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Purpose: Prospective physical education teachers (PPETs) acquire beliefs during acculturation, which is the time before teacher education begins. Beliefs are based on shared experiences and influential in PPETs' professional development. We examined German PPETs' shared beliefs through the lens of teaching quality, comprising classroom management, student support, and cognitive activation. Method: Three focus group discussions were conducted, in which 13 German PPETs were instructed to work on shared lesson planning. The data were analyzed using reflexive thematic analysis. Findings: The PPETs believed that physical education should enable students' participation in sports. Therefore, classroom management was reflected as "managing a physical education class as a prerequisite for the complexity of teaching." Student support was reflected as "providing easy access to sports for all students." Cognitive activation was reflected as "disregarding cognitive activation in favor of transmissive teaching." The PPETs drew on their own physical education experiences as former students. Conclusion: Longitudinal studies focusing on cognitive activation are recommended.

Background: Rituximab has become a standard treatment for non‐Hodgkin lymphoma. Clinical studies have demonstrated the efficacy of rituximab in combination with standard chemotherapies in the treatment of follicular lymphoma (FL) and diffuse large B cell lymphoma (DLBCL) patients. This non‐interventional study aimed to evaluate the effectiveness and safety of subcutaneous (SC) rituximab in routine clinical practice. Methods: Adult patients with previously untreated CD20 positive DLBCL or FL who received rituximab SC and chemotherapy as first‐line treatment were observed between 07/2014 and 07/2019 at 99 institutions in Germany. Primary endpoint was the (unconfirmed) complete remission (CR/CRu) rate. Primary outcome was analyzed inferentially; other variables were evaluated descriptively. Results: Overall 583 patients (247 FL; 336 DLBCL) were evaluated. CR/CRu rates were 51.4% (95% CI: 45.2; 57.6) in the FL set and 48.5% (95% CI: 43.2; 53.8) in the DLBCL set. Regarding progression‐free survival in the FL group, the probability of being event‐free was 94.2% in the first year and 86.2% in the second year. An overall response was achieved in 85.8% (FL) and 85.4% patients (DLBCL). Patient satisfaction at the end of study with the time saving simplification of the SC vs. intravenous route was 98% for FL and 97% for DLBCL. 45.3% of FL and 47.0% of DLBCL patients experienced an adverse event of grade ≥3. Serious adverse events of grade ≥3 occurred in 27.9% FL and 32.4% DLBCL patients, with the highest incidences for leucopenia, anemia, nausea, and fatigue. No new safety signals were detected. Conclusions: The results confirmed the effectiveness and safety of rituximab SC in both the FL and the DLBCL group. Satisfaction of patients and nurses with SC administration was high. [ABSTRACT FROM AUTHOR]

Background: Summary measures such as disability-adjusted life years (DALY) are becoming increasingly important for the standardized assessment of the burden of disease due to death and disability. The BURDEN 2020 pilot project was designed as an independent burden-of-disease study for Germany, which was based on nationwide data, but which also yielded regional estimates. Methods: DALY is defined as the sum of years of life lost due to death (YLL) and years lived with disability (YLD). YLL is the difference between the age at death due to disease and the remaining life expectancy at this age, while YLD quantifies the number of years individuals have spent with health impairments. Data are derived mainly from causes of death statistics, population health surveys, and claims data from health insurers. Results: In 2017, there were approximately 12 million DALY in Germany, or 14 584 DALY per 100 000 inhabitants. Conditions which caused the greatest number of DALY were coronary heart disease (2321 DALY), low back pain (1735 DALY), and lung cancer (1197 DALY). Headache and dementia accounted for a greater disease burden in women than in men, while lung cancer and alcohol use disorders accounted for a greater disease burden in men than in women. Pain disorders and alcohol use disorders were the leading causes of DALY among young adults of both sexes. The disease burden rose with age for some diseases, including cardiovascular diseases, dementia, and diabetes mellitus. For some diseases and conditions, the disease burden varied by geographical region. Conclusion: The results indicate a need for age- and sex-specific prevention and for differing interventions according to geographic region. Burden of disease studies yield comprehensive population health surveillance data and are a useful aid to decision-making in health policy. [ABSTRACT FROM AUTHOR]

