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André Hajek,1 Katharina Grupp,2 Ghazal Aarabi,3 Benedikt Kretzler,1 Hans-Helmut König1 1Department of Health Economics and Health Services Research, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany; 2Division of Plastic, Reconstructive and Aesthetic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 3Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg Eppendorf, Hamburg, GermanyCorrespondence: André Hajek, Department of Health Economics and Health Services Research, University Medical-Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, Tel +49 40 7410 52877, Fax +49 40 7410 40261, Email a.hajek@uke.dePurpose: To analyze the link between Parkinson’s disease and perceived prospects for the future.Patients and Methods: Data were taken from the German Ageing Survey (year 2021; n=4296 individuals, thereof 33 individuals with Parkinson’s disease) were used. This is a nationally representative sample of community-dwelling individuals ≥ 40 years in Germany. Perceived prospects for the future in different life domains (ie, living standard, health and general optimism) were used as outcomes. Physician-diagnosed Parkinson’s disease served as key independent variable . It was adjusted for several covariates.Results: Individuals with Parkinson’s disease had a markedly worse (Cohen’s d=0.65) general optimism compared to individuals without Parkinson’s disease. After adjusting for various factors, these differences disappeared in multiple linear regressions (β=− 0.04, p=0.72). Moreover, multiple ordered logistic regressions showed that individuals with Parkinson’s disease had a worse future self-rated health (OR: 4.10, 95% CI: 1.99– 8.47, p< 0.001) compared to individuals without Parkinson’s disease.Conclusion: Our study first showed that general optimism may be lower among individuals with Parkinson’s disease (bivariate analysis). However, this association disappeared when it was adjusted for health-related factors in regression analysis. In sum, our findings indicate that more general future-related factors did not significantly differ between individuals with and without Parkinson’s disease. However, there were significant differences in future self-rated health.Keywords: perceived longevity, outlook, optimism, health, living standard, Parkinson, Parkinson’s disease

Benedikt Kretzler, Hans-Helmut König, Linéa Brandt, Helene Rabea Weiss, André Hajek Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyCorrespondence: Benedikt KretzlerDepartment of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20251, GermanyTel +49 40 741 024 161Fax +49 40 741 040 261Email b.kretzler.ext@uke.deAbstract: Recent research highlighted the influence of religion among health outcomes. To the best of our knowledge, there is no systematic review that summarizes the evidence on the relationship between religious factors and the utilization of cancer screenings. Therefore, this article aims to list the findings about the influence of religious denominations, the importance of religion in one’s life, and religious practices, such as church attendance on the utilization of cancer screenings. PubMed, PsycInfo and CINAHL were searched using a predefined algorithm in June 2020. We included observational studies that examined the association between religion and cancer screening use and employed appropriate items to quantify these key variables. Study selection, data extraction and quality assessment were performed independently by two reviewers. We detected n=27 studies that fulfilled the inclusion criteria. Hereby, n=16 used data from the United States. Most of the studies that were included in our review found a positive association between religious attendance and cancer screening utilization. There was mixed evidence concerning religious denomination as well as religiosity and use of cancer screenings. The studies suggest that religious factors are related to the utilization of cancer screenings. The findings of this systematic review may be helpful to resolve the underuse of cancer screenings by revealing at-risk-groups.Keywords: spirituality, religiosity, cancer screening, preventive medicine, religious denomination, systematic review

