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The new coronavirus (COVID-19) pandemic and the resulting response measures have led to severe limitations of people’s exercise possibilities with diminished physical activity (PA) and increased sedentary behavior (SB). Since for migrant groups in Germany, no data is available, this study aimed to investigate factors associated with changes in PA and SB in a sample of Turkish descent. Participants of a prospective cohort study (adults of Turkish descent, living in Berlin, Germany) completed a questionnaire regarding COVID-19 related topics including PA and SB since February 2020. Changes in PA and SB were described, and sociodemographic, migrant-related, and health-related predictors of PA decrease and SB increase were determined using multivariable regression analyses. Of 106 participants, 69% reported a decline of PA, 36% reported an increase in SB. PA decrease and SB increase seemed to be associated with inactivity before the pandemic as well as with the female sex. SB increase appeared to be additionally associated with educational level and BMI. The COVID-19 pandemic and the response measures had persistent detrimental effects on this migrant population. Since sufficient PA before the pandemic had the strongest association with maintaining PA and SB during the crisis, the German government and public health professionals should prioritize PA promotion in this vulnerable group.

Background Up to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking. Methods This is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months’ follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund. Discussion The findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices. Trial registration ClinicalTrials.gov NCT04037501. Registered on 30 July 2019.

Objective Stroke remains a leading cause of premature death, impairment and reduced quality of life. Its aftercare is performed by numerous different health care service providers, resulting in a high need for coordination. Personally delivered patient navigation (PN) is a promising approach for managing pathways through health care systems and for improving patient outcomes. Although PN in stroke care is evolving, no summarized information on its cost-effectiveness in stroke survivors is available. Hence, the aim of this systematic review is to analyze the level of evidence on the cost-effectiveness of PN for stroke survivors. Methods A systematic literature search without time limitations was carried out in PubMed, EMBASE, CENTRAL, CINAHL as well as PsycINFO and supplemented by a manual search. Randomized controlled trials published prior to April 2020 in English or German were considered eligible if any results regarding the cost-effectiveness of PN for stroke survivors were reported. The review was conducted according to PRISMA guidelines. Quality of included studies was assessed with the RoB2 tool. Main study characteristics and cost-effectiveness results were summarized and discussed. Results The search identified 1442 records, and two studies met the inclusion criteria. Quality of included studies was rated moderate and high. Programs, settings and cost-effectiveness results were heterogeneous, with one study showing a 90% probability of being cost-effective at a willingness to pay of $25600 per QALY (health/social care perspective) and the other showing similar QALYs and higher costs. Conclusions Since only two studies were eligible, this review reveals a large gap in knowledge regarding the cost-effectiveness of PN for stroke survivors. Furthermore, no conclusive statement about the cost-effectiveness can be made. Future attempts to evaluate PN for stroke survivors are necessary and should also involve cost-effectiveness issues.

Background Studies have shown differences regarding prevalence and incidence of chronic diseases among first (own migration experience) compared to second (born in host country) generation migrants. The aim of this study was therefore to investigate the incidence of cardiovascular diseases (CVD) among persons of Turkish descent with and without migration experience living in Berlin, Germany. Methods In 2012-2013, Berliners with a Turkish migration background were recruited, examined, and contacted again 5 years later via postal mail. Incidence of diagnosed CVD (myocardial infarction, stroke, coronary heart disease, heart failure, cardiac arrhythmia, intermittent claudicatio or transient ischaemic attack) was assessed via self-report. Incidence of any CVD is presented as number and percentages. Associations between the incidence of any CVD and having an own migration experience were investigated with uni- and multivariable regression analyses. Results are presented as odds ratios with a 95%-confidence interval (OR, 95%-CI). Results Data of 234 persons of Turkish descent (62.8% women) with a mean age±standard deviation of 44±12.4 years were included in the analyses. Out of these, 79.9% were first generation migrants. First compared to second generation participants differed regarding CVD incidence (any CVD 16.6% vs. 4.3%, respectively; p = 0.03), socio-demographic, and lifestyle factors. After adjusting for these factors, multivariable analysis showed that only BMI (OR 1.12 per BMI point, 95%CI [1.02;1.24], and having a diagnosis of dyslipidemia (OR 4.0, 95%CI [1.45;12.05]), were independently associated with CVD incidence. Conclusions In a cohort study with Berliners of Turkish descent, CVD incidence was associated with increasing BMI and dyslipidemia, but not with own migration experience. Future migration-related public health research needs to focus on the prevention of harmful health behaviours to avoid the progression of overweight/obesity and dyslipidemia. Key messages CVD incidence is higher in persons with migration experience compared to those without. Migration experience is not associated with CVD incidence after adjusting for confounders (e.g. age, BMI).