Aims: There is evidence for an increased type 2 diabetes (T2D) risk associated with depression, but its role for diabetes prevention remains unclear. This study aimed to add insight by investigating the impact of major depressive disorder (MDD) on prospective glycaemic changes. Methods: The study was based on a cohort of n = 1,766 adults without diabetes (776 men, 990 women; 18-65 years of age) who participated in the mental health supplement of the German National Health Interview and Examination Survey (GNHIES98-MHS, 1997-1999) and in a follow-up survey (DEGS1, 2008-2011). Glycaemic status was defined as normoglycaemia [HbA1c < 39 mmol/mol (<5.7%)], prediabetes [39 ≤ HbA1c < 48 mmol/mol (5.7-6.4%)] and diabetes [HbA1c ≥ 48 mmol/mol (≥ 6.5%), diagnosed diabetes, or antidiabetic medication], and glycaemic changes categorized as 'remission', 'stability' and 'progression'. Baseline MDD was assessed via a modified German version of the WHO Composite International Diagnostic Interview. Multivariable logistic regressions were applied to analyse the association of MDD with glycaemic changes and incident T2D, adjusting for socio-demographics, lifestyle conditions, chronic diseases, antidepressant use and mental health care. Results: MDD prevalence was 21.4% for women and 8.9% for men. Among women, MDD was associated with a lower chance for remission (RRR 0.43; 95% CI 0.23, 0.82). Among men, MDD was not significantly related to glycaemic changes. MDD had no significant effect on incident T2D (men: OR 1.58; 0.55, 4.52; women: OR 0.76; 0.37, 1.58). Conclusions: Findings of the current study highlight the role of depression in T2D prevention, particularly among women. [ABSTRACT FROM AUTHOR]

Physical education teacher educators' health-related beliefs can impact public health. An interactive knowledge-to-action approach, such as Cooperative Planning, might challenge the health-related beliefs of physical education teacher educators, thus contributing to innovation in teacher education. We investigated what health-related beliefs physical education teacher educators had before a Cooperative Planning intervention, how these developed throughout the intervention and how teacher educators' perceptions of Cooperative Planning can explain the identified changes and continuities. We established two Cooperative Planning groups that included physical education teacher educators (university lecturers and teacher trainers), researchers, study course coordinators and prospective teachers. The data of 13 teacher educators were collected before (t 0) and after (t 1) the Cooperative Planning using two methods: observations of teaching practice and interviews. The data analysis was based on the following categories: (i) epistemic beliefs about health (e.g. salutogenic understanding), (ii) beliefs about the health topic in physical education (e.g. health-related knowledge and understanding), (iii) beliefs about the health topic in physical education teacher education (e.g. health-related pedagogical content knowledge) and (iv) process-related beliefs about Cooperative Planning. The findings revealed that teacher educators' health-related beliefs were rather stable but could be challenged through a Cooperative Planning intervention. Epistemic beliefs about health remained, whereas more practice-related beliefs about the health topic in physical education and physical education teacher education changed in individual ways. Here, a change in beliefs was more likely when the participants were open to change and when Cooperative Planning offered opportunities to engage in concrete lesson planning. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) and bipolar disorder are associated with certain cardiovascular risk factors (CVRFs), but it is unclear whether they are associated with unfavourable changes of clinically manifest CVRFs over time. Methods: We used baseline and 12-year follow-up (n = 1887) data from the German Health Interview and Examination Survey 1998. Multivariable linear regression models assessed associations between lifetime CIDI-diagnosed mood disorders at baseline and continuous risk factor-related outcomes (blood pressure, HbA1c, LDL-C, HDL-C, triglycerides, BMI) at follow-up. Results: We did not find consistent deterioration of CVRFs in persons with compared to persons without MDD. Analyses pointed to severity of mood disorder as an important correlate of long-term changes of comorbid hypertension: while a history of mild MDD was not associated with changes in CVRFs, moderate MDD was associated with lower blood pressure [systolic: β = − 7.5 (CI − 13.2; − 1.9); diastolic: β = − 4.5 (CI − 7.8; − 1.3)] and a history of bipolar disorder was associated with higher systolic blood pressure at follow-up (β = 14.6; CI 4.9–24.4). Further, severe MDD was weakly associated with a higher BMI at follow-up [β = 1.2 (CI 0.0; 2.4)]. These outcomes were not mediated by use of psychotropic medication and remained statistically significant after adjusting for the use of antihypertensive medication. Conclusion: Since most investigated parameters showed no associations, participants with a lifetime history of MDD in this cohort did not carry a specific risk for a worsening of pre-existing clinically manifest CVRFs. Our findings extend evidence of MDD severity and bipolar disorder as important correlates of long-term changes of arterial hypertension and obesity. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to examine trends in non-help-seeking for mental disorders among persons with a prevalent mental disorder (12-month prevalence) in Germany between 1997-1999 and 2009-2012.Methods: We examined data from 1909 persons aged 18-65 years who participated in two independent, repeated cross-sectional surveys (German National Interview and Examination Study 1997-1999, German Health Interview and Examination Survey for Adults 2009-2012) conducted 12 years apart. Prevalent mental disorders (12-month prevalence) were determined using the Composite International Diagnostic Interview, which included information on lifetime help-seeking for mental health problems. Correlates of self-reported help-seeking were analyzed according to Andersen's Behavioral Model. Multivariable Poisson regression models were used to assess time trends in the directly standardized and model-adjusted prevalence of non-help-seeking across strata of socio-economic and clinical variables.Results: The proportion of people with a prevalent mental disorder who have never sought help in their lifetime decreased significantly from 62% (95% CI 58.7-64.7) to 57% (95% CI 52.2-60.9) between 1997-1999 and 2009-2012 in adults aged 18-65 years in Germany. Downward trends in non-help-seeking occurred in all investigated strata and reached statistical significance in women, in people who were living alone, people with medium educational level, people living in middle-sized communities, people with non-statutory health insurance, smokers, and people with co-existing somatic conditions.Conclusion: Despite a downward trend over the course of 12 years, a large proportion of people suffering from mental disorders are still not seeking treatment in Germany. Further efforts to increase uptake of help-seeking for mental disorders in hard-to-reach groups are warranted to continue this trend. [ABSTRACT FROM AUTHOR]

