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Aufgrund des demografischen Wandels nimmt die Bedeutung der Versorgung alterer Menschen zu. Ein fur die nachsten Jahre zentrales Dokument ist die „Nationale Demenzstrategie (NDS)“, die 4 Handlungsfelder (HF) definiert, u. a. exzellente Forschung zu Demenz fordern. Auf dieser Basis wird sich die Demenzversorgungsforschung in den nachsten Jahren weiterentwickeln. Die aktuelle Forschung zu einzelnen Themen der NDS wird dargelegt und ein Ausblick auf die Entwicklung in den kommenden Jahren gegeben. Zur Verfolgung der genannten Zielsetzung wurde ein narratives Review erstellt, in dem Konzepte und Beispiele fur ausgewahlte Kapitel der NDS dargelegt wurden (Versorgungsforschungsforderung, Entwicklung und Transfer evidenzbasierter Praventions- und Versorgungskonzepte in die Routineversorgung, Unterstutzung von Menschen mit Demenz [MmD] und ihren Angehorigen, sektorenubergreifende Vernetzung, Partizipation in der Demenzforschung und Netzwerke zur Versorgungsforschung). Diese wurden im Hinblick auf zukunftige Entwicklungen analysiert und anhand aktueller Versorgungs- und Fordermodelle konkretisiert. Es wird ein Einblick gegeben, in die Versorgungskonzepte Dementia Care Management, regionale Versorgungsmodelle wie „Medizin neu denken“ und E‑Health. Beispielhaft fur aktuelle strukturelle Methoden der evidenzbasierten Gestaltung der zukunftigen Versorgung werden der Innovationsfonds und Forschungspraxennetzwerke beschrieben. Die NDS stellt eine ambitionierte Agenda mit sehr umfassenden Zielen und Themen fur die Verbesserung der Versorgung von MmD dar. Es ist davon auszugehen, dass sie die Versorgungsforschung und somit auch Versorgung zukunftig masgeblich pragen wird. Zentrale, sich gegenseitig beeinflussende und verstarkende Bausteine auf dem Weg zur Verbesserung der Situation fur MmD und das Gesundheitssystem sind dabei Translation, Partizipation und Vernetzung in der Forschung.

Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011–2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7%) completed the questionnaire. This was 50.1% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9%) and highest for home visits (18.4%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues.

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 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).

Due to the demographic change healthcare for older people is becoming more important. A key strategic document for the near future is the national dementia strategy (NDS), which defines four fields of action including promoting excellent research on dementia. The NDS will guide and influence the further development of dementia healthcare research in the coming years.The current research on specific NDS topics is presented and an outlook on expected developments is given.This article provides a narrative review in which concepts and examples for selected sections of the NDS are presented: funding and promotion of healthcare research, development of evidence-based prevention and healthcare concepts and transfer into routine care, support for people with dementia (PwD) and their caregiver, cross-sectoral networking, participation in dementia research and networks in healthcare research. These were analyzed with respect to future developments and concretized based on current healthcare and promotion models.Insights are given into the healthcare concept of dementia care management, rethinking regional healthcare models such as medicine and e‑health. The innovation fund and research practice networks are described as examples of current structural methods of evidence-based design of future healthcare.The NDS represents an ambitious agenda with very comprehensive goals and topics for the improvement of healthcare for PwD and will probably significantly influence healthcare research and thus healthcare in the future. Overarching, mutually influencing and strengthening components on the way to improvement of the situation for PwD and the healthcare system are translation, participation and networking in research.

Physical activity (PA) behavior is increasingly described as trajectories taking changes over a longer period into account. Little is known, however, about predictors of those trajectories among migrant populations. Therefore, the aim of the present cohort study was to describe changes of PA over six years and to explore migration-related and other predictors for different PA trajectories in adults of Turkish descent living in Berlin. At baseline (2011/2012) and after six years, sociodemographics, health behavior, and medical information were assessed. Four PA trajectories were defined using data of weekly PA from baseline and follow-up: &ldquo, inactive&rdquo, &ldquo, decreasing&rdquo, increasing&rdquo, and &ldquo, stable active&rdquo, Multivariable regression analyses were performed in order to determine predictors for the &ldquo, trajectory, and results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). In this analysis, 197 people (60.9% women, mean age &plusmn, standard deviation 49.9 &plusmn, 12.8 years) were included. A total of 77.7% were first-generation migrants, and 50.5% had Turkish citizenship. The four PA trajectories differed regarding citizenship, preferred questionnaire language, and marital status. &ldquo, Stable active&rdquo, trajectory membership was predicted by educational level (high vs. low: aOR 4.20, 95%CI [1.10, 16.00]), citizenship (German or dual vs. Turkish only: 3.60 [1.20, 10.86]), preferred questionnaire language (German vs. Turkish: 3.35 [1.05, 10.66]), and BMI (overweight vs. normal weight: 0.28 [0.08, 0.99]). In our study, migration-related factors only partially predicted trajectory membership, however, persons with citizenship of their country of origin and/or with poor language skills should be particularly considered when planning PA prevention programs.