André Hajek,1 Freia De Bock,2 Lena Huebl,3 Benedikt Kretzler,1 Hans-Helmut König1 1Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Federal Centre of Health Education, Cologne, Germany; 3Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyCorrespondence: André HajekDepartment of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, GermanyTel +49 40 7410- 52877Fax +49 40 7410- 40261Email a.hajek@uke.dePurpose: The COVID-19 pandemic is accompanied by various challenges for individual health and the health care system. However, preventive examinations such as cancer screenings should not be postponed during a pandemic. Because nationally representative studies describing postponed cancer screenings and identifying its determinants in Germany are lacking, our aim was to close this gap in knowledge.Materials and Methods: We used cross-sectional data from the nationally representative online-survey “COVID-19 Snapshot Monitoring in Germany (COSMO)” (wave 17), which was conducted in July 2020. The analytical sample included 974 individuals (mean age was 45.9 years, SD: 16.5 years; 18 to 74 years). The outcome measure was whether cancer screening had been postponed since March 2020 due to the COVID-19 pandemic (no, attended as planned; yes, postponed).Results: In total, slightly more than 10% of individuals stated to have postponed cancer screenings between March and July 2020 due to the COVID-19 pandemic, particularly women and individuals aged 30 to 49 years. The likelihood of postponed cancer screening was positively associated with higher affect regarding COVID-19 (OR: 1.65, 95% CI: 1.16– 2.35), whereas it was negatively associated with younger age (eg, 18 to 29 years, OR: 0.17, 95% CI: 0.05– 0.64, compared to individuals 30 to 49 years).Conclusion: Study findings showed that one out of ten individuals postponed cancer screenings during the COVID-19 pandemic. We determined two correlates of them (age and affect regarding COVID-19). Individuals with an increased likelihood of postponed cancer screenings should be specifically addressed.Keywords: cancer screening, corona-virus, COVID-19, delayed screening, postponed screening; SARS-CoV-2; access to health care; availability of medical care; health care use; health care utilization; health services research; postponed treatment

Background/aims: Our current study aimed to investigate the determinants of dementia among the oldest old using longitudinal data from a representative sample covering both community-dwelling and institutionalized individuals., Methods/design: Longitudinal representative data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" that surveyed community-dwelling and institutionalized individuals aged 80 years and above (n = 1,296 observations in the analytic sample), living in North Rhine-Westphalia (most populous state of Germany). The established DemTect was used to measure cognitive impairment (i.e., probable dementia). A logistic random effects model was used to examine the determinants of probable dementia., Results: The mean age was 86.3 years (SD: 4.2 years). Multiple logistic regressions revealed that a higher likelihood of probable dementia was positively associated with lower education (e.g., low education compared to medium education: OR: 3.31 [95% CI: 1.10-9.98]), a smaller network size (OR: 0.87 [95% CI: 0.79-0.96]), lower health literacy (OR: 0.29 [95% CI: 0.14-0.60]), and higher functional impairment (OR: 13.45 [3.86-46.92]), whereas it was not significantly associated with sex, age, marital status, loneliness, and depressive symptoms in the total sample. Regressions stratified by sex were also reported., Discussion: Our study identified factors associated with dementia among the oldest old. This study extends current knowledge by using data from the oldest old; and by presenting findings based on longitudinal, representative data (also including individuals residing in institutionalized settings)., Conclusions: Efforts to increase, among other things, formal education, network size, and health literacy may be fruitful in postponing dementia, particularly among older women. Developing health literacy programs, for example, may be beneficial to reduce the burden associated with dementia., (© 2024. The Author(s).)

Background: There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes., Objective: To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany., Material and Methods: Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models., Results: Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (β = 0.48, p < 0.05), high education (compared to low education, β = 0.46, p < 0.05), having a small social network size (β = -0.02, p < 0.05), having poor self-rated health (β = -0.25, p < 0.05), and more depressive symptoms (β = 0.25, p < 0.001)., Conclusion: A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness., (© 2023. The Author(s).)

Purpose: To examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation)., Methods: We used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems., Results: Adjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (β = 0.17, p < .01) and depressive symptoms (β = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (β = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (β = 0.43, p < 0.05)., Conclusion: Our longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life., (© 2023. The Author(s).)