Background: This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women.Methods: We used cross-sectional data from the German Health Interview and Examination Survey 2008-11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m2 to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders.Results: This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: -7.0 [-8.2; -5.8]; women: -9.0 [-10.2; -7.9]), intermediate for MUNO (men: -4.2 [-5.3; -3.1]; women: -5.6 [-6.8; -4.4]) and least pronounced for MHO (men: -2.2 [-3.6; -0.8]; women -3.9 [-5.4; -2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:-1.3 [-2.3; -0.3]; women: -1.5 [-2.7; -0.3].Conclusions: Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men. [ABSTRACT FROM AUTHOR]

Background: Prevalence estimates for depression vary considerably by the type of assessment instrument, and there is limited information on their overlap in population-based samples. Our aim was to compare the Patient Health Questionnaire-9 (PHQ-9) with the Composite International Diagnostic Interview (CIDI) as measures for current major depressive syndrome (MDS) in a large population-based sample. Methods: Data derived from the mental health module of the nationwide cross-sectional German Health Interview and Examination Survey for Adults (DEGS1-MH) (n = 4483; age 18-79 years). MDS in the past two weeks was assessed (a) using the PHQ-9 diagnostic algorithm (PHQ-MDS) and (b) based on CIDI information about the latest symptom occurrence (recency) (CIDI-MDS). Prevalences, overall concordance and percentages of overlap of both MDS measures were determined. Prevalences of affirmed PHQ-9 depression symptoms and the mean and median PHQ-9 sum scores were analyzed per measure. Results: Prevalence of current MDS was 2.7% (95% CI: 2.0-3.6) for PHQ-MDS and 3.9% (95% CI: 3.1-5.0) for CIDI-MDS. The overall agreement between both measures was moderate (kappa: 0.43). Of all the participants, 1.5% (95% CI: 1.0-2.2) were classified as MDS cases by both measures, with 54.5% (95% CI: 42.7-65.9) of PHQ-MDS cases and 37.9% (95% CI: 27.8-49.1) of CIDI-MDS cases also being classified as MDS by the respective other MDS measure. However, 94.8% (95% CI: 93.6-95.8) of the participants were classified as non-MDS by both measures, with 97.5% (95% CI: 96.6-98.1) of non-PHQ-MDS and 98.7% (95% CI: 98.2-99.1) of non-CIDI-MDS being classified as non-MDS by the respective other MDS measure. The mean and median PHQ-9 sum score was higher in those with PHQ-MDS than in those with CIDI-MDS. Conclusions: Both measures have a high level of agreement for ruling out current MDS, but the overlap in their classification of cases is moderate. Our results indicate that they cannot be interpreted as equal measures of the same construct, suggesting limited comparability of their prevalence estimates. However, further exploration of algorithms and correlates and a proper labeling of measures in epidemiological studies are required. Conclusions: Both measures have a high level of agreement for ruling out current MDS, but the overlap in their classification of cases is moderate. Our results indicate that they cannot be interpreted as equal measures of the same construct, suggesting limited comparability of their prevalence estimates. However, further exploration of algorithms and correlates and a proper labeling of measures in epidemiological studies are required. [ABSTRACT FROM AUTHOR]

This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample ( N = 5318) of the adult (18-79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18-34: 37% versus 20% in age group 65-79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The present study aims to examine the association between sociodemographic variables and health locus of control (HLC) as well as HLC and health behaviour. Data from a representative sample of the German adult population, the Telephone Health Survey 2006 (GSTel06; N = 5542), were used. A German version of the MHLC (multidimensional HLC) scales was used. Associations between sociodemographic variables and three dimensions of HLC (internal, powerful others and chance) and between HLC and health behaviour were calculated. In particular, higher age, low socioeconomic status and migration background were associated with higher HLC scores on the powerful others and chance dimension. Subjects scoring high on the chance dimension did less sports activity (OR: 0.8; CI: 0.7-0.9), had less medical teeth protection (0.7; 0.6-0.9), fewer health courses (0.8; 0.7-0.9) and conducted less systematic information-seeking (0.8; 0.6-0.9), while results regarding internal and powerful others HLC remained mainly insignificant. High chance HLC can be regarded as risk factor of adequate health behaviour. The associations between high chance HLC, low socioeconomic status and migration background emphasise the need for treatments and prevention programmes tailored to modify the high chance HLC of socially disadvantaged populations. [ABSTRACT FROM AUTHOR]

Background: As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older. Methods/Design: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multidimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%). Discussion: The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints. [ABSTRACT FROM AUTHOR]

The article discusses a continuing education conference held from September 24–25, 2007 in Berlin, Germany. The main focus of the conference was on library science and the changing culture of libraries due to increased digitalization and electronic media. Speakers included Benjamin F. Bowman, Herbert Laubvogel, and Wolfgang Zick.