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 The growing proportion of people with a migration background poses major challenges for public health and the health care system in Germany. People of Turkish descent represent the largest group within this specific population. The aim of this study was therefore to examine the use and satisfaction of medical services and barriers to health care access among adults of Turkish descent in Germany. Methods A cohort study of a group of nearly 1200 Turkish adults in Berlin and Essen constitutes the basis of this analysis. The baseline examination was carried out as part of the pretests of the German National Cohort study. This follow-up survey assessed utilization, satisfaction and subjectively perceived barriers in the German health care system, as well as socio-demography, lifestyle, health status and quality of life via self-report (paper based or online) in Turkish or German. Descriptive preliminary results are presented in this abstract. Results The first 287 participants interviewed until December 31, 2018 were on average 49 years old, with 64% being female. 90% of the participants had a family doctor and in the last 12 months, 17% were in a hospital for in-patient treatment and 23% in an emergency room. The use of screening programs varied from 15% (skin cancer screening) to 87% (mammography). The most frequently visited physician was the general practitioner (86%). The participants were satisfied regarding many aspects, with the best values for the communication with their doctor. However, 22% reported problems or barriers in the context of medical care in the last five years. Conclusions These preliminary results provide a first insight into the utilization behaviour among adults of Turkish descent, their satisfaction as well as barriers with the German health care system. However, possible consequences of our study should only be discussed after all analyses have been completed. Key messages This is one of the few cohort studies in a migrant population in Germany. Knowledge of barriers could provide indications of problems of adults of Turkish descent in the German health care system.

Background Follow-up participation and retention are essential in long-term cohort studies. Loss to follow up may reduce the power of statistical analyses and external validity. The aim of this analysis was to evaluate the response after different contact methods in a cohort study with Berliners of Turkish descent and to compare characteristics of participants with those of non-participants. Methods In 2012-2013, Berliners with a Turkish migration background were recruited for this cohort study that initially aimed to examine recruitment strategies. The participants were contacted again 5 years later via postal mail and were asked to complete a questionnaire on the onset of new diseases and health care utilization. Written reminders, phone calls, and home visits were used to increase the response. Study documents were available in German and Turkish language. In descriptive analyses, we examined the response rate in relation to the recruitment approach. A regression analysis was conducted to investigate associations between individual, socioeconomic, and medical factors and the response. Results Out of 560 contacted persons, the neutral non-response (unknown address or death) was 13.6%. Of the remaining 484, 234 persons participated in the follow-up (women: 63.1%, mean age±SD: 49.8±12.6 years). The response was 16.1% after the first invitation letter, 24.2% after phone calls, 33.3% and 42.1% with a first and a second reminder letter, respectively, and 48.3% after home visits. The participants had more often German citizenship and a higher net income at baseline than non-participants. Migration generation, age, sex, education, and chronic diseases were not associated with participation (preliminary results). Conclusions In our participants with a migration background, every additional contact effort including home visits further increased cohort retention. Investing in comprehensive retention efforts may lead to studies that are more valid to examine the health of migrants. Key messages Investing in different contact efforts including reminder letters and home visits can improve follow-up response in longitudinal studies. Retention strategies should be used in longitudinal studies to increase statistical power and external validity.

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.

More than half of all cardiovascular diseases are caused by eight, mostly preventable risk factors.In view of the considerable differences in the prevalence and mortality of cardiovascular diseases between the 16 German federal states, the regional distribution of cardiovascular risk factors was analyzed stratified for men and women, using population-based data.Pooled data (n = 62,606) from the national, telephone health surveys "German Health Update" from 2009, 2010 and 2012 were used to estimate the prevalence of physical inactivity, risky alcohol consumption, smoking, low fruit and vegetable consumption, obesity and diagnosed hypertension, diabetes and dyslipidemia and the accumulated number of risk factors stratified for men and women in the federal states. Furthermore, we analyzed the influence of age and social status on prevalence differences.At the national level, 36.0% of men and 26.6% of women had three or more risk factors. Large differences between men and women were found for risky alcohol consumption (32.8% versus 21.7%), low fruit and vegetable consumption (20.6% versus 10.4%) and current smoking (32.6% versus 24.9%). The prevalence of all eight risk factors differed considerably between federal states. The highest prevalence of physical inactivity, obesity, hypertension and diabetes in both sexes as well as risky alcohol consumption in men were observed in the Eastern federal states (except for Berlin). Sachsen-Anhalt was the only federal state with the highest prevalence for two risk factors. Current smoking was most prevalent in the three federal city states Berlin, Hamburg and Bremen. Saarland had the highest prevalence of low fruit and vegetable consumption in both sexes. Regional differences remained after adjustment for age and social status.There is evidence for regional differences in cardiovascular risk factor levels in Germany that resemble variations in the prevalence and mortality of cardiovascular diseases between federal states with a more unfavorable situation in the East (except for Berlin). Overall, this study shows a considerable need for the prevention of mostly modifiable risk factors for cardiovascular diseases in men and women in Germany.

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.