Objectives: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany., Methods/design: Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted., Results: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes., Conclusions: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Background: Given the very limited knowledge, the purpose of this study was to identify the current prevalence and correlates of fear of conventional and of nuclear war in the general adult population (Germany)., Methods: Data were taken from a representative survey (n = 3091 participants; mid-March 2022). Established items were used to quantify fear of conventional war and fear of nuclear war. Linear regressions were used to examine the correlates of fear of conventional war and fear of nuclear war, adjusting for several covariates., Results: While 5.3 % of the respondents were not at all worried about a conventional war, 44.2 % of the respondents reported some fear and 50.5 % of the respondents reported severe fear of a conventional war. Similarly, 7.7 % of the respondents were not at all worried about a nuclear war, whereas 45.7 % of the respondents reported some fear and 46.6 % of the respondents reported severe fear of a nuclear war. The prevalence rates mainly slightly differed between sociodemographic groups (with the exception of gender and having children) and were thus consistently high. Regressions showed that both higher fear of a conventional war and higher fear of a nuclear war were associated with being female, having children in own household, being married and living together with spouse, having at least one chronic illness and poor self-rated health., Conclusion: Our study showed high prevalence rates for fear of war (both, conventional war and nuclear war). Knowledge about the correlates may assist in tackling individuals at risk for severe fear. Against the background of the current events in Eastern Europe, future research in this area is urgently required., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Purpose: To investigate the longitudinal association between neighbourhood cohesion and loneliness as well as perceived social isolation prior and during the COVID-19 pandemic (stratified by sex)., Methods: Longitudinal data were taken from a nationally representative sample (German Ageing Survey) of inhabitants aged 40 years and over in Germany prior (wave 6: year 2017) and during the COVID-19 pandemic (wave 8: November 2020 until February 2021; n = 6688 observations, mean age was 67.4 years). The De Jong Gierveld tool was used to measure loneliness and the Bude and Lantermann tool was used to measure perceived social isolation. Neighbourhood cohesion was assessed based on different items., Results: FE regressions showed that decreases in closeness of contact with neighbours were associated with increases in loneliness and perceived social isolation levels among men, but not women. In contrast, decreases in different indicators of involvement in neighbourhood activities were associated with increases in loneliness and perceived social isolation levels among women, but not men., Conclusion: Changes in neighbourhood factors are differently associated with loneliness and perceived social isolation among middle-aged and older women and men. Gender-specific efforts to avoid loneliness and social isolation are, therefore, needed., (© 2023. The Author(s).)

Background: Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL., Methods: A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses., Results: Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (β = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (β = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (β = 1.89, p < 0.01)., Conclusion: Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: To identify the reasons of individuals aged 60 years and older in Germany for not getting vaccinated against Covid-19., Methods: Data for this study were collected in July/August 2021 from "Kommunikation der Corona-Schutzimpfung in Deutschland" (CoSiD)", a representative survey of the general adult population in Germany. The focus was on individuals aged 60 years and older in our current study (n=1,281 individuals)., Results: Approximately 92% of individuals 60 years and older were already vaccinated against Covid-19. Among the older unvaccinated, nearly 60% were opposed to vaccination. Major reasons among older (and also younger) unvaccinated persons for "rather not getting vaccinated"/"definitely not" wanting to be vaccinated against Covid-19 were: (1) too little research on the vaccines or too short a time of research (roughly half of the individuals) and (2 and 3) no confidence/general skepticism or because of side effects (in each case, just over a quarter of the group surveyed)., Conclusion: To increase the vaccination rate, these three arguments must be countered, for instance, during conversations in the context of medical care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge., Methods: Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis., Results: Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (β = 0.11, P < 0.001) and higher depressive symptoms (β = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (β = 0.02, P < 0.001) and higher depressive symptoms (β = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (β = -0.35, P < 0.001) and lower depressive symptoms (β = -0.36, P < 0.001)., Conclusion: Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required., (© 2023 The Authors. Psychogeriatrics published by John Wiley & Sons Australia, Ltd on behalf of Japanese Psychogeriatric Society.)

Background: There is a complete lack of studies focusing on the association between care degree (reflecting the long-term care need) and loneliness or social isolation in Germany., Aims: To investigate the association between care degree and loneliness as well as perceived social isolation during the COVID-19 pandemic., Methods: We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. We used wave 8 of the German Ageing Survey (analytical sample: n = 4334 individuals, mean age was 68.9 years, SD: 10.2 years; range 46-100 years). To assess loneliness, the De Jong Gierveld instrument was used. To assess perceived social isolation, the Bude and Lantermann instrument was used. Moreover, the level of care was used as a key independent variable (absence of care degree (0); care degree 1-5)., Results: After adjusting for various covariates, regressions showed that there were no significant differences between individuals without a care degree and individuals with a care degree of 1 or 2 in terms of loneliness and perceived social isolation. In contrast, individuals with a care degree of 3 or 4 had higher loneliness (β = 0.23, p = 0.034) and higher perceived social isolation scores (β = 0.38, p < 0.01) compared to individuals without a care degree., Discussion/conclusions: Care degrees of 3 or 4 are associated with higher levels of both loneliness and perceived social isolation. Longitudinal studies are required to confirm this association., (© 2023. The Author(s).)