Aims: Previous studies investigating dose-response relations between volume of drinking and diseases have focused on single diseases only. Until now, the relation between the drinking volume and the risk of having any alcohol-attributable disease is largely unknown. The aim of the present study is to investigate to what extent is the risk of diseases with different alcohol-attributable fractions (AAFs) predicted by daily alcohol consumption (>120 g, 61-120 g vs 31-60 g). Methods: The sample consisted of 805 inpatients classified as at-risk drinking, aged 18-64 years hailing from four general hospitals in North-eastern Germany. Inpatients were classified into three groups (AAF = 1, AAF < 1, AAF = 0). Group differences regarding alcohol-related variables, smoking, and demographics were analysed. A multinomial logistic regression analysis was conducted to predict the risk of diseases with AAF = 1 and AAF < 1. Results: In our sample, 26.6% of the inpatients showed a disease with AAF = 1, while 20.2% had a disease with AAF < 1. Inpatients consuming >120 g, and inpatients consuming 61-120 g revealed significantly higher odds for diseases with AAF = I compared to inpatients consuming 31-60 g (OR = 6.30, CI = 3.55-11.26; OR = 2.91, CI = 1.64-5.13). Regarding diseases with AAF < 1, inpatients consuming >120 g revealed significantly higher odds compared to the inpatients consuming 31-60 g (OR = 1.97, CI = 1.15-3.37). Conclusions: A dose-response relation between the level of the drinking volume and the risk of diseases with AAF = 1 was found in this sample of inpatients from the general hospitals. [ABSTRACT FROM AUTHOR]

Starting from the changing role of the user in information systems in the Web 2.0 this paper critically questions the concept of information literacy. Five theses on information literacy 2.0 as well as suggestions for further reading offer the possibility to change the perspective of the view on information literacy predominating in German libraries in the direction of a more holistic view of information and learning processes. [ABSTRACT FROM AUTHOR]

This population-based study compares a group of ‘risky drinking’ smokers (n = 137) with groups of either smokers (n = 760) or ‘risky drinkers’ (n = 173) regarding sociodemographic, behavioral and motivational variables. The study took place in a rural and urban region of Germany in 1997. No differences were found in sociodemographics, nicotine-related variables, frequency of alcohol consumption, and most alcohol-related diagnoses. People who drink and smoke show a higher proportion of alcohol dependence (ES: h = .20), drink more alcohol per occasion (ES: d = .39), and are more motivated to decrease alcohol consumption (ES: h = .45). The data suggest focusing research in more alcohol-related clinical settings and examining the relationship between smoking cessation and alcohol reduction. [ABSTRACT FROM AUTHOR]

Aims: To investigate the correspondence between readiness for behaviour change in general and readiness for alcohol related help-seeking in particular. A related aim was to examine how, if at all, measures of dependence severity, use, and consequences were related to a composite measure depicting agreements and disagreements between general change readiness and help-seeking readiness. Methods: Non-treatment seeking alcohol-dependent patients, numbering 549, from general hospitals in Germany were inter- viewed. Results: When taking into account both dimensions of motivation, findings indicate 42% of the subjects were characterized by different motivation levels regarding readiness for change and readiness for help-seeking. Higher help-seeking readiness was associated with higher alcohol problem severity. Readiness to change was not affected by alcohol problem severity. Conclusions: Findings underscore the need to evaluate both motivational constructs in determining clients' need and receptivity to formal help. [ABSTRACT FROM AUTHOR]

Background: This study examined the pattern, direction, and magnitude of longitudinal relationships among the constructs involved in the Transtheoretical Model (TTM). Purpose: The goal was to explore within-TTM relationships to create an integrated structural model that adequately represents the change process. Method: Data were collected as part of a representative general adult population study in Germany. A total of 688 smokers in the precontemplation and contemplation stages of change were assessed two times, 6 months apart, with respect to the TTM constructs. Structural equation modeling was used and a step approach was employed to evaluate the relationships between cognitive-affective processes, behavioral processes, the pros and cons of smoking, and self-efficacy, stratified for baseline stage of change. Results: The model-building process resulted in two final structural equation models detailing longitudinal TTM relationships for precontemplation and contemplation. A structural invariance test showed that the precontemplation model also held for the contemplation sample and visa versa. Conclusions: The TTM constructs can be integrated in a longitudinal structural model. The findings provide empirical support for specific relationships that are posited in the TTM framework. However, differing relationships between TTM constructs for precontemplation and contemplation could not be established. [ABSTRACT FROM AUTHOR]