Although complementary medicine is frequently used in Germany, there is almost no information about complementary medicine use in competitive sports. The aim was to assess the use of complementary medicine among elite athletes in Germany.A cross-sectional study among athletes was performed between March 2012 and September 2013. Athletes of both sexes who visited a sports medical outpatient clinic in Munich, Bavaria were included. Data about the use of complementary medicine were collected by means of a standardized measurement instrument, the German version of the international complementary and alternative medicine questionnaire.Of the 334 athletes (female 25%, mean age 20.2 ± 6.6 years) who completed all 4 sections of the questionnaire, 69% reported the use of at least one type of complementary medicine within the last 12 months. 505 athletes (female 26%, mean age 20.5 ± 7.0 years) completed at least one section of the questionnaire entirely. Within 12 months, the osteopath (11%), herbal medicine (17%), vitamins/minerals (32%), and relaxation techniques (15%) were the most frequently visited/used in relation to the respective sections of the questionnaire.Complementary medicine is frequently used by athletes in Germany. The efficacy, safety, and costs of complementary medicine should be investigated in clinical trials among athletes in the future.Hintergrund: Obgleich die Komplementärmedizin in Deutschland häufig eingesetzt wird, gibt es fast keine Informationen zum Einsatz im Bereich des Leistungssports. Ziel war es daher, den Einsatz der Komplementärmedizin bei Leistungssportlern in Deutschland zu untersuchen. Patienten und Methoden: Eine Querschnittsstudie unter Leistungssportlern wurde zwischen März 2012 und September 2013 durchgeführt. Eingeschlossen wurden Leistungssportler beiderlei Geschlechts, die eine sportmedi­zinische Ambulanz in München, Bayern besuchten. An­gaben zur Nutzung von Komplementärmedizin wurden mit Hilfe eines standardisierten Messinstruments, der deutschen Version des internationalen Fragebogens für Komplementär- und Alternativmedizin, erhoben. Ergebnisse: Von den 334 Leistungssportlern (25% weiblich, Durchschnittsalter 20,2 ± 6,6 Jahre), welche alle vier Abschnitte des Fragebogens ausgefüllt hatten, gaben 69% an, innerhalb der letzten 12 Monate mindestens eine Art von Komplementärmedizin angewendet zu haben. 505 Leistungssportler (26 % weiblich, Durchschnittsalter 20,5 ± 7,0 Jahre) füllten mindestens einen Abschnitt des Fragebogens vollständig aus. Innerhalb der letzten 12 Monate wurden, in Bezug auf die jeweiligen Abschnitte des Fragebogens, der Osteopath (11%), die Phytotherapie (17%), Vitamine und Mineralien (32%) und Entspannungstechniken (15%) am häufigsten besucht/verwendet. Schlussfolge­rung: Komplementärmedizin wird von Leistungssportlern in Deutschland häufig eingesetzt. Die Wirksamkeit, Sicherheit und Kosten der Komplementärmedizin sollten in Zukunft in klinischen Studien bei Sportlern untersucht werden.