Background: Prior to the COVID-19 pandemic, research findings pointed towards an alleviating effect of religion on depressive symptoms and loneliness. However, it is not clear whether such a relationship persisted when worships were mostly held as online events. Consequently, this study investigates the link between religion-related internet utilization, particularly for online worships, depressive symptoms, and loneliness during the lockdown period., Methods: Data were derived from a representative sample of German individuals aged 40 years and above, which was conducted in June and July 2020. Utilization of internet for religious purposes was treated as a dichotomous variable., Results: Regarding bivariate analysis, individuals that used the internet for religious purposes were significantly older, and more likely to be female or to live in an urban setting. Furthermore, they had significantly more severe depressive symptoms. According to multiple linear regression, internet usage for religious purposes was both associated with more depressive symptoms, R² = .30, F(11, 3367) = 113.01, ß = 0.39, p = .050, and higher loneliness levels, R² = .09, F(11, 3367) = 25.75, ß = 2.24, p = .025., Conclusions: It seems possible that the alleviating effect of religion on depressive symptoms and loneliness did not hold during the COVID-19 pandemic, which may imply that online worships are not perfect replacements for traditional worships in terms of their social and health benefits., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

Objective: to examine whether perceived norms are associated with vaccination against COVID-19 (also stratified by age group)., Study Design: nationally representative survey., Methods: Data were taken from a sample of the general adult population ( n = 3829, 16 to 94 years). Data collection took place from early July to early August 2021, and 3 different groups (1: not yet vaccinated and no intention to vaccinate against COVID-19; 2: not yet, but intended to vaccinate against COVID-19; 3: yes, at least one vaccination against COVID-19) were distinguished in the analyses. Data were adjusted for several sociodemographic and health-related factors. Perceived norms served as key independent variables (1: number of important friends and relatives who would like me to get vaccinated; 2: number of important friends and relatives who already have been vaccinated or still want to do so; 3: how your general practitioner (GP) thinks about Corona vaccination)., Results: Multiple logistic regression showed that, in particular, the number of important friends/relatives who would like an individual to get vaccinated is associated with the actual COVID-19 vaccination status among individuals aged 16 to 59 years. Interestingly, all 3 indicators for perceived norms are associated with the likelihood of COVID-19 vaccination status among individuals aged 60 years and over., Conclusions: Our study adds to the understanding of the association between perceived norms and COVID-19 vaccination status. This highlights potential pathways to increase vaccination rates to further combat the later stages of the pandemic.