Background: It has become well known that 'light' cigarettes are deceiving in fostering the attitude that they are 'safer' or less health damaging than regular cigarettes. The goal of this study is to analyse the smoking of 'light' cigarettes according to the progress over the stages of change to stop or reduce smoking. Methods: A sample representing the general population of a northern German region aged 18 to 64 was drawn (T1, N = 4075). 1520 smokers of 'light' and regular cigarettes were identified by a face-to-face interview and reassessed longitudinally by questionnaire 30 months later (T2, n = 913). Results: At baseline smokers of 'light' cigarettes, in particular males, were more likely to be contemplators or preparators in terms of smoking cessation. Those who smoked 'light' cigarettes were more likely to have made a quit attempt, were more likely to be female, at younger age, never married, higher educated and less nicotine dependent compared to smokers of regular cigarettes. The follow-up data shows that males who smoked 'light' before or changed to 'light' cigarettes were more likely to contemplate or to prepare quitting, had more often tried a quit attempt and stopped smoking more often. Conclusion: The results suggest that 'light' cigarettes especially by males are used for reasons of reducing or quitting smoking. It is concluded that as such they deceive the smoker and potentially hinder the process of reducing or quitting. [ABSTRACT FROM AUTHOR]

Aims: Little is known about the relationship between current and past smoking behaviour and the severity of alcohol dependence. The purpose was to explore the strength of this relationship. Methods: A random population sample of 18 to 64 year-olds from northern Germany was used (n = 4075; participation rate: 70%). It included 761 cigarette smokers fulfilling at least one alcohol-dependence criterion. The severity of alcohol dependence according to the alcohol-dependence syndrome criteria frequency (ASF) was estimated by a standardized questionnaire based on diagnostic instruments of the alcohol dependence syndrome and which included five response categories, from 'never' to 'daily'. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM-IV) with the Composite International Diagnostic Interview (CIDI). As a second measure, the Fagerström Test of Nicotine Dependence (FTND) was used. Results: The number of cigarettes and years of daily smoking, nicotine dependence, and the number of nicotine dependence symptoms each showed a relationship with the ASF. Effect size (w) were 0.17-0.21 for chi-squared (χ2) tests. In a general linear regression model with the ASF as the dependent variable (R2 = 0.17), number of years of daily smoking, age at onset of smoking, number of attempts to reduce or quit, the number of nicotine-dependence symptoms according to DSM-IV and the FTND sum score were retained as independent variables. Conclusions: Long-term smoking, a large number of nicotine-dependence symptoms according to DSM and a strong urge to smoke according to the FTND are related with a high ASF. [ABSTRACT FROM AUTHOR]

Aims To compare data from the general population on intentionally reduced smoking and smoking cessation. Design Longitudinal observation study. Setting Northern German region. Subjects Randomly sampled residents aged 18-64 (T1; n=4075, response rate 70%). Daily cigarette smokers (n=1520) were followed up after 30 (T2; n=913) and 36 months (T3; n=786). Measures Self-reported smoking-related and socioeconomic variables. Participants were explicitly asked for reduction attempts (reducing cigarettes per day) and maintenance of reduction, which was defined independently of consumption measures. Findings Between T1 and T2, reduction attempts (39%) were more frequent than quit attempts (33%), and according to self-report, reduction was more likely to be maintained for up to 12 months. Smokers maintaining reduction for up to 6 months had reduced their consumption at T3 by 34% compared with T2. Between T1 and T2, the occurrence of both a reduction and a quit attempt was most frequent (22%), followed by subjects exclusively trying to reduce (17%) and subjects exclusively trying to quit (4%). Subjects who exclusively tried to reduce had a significantly increased probability of further reduction attempts at T3 (OR=4.4, 95% CI 2.0-10.1), while the probability of quit attempts was equal compared with subjects not attempting to reduce or quit (OR = 1.1, 95% CI 0.3-3.2). DSM-IV nicotine dependence was less common in subjects who exclusively tried to reduce. Other smoking-related and socioeconomic variables did not predict whether individuals attempted to reduce or attempted to quit. Conclusions A considerable proportion of general population smokers attempt to reduce, and are able to maintain reduction of, cigarette consumption over time. Reduction attempts did not reduce the probability of a subsequent cessation attempt. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To estimate probabilities of alcohol high-risk drinking, alcohol abuse and alcohol dependence on grounds of smoking-behaviour related variables and single nicotine dependence criteria. Design Cross-sectional population-based study. Setting Adult population of a region in north Germany. Participants Cigarette smokers (n = 2437) among a random sample of 4075 females and males aged 18–64, drawn in 1996. Measurement Smoking, nicotine dependence according to the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol-related harm (ARH): high-risk drinking, DSM-IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI). Findings Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking. Conclusions Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account. [ABSTRACT FROM AUTHOR]