Background: Patient navigation (PN) programs have been shown to increase patient satisfaction and quality of life among patients with lung cancer and to decrease time to treatment. However, the general cost-effectiveness of such programs in the context of lung cancer remains unknown. Hence, the aim of the present systematic review was to analyze the scientific literature and quantitatively assess the level of evidence on the cost-effectiveness of PN programs for patients diagnosed with lung cancer. Methods: A systematic literature search was carried out in PubMed, EMBASE, CENTRAL, CINAHL and PsycINFO databases without time limitations. Randomized controlled trials written in English or German were eligible for inclusion if any results regarding the cost-effectiveness of personally delivered PN programs for patients after lung cancer diagnosis were reported. A manual search was carried out to supplement the systematic search. Additionally, the authors of ongoing or unpublished relevant research were contacted. The titles, abstracts and full texts of relevant citations were screened independently by two reviewers. Results: The initial search yielded 814 articles, including four papers identified manually. Twenty-one articles were included in the full text screening. However, no study met the inclusion criteria. Contacting the authors of ongoing or unpublished research and cross-cancer studies did not yield any studies that met the inclusion criteria. Conclusion: Since no study met the inclusion criteria, this study reveals a research gap in this area. Furthermore, no conclusive statement regarding the cost-effectiveness of patient navigation programs for patients diagnosed with lung cancer can be made. Since the implementation of new healthcare models such as PN at least partially depends on their cost-effectiveness, future attempts to evaluate PN programs for lung cancer patients should consider examining outcomes related to cost-effectiveness to overcome the identified research gap.

Uber die Halfte aller kardiovaskularen Erkrankungen wird von acht zum Teil vermeidbaren Risikofaktoren verursacht. Angesichts deutlicher Pravalenz- und Mortalitatsunterschiede bei Herz-Kreislauf-Erkrankungen zwischen den deutschen Bundeslandern wird die regionale Verteilung von kardiovaskularen Risikofaktoren bevolkerungsreprasentativ und geschlechtsspezifisch untersucht. Anhand von gepoolten Daten (n = 62.606) der bundesweiten, telefonischen Gesundheitssurveys „Gesundheit in Deutschland aktuell (GEDA)“ 2009, 2010 und 2012 wurden die Pravalenz von sportlicher Inaktivitat, riskantem Alkoholkonsum, Rauchen, geringem Obst- und Gemuseverzehr, Adipositas, arztlich diagnostizierter Hypertonie, Diabetes und Fettstoffwechselstorungen sowie die zusammengefasste Anzahl von Risikofaktoren getrennt fur Manner und Frauen in den Bundeslandern bestimmt. Zusatzlich wurde der Einfluss von Alter und Sozialstatus auf Pravalenzunterschiede untersucht. Im Bundesdurchschnitt hatten 36,0 % der mannlichen und 26,6 % der weiblichen Bevolkerung drei oder mehr Risikofaktoren. Grose Unterschiede zwischen Mannern und Frauen gab es vor allem beim riskanten Alkoholkonsum (32,8 % versus 21,7 %), einem geringen Obst- und Gemuseverzehr (20,6 % versus 10,4 %) sowie beim aktuellen Rauchen (32,6 % versus 24,9 %). Bei allen acht Risikofaktoren wurden deutliche Pravalenzunterschiede zwischen den Bundeslandern gefunden. In den ostdeutschen Bundeslandern mit Ausnahme von Berlin wurden die hochsten Pravalenzen von sportlicher Inaktivitat, Adipositas, Hypertonie und Diabetes bei beiden Geschlechtern und von riskantem Alkoholkonsum bei Mannern beobachtet. Sachsen-Anhalt war das einzige Bundesland mit den hochsten Pravalenzen fur zwei Risikofaktoren. Beim Rauchen nahmen die drei Stadtstaaten Berlin, Hamburg und Bremen vordere Rangplatze ein. Der Anteil der Bevolkerung mit weniger als einer Portion Obst, Gemuse oder Saft pro Tag war geschlechtsubergreifend im Saarland am hochsten. Die regionalen Unterschiede blieben auch nach Adjustierung fur Alter und sozialen Status bestehen. Die Verteilung der Risikofaktoren zwischen den Bundeslandern zeigt ahnliche regionale Unterschiede wie die Pravalenz und Mortalitat von Herz-Kreislauf-Erkrankungen mit einer ungunstigeren Situation in den ostdeutschen Landern mit Ausnahme von Berlin. Insgesamt ist fur ganz Deutschland ein erheblicher Bedarf hinsichtlich der Pravention von grostenteils modifizierbaren Risikofaktoren fur Herz-Kreislauf-Erkrankungen bei Mannern und Frauen erkennbar.