Introduction: There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)-which is important for successful aging., Methods/design: Data were taken from a nationally representative sample-the German Ageing Survey-including older community-dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations., Results: In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65-97 years). After adjusting for various socioeconomic, lifestyle-related, and health-related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (β = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender., Conclusions: The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Objective: There is a lack of knowledge regarding utilization of and attitudes towards tests for the detection of SARS-CoV-2 in Germany. Our work aimed to reduce this gap., Methods: Data were taken from a nationally representative online survey (August 24th to 3rd September 2021, n=3,075; mean age: 44.5 years). Utilization of and attitudes toward Covid-19-tests were quantified in detail., Results: In sum, 79.1% of respondents had already undergone an appropriate test to detect SARS-CoV-2 test (mainly rapid antigen testing at rapid testing centers and self-testing) or an antibody test. With the exception of a PCR test, Covid-19 tests were rarely perceived as uncomfortable. Respondents were most likely to prefer a rapid antigen test in a rapid testing center. The main reasons for using self-testing as well as rapid antigen testing at rapid testing centers were (i) protection of others, (ii) for their own health precautions, and (iii) traveling. The main reasons for not using self-testing/rapid antigen testing at the workplace/training center were: (i) already vaccinated against Covid-19/recovered from Covid-19, followed by (ii) the home office workplace, and (iii) a lack of perceived benefit. Nearly 80% were somewhat or very satisfied, with access to testing at the workplace/training center and rapid testing centers., Conclusion: Our work described the use of and aspects of attitudes toward tests for the detection of SARS-CoV-2 in Germany in late summer 2021. At that time, such test offers were already used quite often and were predominantly perceived as not being very unpleasant. The protection of other individuals was one of the main reasons for the use of such tests. Future research in this area is desirable (e. g., among the oldest old and in times when free-of-charge testing is no longer offered)., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: Since there is limited knowledge with regard to the frequency and correlates of mild cognitive impairment and dementia among the oldest old based on large representative data (including institutionalized individuals), our objective was to fill this research gap., Methods: For our study, data came from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)". This study included community-dwelling and institutionalized individuals aged 80 years and over (n = 1,173, mean age: 86 years) residing in the most populous state of Germany (North Rhine-Westphalia). The DemTect was used to quantify cognitive impairment (i.e., probable mild cognitive impairment and probable dementia)., Results: Overall, 73.1% of the individuals were not cognitively impaired, 17.0% of the individuals had probable mild cognitive impairment and 9.9% of the individuals had probable dementia. Compared to individuals without cognitive impairment, individuals with probable mild cognitive impairment were more likely to be male, live in an institutionalized setting, have a lower educational level, have a smaller network size, and have lower functional abilities. Moreover, compared to individuals without cognitive impairment, individuals with probable dementia were more likely to be older, live in an institutionalized setting, have a lower educational level, have a smaller network size, not be multimorbid, and have lower functional abilities., Conclusions: Our study identified several sociodemographic and health-related factors which are associated with probable mild cognitive impairment and probable dementia among the oldest old. This knowledge may help to address individuals at risk for mild cognitive impairment and dementia., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: Several publications explored a relationship between pet ownership and lower levels of loneliness and social isolation. However, to the best of our knowledge, no systematic review has yet synthesized the evidence on these associations. Thus, this systematic review aims to evaluate the findings regarding the relations between pet ownership, loneliness, and social isolation., Methods: PubMed, CINAHL, and PsycInfo were searched in January 2022. Observational studies relying on appropriate instruments to assess the exposure and the outcome variables were included. Two reviewers independently executed study selection, data extraction, and quality assessment., Results: n = 24 studies were included. Among adult samples, the studies examining the relationship between pet ownership and social isolation found that owning a pet was associated with lower levels of social isolation. Concerning loneliness, studies that were conducted after the outbreak of COVID-19 mostly showed that pet ownership can contribute to lower levels of loneliness, but did not reveal an overall significant association until then. In turn, the studies that examined child and adolescent samples suggest that pet ownership was related to reduced loneliness before COVID-19. Furthermore, most of the studies did not reveal any differences between dogs, cats, and other kinds of pets regarding their relationship to loneliness and social isolation., Conclusion: All in all, only a part of the studies detected a significant association between pet ownership, loneliness and social isolation. However, the COVID-19 pandemic seemed to strengthen this relationship, so that future research is required to assess the longevity of this potential effect., (© 2022. The Author(s).)

Objectives: Clarify the association between income group and oral health-related quality of life., Methods: Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values., Results: Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen's d = -0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen's d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen's d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (β = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (β = -0.28, p < 0.10)., Conclusions: The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.