— Aims: To investigate properties and aspects of validity of the Readiness to Change Questionnaire (RCQ) when applied to hazardous drinking, alcohol-abusing or alcohol-dependent subjects sampled from the general population. Methods: In a representative survey conducted in the general population of a region in northern Germany, participants were randomly selected from resident registration office files, contacted and interviewed personally (n = 4.075). A total of 302 subjects who showed hazardous drinking behaviour (n = 202) or met diagnostic criteria of alcohol misuse (n = 46) or alcohol dependence (n = 54) were assessed and diagnosed using the Munich Composite International Diagnostic Interview (M-CIDI) according to DSM-IV diagnostic criteria. The battery of self-report questionnaires comprised, among others, the RCQ, and two methods of allocation were used, the quick method and the refined method of allocation. According to the method of allocation used, the stages are: precontemplation (PC), contemplation (C), preparation (P) and action (A); P may only be assigned using the refined method. Results: The RCQ, a brief instrument to assess stages of change in individuals sampled from the general population, gave internal consistencies of: PC = 0.68, C = 0.79, A = 0.83. Allocation to stages of change according to the quick method resulted in 67% of subjects being allocated to PC, 24% to C and 8% to A and according to the refined method in 58% to PC, 15% to C, 4% to P, 4% to A, with 19% not being classified because of non-theory-consistent scale profiles. Conclusions: Classification did not differ substantially according to the method of allocation. A three-factor solution, as reported in the literature, could not be replicated. Allocation to stages of change with the RCQ reflected predictions made from the Transtheoretical Model of behaviour change. [ABSTRACT FROM PUBLISHER]

Aims. To analyse factors related to remission without formal help by using a representative sample and standardized instruments. Design. Two groups of untreated alcohol-dependent subjects were compared. Setting. General population survey. Participants. Thirty-two subjects fully remitted without formal help (NFH) and 26 current alcohol-dependent individuals (CAD) according to DSM-IV drawn from a representative general population sample in northern Germany (response rate: 70.2%, n = 4075). Measurements. Data focusing on the 2 years prior to remission from NFH were compared with past-year data from CAD. Groups were compared on variables found to be associated with remission without formal help in previous research. Findings. Logistic regression analysis revealed that individuals remitted from alcohol-dependence without formal help reported a higher non-physiological severity of alcohol dependence, less social pressure to quit drinking and more incidents of driving while intoxicated. Furthermore, they tended to report more satisfaction with work and financial situation and were more likely to live in a stable partnership. Conclusions. Findings support the concept of psychosocial resources as important enabling factors in remission from alcohol dependence without formal help. Implications for brief interventions are discussed. [ABSTRACT FROM AUTHOR]

Background: The aim of the Transitions in Alcohol Consumption and Smoking (TACOS) project is to investigate substance use and use disorders in the adult general population in a region of the under-researched north of Germany, focussing on smoking and alcohol consumption. In this study, the design and quality assurance provisions of the baseline cross-section of the longitudinal project are described. Prevalence rates of alcohol use disorders, consumption pattern, and the nature of their association are also analysed with regard to preventive strategies.Method: A random sample of 4075 participants, aged 18 to 64 and drawn from residents registration office files, was interviewed with a DSM-IV adapted version of WHO CIDI. Fieldwork resulted in a response rate of 70.2% and an unbiased database with regard to demographic characteristics.Results: Low lifetime prevalence of alcohol use disorders (4.5% abuse, 3.8% dependence) and hazardous consumption (13.2% lifetime; 6.0% 12-month) was found compared to southern regions of Germany and US American data. In contrast, we found a comparatively high percentage of moderate alcohol uses. Male subjects are more affected by lifetime alcohol use disorders (abuse OR 8.3, 95% CI 5.3-13.2; dependence OR 4.3, 95% CI 2.8-6.4). The association between alcohol use disorders and alcohol consumption pattern revealed a weaker relation for alcohol abuse compared to dependence.Conclusion: National and regional drinking habits and norms have to be considered as a significant source of variance, supporting the need for European epidemiological research on substance use in addition to US American activities, and emphasising the advantages of community-based preventive measures. An evaluation of public recommendations for safe limits of alcohol consumption and prevention targets referring to average consumption is indicated. There is also a need for a clear distinction between alcohol abuse and dependence. [ABSTRACT FROM AUTHOR]

Examines German literature on the history of information and documentation. Elke Behrends' `Technical and Scientific Documentation in Germany from 1900 to 1945: With a Special Look at the Relationship Between Library and Documentation'; Rainer Schmitz's `The State of the Art in the History of Documentation'; Instruments of scholarly information and communication.

Presents the results of a study which compared the validity of two screening questionnaires, the Michigan Alcoholism Screening Test (MAST) and the CAGE questionnaire, in detecting hazardous consumption of alcohol in a general hospital in Lubeck, Germany. Methodology used in the study; Validity measures according to hazardous alcohol consumption; What the findings of the study indicate.

