7%) when all cases were considered (including those without images in miosis which could be evaluated). The kappa coefficient of 0.334 (p < 0.001) shows sufficient agreement between IDx-DR and physician's image analysis based on the fundus photograph, considering all patients with IDx-DR analysis that could be evaluated. The comparison between IDx-DR and the physician's funduscopy under the same conditions shows a low agreement with a kappa value of 0.168 (p < 0.001)., Conclusion: The present study shows the possibilities and limitations of AI-assisted DR screening. A major limitation is that sufficient images cannot be obtained in miosis in approximately 40% of patients. When sufficient images were available the IDx-DR and ophthalmological diagnosis matched in more than 50% of cases. Underestimation of severity by IDx-DR occurred only rarely. For integration into an ophthalmologist's practice, this system seems suitable. Without access to an ophthalmologist the high rate of insufficient images in miosis represents an important limitation., (© 2022. The Author(s).)

Background: In Europe, there have been several addiction-expert rankings of harms related to the use of psychotropic substances in the last 15 years. Among them, only one expert ranking took into account the potential benefits of these drugs. Non-Opioidergic Analgesics (NOAs), such as gabapentinoids and NSAIDs, which have been increasingly the subject of abuse / misuse reports, have not been considered in such expert rankings. Likewise, there is currently no multi-substance comparison as to whether the valuation rank of the harmfulness of an illegal drug may change along with an imagined change in legal status in Germany., Objectives and Methods: Using a questionnaire, 101 experienced addiction physicians (first cohort) evaluated 33 psychoactive substances including analgesics with regard to their health and social harms as well as potential usefulness for the consumer and their environment / society ('others'). In addition, this cohort investigated whether the harmfulness assessment of an illegal substance changes if it would be legalized. In order to obtain the average overall harmfulness (overall risk) of a substance, the percentage contribution of each dimension to the overall harmfulness was determined in a second survey (second cohort, 36 experienced addiction medicine experts). Finally, the average benefit and overall risk ratings of each substance were related to each other., Results: Prescription psychoactive substances such as analgesics, NOAs (including gabapentinoids) and opioidergic maintenance medications to treat opiate dependence were judged to have a favorable benefit-harm profile. Cannabis and ketamine were placed in the midfield of both, the harm and benefit rankings. Together with most illicit narcotic drugs, alcohol and nicotine, have been ranked among the most harmful and least useful substances, whereby alcohol was judged on average to be more harmful but also more useful than nicotine. In the event of potential legalization, the overall harm of the traditional illegal drugs methamphetamine, heroin, cocaine and cannabis was estimated to be reduced. This was mainly due to a more favorable valuation of the harm to others under these virtual conditions., Conclusion: Prescription substances including opioidergic and non-opioidergic analgesics as well as opioid maintenance therapy medications (methadone and buprenorphine) were assigned a favorable benefit-harm profile. Alcohol, nicotine and traditional illicit drugs (with the exception of cannabis and ketamine) were determined to have an unfavorable profile. The overall harm of traditional illicit drugs was assessed to decrease along with legalization, mainly by decreasing the harm to others in this virtual event., Competing Interests: Prof. Dr. med. Scherbaum erhielt Honorare für verschiedene Aktivitäten (z. B. Mitgliedschaft im Beirat, Vorträge, Manuskripte) von AbbVie, Camurus, Hexal, Janssen-Cilag, MSD, Medice, Mundipharma, Reckitt-Benckiser/Indivior und Sanofi-Aventis. In den letzten drei Jahren hat er an klinischen Studien teilgenommen, die von der Pharmaindustrie finanziert wurden.Dr. med. Thomas Alberti erhielt Honorare (z. B. Mitgliedschaft im Beirat) und / oder Ausbildungsstipendien von Janssen-Cilag, Medice und Otsuka-Lundbeck.Prof. Dr. med. Norbert Wodarz erhielt Honorare für (nicht produktbezogene) Vorträge (Janssen-Cilag, Mundipharma und Reckitt-Benckiser/Indivior). Er erhielt öffentliche Mittel (BayStMGP) zur Bewertung von „Naloxon zum Mitnehmen“.Prof. Dr. med. Thomas Hillemacher hat Honorare für verschiedene Aktivitäten (z. B. Mitgliedschaft im Beirat, Vorträge) von Janssen-Cilag, Amomed, Shire, Takeda, Servier erhalten.Prof. Dr. med. Michael Soyka arbeitet seit drei Jahren als Berater oder hält Vorträge für Ammomed, Indivior, Camurus.Prof. Dr. med. Jens Reimer erhielt Honorare für die Teilnahme an Beiräten, Beratungen und Vorträgen von AbbVie, Amomed, Camurus, Gilead, Indivior und Sanofi-Aventis.Prof. Dr. med. Jens Kuhn erhielt Honorare von Bayer, Janssen, Lundbeck, Neuraxpharm, Otsuka Pharma, Schwabe und Servier für Vorträge auf Konferenzen und für die Reisen dorthin. Von der Medtronic GmbH hat er finanzielle Unterstützungen für Investigator-initiierte Studien erhalten. Die übrigen Autoren gaben an, keine Interessenskonflikte bezüglich dieser Studie zu haben., (Thieme. All rights reserved.)

Background: "Avoidable mortality" is used as an indicator in health reporting. The indicator aggregates selected causes of death. In Germany two versions exist, both of which are no longer up to date. A new version is proposed., Methods: The new version is based on preparatory work on the European level. The feasibility and plausibility of a common OECD Eurostat list are examined using official statistics data from Bavaria from 2016 to 2018. The analysis includes an examination of the variability over time and within the Bavarian administrative districts, as well as possible systematic errors through regional differences in coding behaviour or changes over time., Results: The OECD Eurostat list can be implemented at the regional level with only minor modifications. The age-standardized avoidable mortality in Bavaria in 2018 is almost 23 deaths per 10,000 inhabitants, with preventable deaths by far outweighing treatable deaths. For men, the death rate due to avoidable causes is 30 per 10,000 male inhabitants, which is almost twice as high as that for women (16 per 10,000 female inhabitants). The regional findings on avoidable mortality are consistent with findings on regional health from other studies., Discussion and Conclusion: The results do not indicate a threat to reliability due to random fluctuation or systematic methodological errors. The new version is recommended for application in health reporting., (© 2021. The Author(s).)

To raise awareness that families with a mentally ill parent face special challenges and the correct handling of it, need to be considered more in health care. The simple question "how are you as a parent and your children?" is often not asked but this question is important so as not to endanger the healing process, to identify the need for assistance and to break the potential vicious circle for children. Awareness of the problem in the psychiatry of adults can support the care of affected persons and their children., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)