Objective: There is a lack of studies focusing on the use of health care facilities by homeless people. The aim of this study was to survey health care use by the homeless., Methods: Data were taken from the Hamburg survey of homeless individuals (n=150, mean age:12,5 years; SD: 12,5 years). Assessment covered details of health insurance status, use of ambulatory and hospital care, medication use, and reasons for not accessing health services., Results: In total, 61,2% of the homeless individuals had health insurance. About two thirds of homeless individuals (65,9%) had accessed some sort of medical services in the past 12 months. The key reason for not making use of health services was the absence of any need for treatment (74,6%). In sum, 39,8% of homeless individuals had made at least one hospital visit in the past 12 months. About one third (34,2%) had used mobile support services (mainly a mobile doctor's office). In total, 37,7% of homeless individuals took medications regularly, with 'prices too high' (63,6%) being the key reason for difficulties in access to medications. Almost one half of homeless individuals (47,0%) had not made a visit to a physician in the past three months., Conclusion: Additional efforts are required to improve access to health care by homeless individuals. Future research in this area is therefore necessary., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: To analyze the link between individuals with and without migration background and oral health-related quality of life (also stratified by sex)., Methods: Data in this cross-sectional study were taken from a nationally representative survey (n = 3075, August/September 2021). The Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. Two-part models were calculated, adjusting for various covariates., Results: Individuals with migration background had lower oral health-related quality of life (total sample, Cohen's d = - 0.30; in men, d =- 0.44; in women, d =- 0.22). Two-part models also revealed that the migration background was associated with a higher likelihood of OHIP-G5 scores of one or higher (total sample and in both sexes). Moreover, migration background was positively associated with the extent of oral health-related quality of life (conditional on OHIP-G5 scores of one or higher; total sample and in men). Furthermore, regressions showed that migration background was associated with lower oral health-related quality of life (total sample and in both sexes)., Conclusions: Our study emphasized the link between having a migration background and lower oral health-related quality of life among both women and men. Maintaining oral health among individuals with a migration background is a key challenge. Culturally and socially sensitive actions should provide easy accessible oral health information and preventive measures in order to lower access barriers in dental care for individuals with migration background., (© 2022. The Author(s).)

Thus far, the prevalence and correlates of obesity among the oldest have been identified in several studies. Nevertheless, there is a lack of a systematic review, meta-analysis and meta-regression synthesizing the existing observational studies. Consequently, our aim was to fill this knowledge gap. Three electronic databases were searched (Medline, PsycINFO, CINAHL) and an additional hand search was performed. Observational studies (both, cross-sectional and longitudinal) determining the prevalence and (preferably) the correlates of obesity in the oldest old (≥80 years) were included. Data extraction covered study design, measurement of obesity, analytical approach, sample characteristics and main results. In total, 19 studies were included. Reported prevalence of obesity in the community varied greatly (range 0.7%-71.5%). The pooled prevalence of obesity was 17.8% (95% CI: 13.3%-22.2%), with significant heterogeneity between studies (I 2  = 99.7%, P < 0.001). There is evidence of a publication bias. Meta-regressions showed that some of the heterogeneity was explained by the types of measures of obesity and country of the respective sample. In conclusion, obesity remains a key challenge among the oldest old. Future research in this age bracket is urgently required in regions mostly neglected thus far (e.g., South America, Africa or Asia). Moreover, studies based on longitudinal data are required to clarify the determinants of obesity among the oldest old. Furthermore, studies based on objectively recorded obesity (e.g., waist circumference) are also required. Geriatr Gerontol Int 2022; 22: 373-383., (© 2022 The Authors. Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Purpose To examine the relationship between regular childhood dental visits, and health status and quality of life in later life. Methods Cross-sectional data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (n = 2,368; mean age was 66.2 (SD: 9.1, ranging from 50 to 95 years). We focused on data from Germany. Health-related outcome measures (i.e. functional status, cognitive functioning, and self-rated health) were quantified using established tools. Quality of life was assessed using the well-recognized CASP-12. Results In sum, 65.8% of the individuals had regular childhood dental visits. Multiple linear regressions showed that regular childhood dental visits were not associated with present functional status, cognitive functioning or with self-rated health. However, regular childhood dental visits were associated with better quality of life. Moreover, being married, tertiary education (reference: primary education) and not being obese were each associated with higher cognitive functioning, better self-rated health and better quality of life. Conclusion: Regular childhood dental visits were associated with better quality of life. Future studies are required to elucidate the underlying causes., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Several economic evaluations of musculoskeletal physiotherapy have been published in the literature. We aim to provide an overview of these existing economic evaluations. This overview will be useful for healthcare funders in identifying studies matching their context. In addition, research gaps as well as literature extensive enough to be combined in a meta-analysis will be identified. This will support researchers in planning relevant research projects., Methods and Analyses: We will search in PubMed, EconLit and NHS-EED for relevant literature. Full economic evaluations of musculoskeletal physiotherapy interventions will be included, regardless of type, and economic evaluation perspective. Initial searches were performed on 7th October 2021. Study selection, data extraction and the quality evaluation will be conducted initially by two independent researchers. If their agreement is sufficient, one reviewer will proceed with the respected process. From the included studies, we will extract information on the publication year, the country of origin, the type of economical evaluation analyses and the specific musculoskeletal condition. An overview will be provided, concerning the distributions of the included studies regarding the extracted information. Furthermore, an evaluation of the individual study quality will be offered., Ethics and Dissemination: No ethical approval will be required for this systematic review, since no human participants are involved. We aim to distribute the findings of this review in a peer-reviewed journal, on national and international conferences, as well as via social media., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Our aim was to investigate to what extent physician visits were replaced by telemedicine services because of the COVID-19 pandemic and the satisfaction with such telemedicine services. Cross-sectional data from the "COVID-19 Snapshot Monitoring in Germany" (COSMO, wave 49 from 11 to 12 August 2021 with n = 967). The average age was 44.9 years (SD: 15.6 years, ranging from 18 to 74 years) and 50.8% were female. Indiviuals were asked whether any physician visit was replaced by a telemedicine service (e.g., video consultation) since March 2020 because of the pandemic (yes, once; yes, several times; yes, always; no, not replaced; no, there was no need to see a doctor). Additionally, individuals who gave positive responses (i.e., yes, once; yes, several times; yes, always) were asked how satisfied they were with the corresponding telemedicine services (from 1 = very dissatisfied to 7 = very satisfied). While 55.4% of the respondents reported no need to see a doctor and 31.3% of the respondents did not replace physician visits by telemedicine services, about 13.3% of the respondents did replace physician visits by telemedicine services (4.8%: yes, once; 6.4%: yes, several times; 2.1%: yes, always). Among the individuals who used such services, the average satisfaction was moderately high (4.7, SD: 2.0). Additionally, several correlates of the replacing telemedicine service use were identified (e.g., perceived severity of a COVID-19 infection). In conclusion, about one out of seven individuals replaced physician visits by telemedicine services during the pandemic. For example, knowledge about the correlates of satisfaction with such services might be of importance to increase the quality of such services.