Background. Nicotine dependence might function as a barrier to smoking cessation. Therefore, the goal was to determine whether single symptoms of nicotine dependence are related to the number of quit attempts and smoking status.Methods. In a random population sample of 4075 women and men aged 18–64, drawn from 47 German communities, data about nicotine dependence according to the US Diagnostic and Statistical Manual of Mental Disorders and according to the Fagerstro¨m Test for Nicotine Dependence (FTND), and data on quit attempts and quitting were collected at baseline with an interview and 30 months later with a questionnaire.Results. Nicotine dependence, in particular withdrawal, was related to a high number of quit attempts and to remaining a current smoker. The urgent need for tobacco, craving for nicotine, smoking to avoid withdrawal, and the expectation of increased appetite or weight gain correctly classified smoking status in 72.1% of individuals through logistic regression analysis.Conclusions. Nicotine dependence is a strong factor that may partly explain the failure of a subpopulation of smokers to live abstinent. Population-based interventions should include measures of tobacco control and brief interventions carried out, for example, by experts in health care. [Copyright &y& Elsevier]

• Depression and obesity are clinically heterogeneous and frequently co-occur. • We examined sociodemographic and socioeconomic risk factors for the comorbidity. • We used nationally representative data for the german adult population. • Prevalence of comorbid depression and obesity was 1.3% in men and 2.0% in women. • Targeted public health strategies are needed for women with a low socioeconomic position. Depression and obesity are common health problems with major public health implications. These conditions frequently co-occur, adversely affecting the course of the other. The sociodemographic and socioeconomic risk factors for comorbid depression and obesity in the German adult population have not yet been reported. We analyzed the prevalence and sociodemographic and socioeconomic correlates of comorbid depression and obesity using cross-sectional data from the national German health interview and examination survey for adults (DEGS1; n = 7987) and its mental health module (DEGS1-MH; n = 4493). The Composite International Diagnostic Interview was used to diagnose major depressive disorder (CIDI-MDD). Sensitivity was analyzed using the self-reported depression measure and current depressive symptoms measured by Patient Health Questionnaire-9 (PHQ-9). Obesity was defined by body mass index calculated from measured data. Prevalence of comorbid depression and obesity was 1.3% (95% CI 0.8–2.0) in men and 2.0% (95% CI 1.3–3.0) in women. We found significant sex differences in results from the self-reported depression measure and the PHQ-9, but not from the CIDI-MDD. Low socioeconomic status and poor social support were linked to a higher prevalence of comorbid depression and obesity among women. Severe depression may have been underreported. Depression is statistically more prevalent in women than in men, which accounts for many of the sex differences in the prevalence of comorbid depression and obesity in our models. Targeted public health strategies need to be developed to prevent and treat comorbid depression and obesity in women with a low socioeconomic position. [ABSTRACT FROM AUTHOR]

Introduction Depressive disorders have been related to increased health service utilization, but specific information about associations between health professional-diagnosed depression and the utilization of health care and preventive services in the general population is limited. Objectives To compare the use of health care and preventive services among men and women with and without diagnosed depression in the general population in Germany. Aims To examine the association of diagnosed depression with the utilization of healthcare and preventive services. Methods Cross-sectional analysis of data from the representative telephone survey German Health Update (GEDA) 2009 and 2010 ( n = 43.312 residents in private households 18 years and older). We analyzed associations between self-reported health professional-diagnosed depression (past 12 months) and the use of a range of healthcare services and preventive services covered by statutory health insurances using multivariable regressions adjusted for age, socio-economic status, marital status, employment and number of chronic somatic conditions. Results Twelve-month diagnosed depression was associated with increased health care service utilization (physician contacts, hospital admissions, rehabilitation) in both sexes. Of the preventive services, diagnosed depression was associated with increased use of general health check-ups, cancer screening and flu vaccination among women, while there was no association with dental check-up and tetanus and pertussis vaccination. Among men, no association of diagnosed depression with any preventive service was found except for cancer screening. Conclusions Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. This includes some preventive services in women and only one preventive service in men. [ABSTRACT FROM AUTHOR]