Background Somatic comorbidities are a serious problem in patients with severe mental illnesses. These comorbidities often remain undiagnosed for a long time. In Germany, physicians are not allowed to access patients’ health insurance data and do not have routine access to documentation from other providers of health care. Against this background, the objective of this article was to investigate psychiatrists’ knowledge of relevant somatic comorbidities in their patients with severe mental illnesses. Methods Cross- sectional secondary data analysis was performed using primary data from a prospective study evaluating a model of integrated care of patients with serious mental illnesses. The primary data were linked with claims data from health insurers. Patients’ diagnoses were derived on the basis of the ICD-10 and the Anatomical Therapeutic Chemical (ATC) classification system. Diabetes, hypertension, coronary artery disease (CAD), hyperlipidaemia, glaucoma, osteoporosis, polyarthritis and chronic obstructive pulmonary disease (COPD) were selected for evaluation. We compared the number of diagnoses reported in the psychiatrists’ clinical report forms with those in the health insurance data. Results The study evaluated records from 1,195 patients with severe mental illnesses. The frequency of documentation of hypertension ranged from 21% in claims data to 4% in psychiatrists’ documentation, for COPD from 12 to 0%, respectively, and for diabetes from 7 to 2%, respectively. The percentage of diagnoses deduced from claims data but not documented by psychiatrists ranged from 68% for diabetes and 83% for hypertension, to 90% for CAD to 98% for COPD. Conclusions The majority of psychiatrists participating in the integrated care programme were insufficiently aware of the somatic comorbidities of their patients. We support allowing physicians to access patients’ entire medical records to increase their knowledge of patients’ medical histories and, consequently, to increase the safety and quality of care.

Background Cardiovascular disease continues to be the single most common cause of death and to account for the largest single portion of treatment costs in Germany. Reliable data on regional differences in the frequency of cardio - vascular disease are important for the planning of targeted care structures and preventive measures. Methods Pooled data from the German Health Update (GEDA), a nationwide telephone health survey conducted in 2009, 2010 and 2012 (n = 62 214) were used to estimate the lifetime prevalence of major cardiovascular disease (self-reported medical diagnosis of myocardial infarction, other coronary heart disease, stroke, or congestive heart failure) in each of the German federal states. The influence of sociodemographic factors on regional prevalence differences was examined in adjusted logistic regression analyses. Prevalences were compared with mortality rates from cardiovascular disease that were obtained from cause-of-death statistics. Results The lifetime prevalence of cardiovascular disease in Germany ranged from 10.0% in Baden-W¨rttemberg to 15.8% in Saxony-Anhalt. After adjustment for age, sex, socioeconomic status, and size of the communities of residence, nine of the other 15 states had significantly higher prevalences than Baden-W¨rttemberg, with odds ratios ranging from 1.26 (Hesse) to 1.55 (Saxony-Anhalt). Four of the five states that previously constituted the German Democratic Republic (East Germany) had above-average figures for prevalence and mortality. Conclusion There are relevant differences among the German federal states in the lifetime prevalence of major cardiovascular disease, which are only partly accounted for by differences in age and sex distribution, socioeconomic status, and community size.