Introduction: Several studies explored a relationship between religiousness and the utilisation of cancer screenings, as religious people may obtain an increased social network or could have certain personality traits that enhance screening use. To the best of our knowledge, there is no systematic review that sums up the evidence gained from research on that relationship. Thus, our review aims to appraise the findings of observational studies regarding that relationship. Its findings may be useful in addressing specific target groups to increase ineffectively the low cancer screening rates., Methods and Analysis: Employing a predefined search algorithm, three online databases (CINAHL, PsycInfo and PubMed) will be searched. In addition, the bibliographies of the studies included in our review will be searched through manually and independently by two reviewers. We are looking for observational studies (both cross-sectional and longitudinal) which examine the association between religion and cancer screening utilisation. However, studies regarding specific samples (as ethnic minorities or religious sects) will be excluded. We expect that the studies examine various dimensions of religion, such as religious attendance or religious intensity. We will extract data that describe methodology, sample characteristics and the findings concerning our object of investigation. Moreover, a quality assessment will be performed. Two reviewers will independently select the studies, extract the data and assess the studies' quality. Disagreements will be dissolved by discussion or by inclusion of a third party. The findings will be presented narratively in text and tables. If possible, a meta-analysis will be carried out., Ethics and Dissemination: As no primary data are collected, the approval from an ethics committee is not required. Our review will be published in a peer-reviewed, scientific journal., Prospero Registration Number: CRD42021229222., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Job characteristics are an important predictor of depressive symptoms. Recent research detected unemployment's spillover effects on spouses' depressive symptoms, but there is still a lack of studies that examine the association between objective job demands of oneself and one's partner and depressive symptoms., Methods: Data were derived from the German Ageing Survey (DEAS), which is a representative sample that includes individuals aged 40 years and older. Psycho-social, physical, and overall job characteristics were assessed objectively, using a validated index developed by Kroll. Depressive symptoms were quantified by the Center for Epidemiologic Studies Depression Scale (CES-D)., Results: Regarding fixed-effects regression, we found no significant association between the own or the partner's job demands and depression among the total sample and among men. However, among women, both increasing psychosocial demands of one's own occupation and physical job demands of one's partner's occupation were related to higher levels of depression, as well as the partner's overall job demands., Conclusions: The findings of the present longitudinal study highlight the association between job demands and depressive symptoms in women, but not in men, especially regarding the partner's employment characteristics. Efforts to reduce the burden of high job demands may be helpful. This could help alleviate depressive symptoms. In turn, geriatric giants caused by increased depressive symptoms, such as frailty, could be postponed.