Background: While standardized diagnostic interviews using established criteria are the gold standard for assessing depression, less time consuming measures of depression and depressive symptoms are commonly used in large population health surveys. We examine the prevalence and health-related correlates of three depression measures among adults aged 18-79 years in Germany.Methods: Using cross-sectional data from the national German Health Interview and Examination Survey for Adults (DEGS1) (n=7987) and its mental health module (DEGS1-MH) (n=4483), we analysed prevalence and socio-demographic and health-related correlates of (a) major depressive disorder (MDD) established by Composite International Diagnostic Interview (CIDI) using DSM-IV-TR criteria (CIDI-MDD) in the last 12 months, (b) self-reported physician or psychotherapist diagnosed depression in the last 12 months, and (c) current depressive symptoms in the last two weeks (PHQ-9, score ≥10).Results: Prevalence of 12-month CIDI-MDD was 4.2% in men and 9.9% in women. Prevalence of 12-month self-reported health professional-diagnosed depression was 3.8% and 8.1% and of current depressive symptoms 6.1% and 10.2% in men and women, respectively. Case-overlap between measures was only moderate (32-45%). In adjusted multivariable analyses, depression according to all three measures was associated with lower self-rated health, lower physical and social functioning, higher somatic comorbidity (except for women with 12-month CIDI-MDD), more sick leave and higher health service utilization.Limitations: Persons with severe depression may be underrepresented. Associations between CIDI-MDD and correlates and overlap with other measures may be underestimated due to time lag between DEGS1 and DEGS1-MH.Conclusions: Prevalence and identified cases varied between these three depression measures, but all measures were consistently associated with a wide range of adverse health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate proportions of alcohol problem drinking: alcohol use disorders (AUDs) and drinking above recommended levels among general hospital inpatients in northeastern Germany. Method: The sample includes consecutively admitted inpatients (n=14,332) between 18 and 64 years old. This study adopted a two-stage-sampling approach including screening and ascertainment of diagnosis based on DSM-IV criteria and a quantity-frequency index. Results: In total, 20.4% of all inpatients screened positive. Nine percent of the total sample were identified with current problem drinking in the following descending order: 5.3% AUD and 3.6% drinking above recommended levels. In addition, 3.1% of persons were diagnosed with alcohol dependence in remission. Proportions differed significantly among men and women (P<.001). Higher proportions of problem drinking were found at rural sites compared to urban sites (13.7% vs. 7.5%, P<.001). Conclusions: In addition to AUDs, drinking above recommended levels is a common problem among general hospital inpatients. Thus, the implementation of systematic alcohol screening and brief interventions should be considered. [Copyright &y& Elsevier]

Objective: This study tests two hypotheses. The first is that a U-shaped or inverse linear association exists between alcohol consumption and health-services utilization. Although this relationship has been examined previously, conclusions have been inconsistent. Additional research is needed to explain why abstainers use more health services than drinkers. Our second hypothesis is that abstainers with a history of heavy drinking seek out more health services than those without heavy drinking histories. Method: Data were from two surveys conducted in Germany (N's = 4,268 [51% women] and 6,857 [52% women]). Alcohol consumption was assessed using a quantity-frequency measure. Results: Outpatient and inpatient services showed an inverse linear relation with alcohol consumption. Among abstainers, those with a drinking history exhibited a higher use of outpatient visits but were not more likely to have been hospitalized. Conclusions: This study supports the view that alcohol consumption is associated with decreased utilization of health services. Results provide some evidence for the hypothesis that former heavy drinkers have higher health-services utilization than either moderate drinkers or other abstainers. [ABSTRACT FROM AUTHOR]

Few data exist about the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) from population samples. The goal was to prove to what degree (1) a reduced item solution of the FTND and (2) the HSI represent the FTND. Two randomized adult population samples were used from northern Germany. Sample 1 included 1462 and sample 2 included 1042 current daily cigarette smokers aged 20–64 years with FTND data. The results show that four items of the FTND as well as the HSI represent the FTND. It is concluded that both are valid measures of the urge to smoke and the tobacco-smoke-seeking behavior. [Copyright &y& Elsevier]

Little is known about the specific pathways between depression and low self-efficacy to stop smoking, particularly among the general population. The goal was to examine whether depression and nicotine dependence may predict the confidence in the ability to refrain from smoking (CAS). A random population sample aged 18–64 was used from northern Germany. It included 1520 current smokers, who were eligible for a first follow-up after 30 months and a second follow-up after 36 months. The results show that DSM-IV major depression and nicotine dependence, the Fagerström Test for Nicotine Dependence (FTND), the number of cigarettes smoked, the age at onset of daily smoking, and the intention to stop smoking predict the CAS. It is concluded that there may be an additive effect from nicotine dependence and major depression on the CAS. [Copyright &y& Elsevier]

: BackgroundThe aim of this study was to provide evidence about the individual intention to quit smoking and accompanying characteristics in a country with a low amount of tobacco control (TC) provisions.: MethodsThis study used a random sample of the population aged 18–64 in a German area to make a quantitative estimation of the stages of change to quit smoking among current smokers who had at least one quit attempt (n = 1075).: ResultsThe rate of those who did not intend to stop smoking (precontemplators) was 76.4%, that of those who intended to quit during the next 6 months (contemplators) was 17.0%, and that of those who intended to quit during the next 4 weeks was 6.6%. The three groups did not differ according to gender or age. Of those who had at least 16 years of education, more were contemplators than were those with fewer years of education. Among those who had somatic complaints or nausea from smoking, who had their first cigarette within 1 h or less after awakening, and who had more quit attempts, more were in the contemplation or preparation stage.: ConclusionsNicotine dependence may add to contemplating about quitting. The precontemplation rate was substantially higher than in samples from nations or states which show a large amount of TC provisions. [Copyright &y& Elsevier]