Background: Several empirical studies have shown an association between informal caregiving for adults and loneliness or social isolation. Nevertheless, a systematic review is lacking synthesizing studies which have investigated these aforementioned associations. Therefore, our purpose was to give an overview of the existing evidence from observational studies. Materials and Methods: Three electronic databases (Medline, PsycINFO, CINAHL) were searched in June 2021. Observational studies investigating the association between informal caregiving for adults and loneliness or social isolation were included. In contrast, studies examining grandchild care or private care for chronically ill children were excluded. Data extractions covered study design, assessment of informal caregiving, loneliness and social isolation, the characteristics of the sample, the analytical approach and key findings. Study quality was assessed based on the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Each step (study selection, data extraction and evaluation of study quality) was conducted by two reviewers. Results: In sum, twelve studies were included in our review (seven cross-sectional studies and five longitudinal studies)-all included studies were either from North America or Europe. The studies mainly showed an association between providing informal care and higher loneliness levels. The overall study quality was fair to good. Conclusion : Our systematic review mainly identified associations between providing informal care and higher loneliness levels. This is of great importance in assisting informal caregivers in avoiding loneliness, since it is associated with subsequent morbidity and mortality. Moreover, high loneliness levels of informal caregivers may have adverse consequences for informal care recipients.

Introduction: Our aim was to examine attitudes of the general population towards reasonableness of these costs, as well as the degree to which these costs are shared across society (solidarity financing) and to determine the factors associated with them., Method: Repeated cross-sectional data from a nationally representative online-survey. More precisely, data from wave 8 (21-22 April 2020) and wave 16 (7-8 July 2020) were used (in wave 8: analytical sample with n = 976, average age was 47.0 years (SD: 15.3 years), ranging from 18 to 74 years, 51.8% female; in wave 16: analytical sample with n = 978, average age was 46.1 years (SD: 15.9 years), ranging from 18 to 74 years, 50.9% female). After a short introduction emphasizing considerable economic costs associated with the measures against the spread of the coronavirus, individuals were asked to rate the following statements (outcome measures), in each case from 1 = strongly disagree to 7 = strongly agree: "These economic costs are currently reasonable in relation to the objective pursued" (reasonableness of costs), "These economic costs should be borne jointly by all citizens and depending on income" (solidarity financing)., Results: In wave 8 (wave 16 in parentheses), the average rating for the attitude towards reasonableness of costs was 4.3, SD: 1.8 (wave 16, average: 4.2, SD: 1.8) and the average rating for the attitude towards solidarity financing was 3.7, SD: 1.9 (wave 16, average: 3.3, SD: 2.0). In wave 8, more positive attitudes towards the reasonableness of costs and solidarity financing were associated with being male, higher education, not being in a partnership/being unmarried, higher affect regarding COVID-19 and higher presumed severity with respect to COVID-19. Furthermore, more positive attitudes towards the reasonableness of costs were associated with having a migration background. More positive attitudes towards solidarity financing was associated with higher age groups. Mainly similar findings were observed in wave 16., Discussion: Agreement with reasonableness of costs of preventative measures as well as solidarity financing was moderately high. Knowledge of these attitudes is important to ensure social cohesion during the fight against COVID-19., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To date, some empirical studies showed a link between personality factors and frailty. Nevertheless, a systematic review is lacking synthesizing the current evidence. Consequently, the purpose of this review was to fill this gap in knowledge based on observational studies., Materials and Methods: Three electronic databases (PubMed, PsycINFO, CINAHL) were searched. Moreover, a hand search was conducted. Observational studies focusing on the association between personality and frailty were included, whereas disease-specific studies were excluded. Data referring to methods, characteristics of the sample and key findings were extracted. The NIH tool was used to assess study quality/risk of bias. Two reviewers performed study selection, extracted the data and conducted the quality assessment., Result: In sum, five (mostly longitudinal) studies were included in the final synthesis. Mainly based on large, nationally representative cohorts, these studies point to an association between personality and frailty. More precisely, they mainly point to a link between low conscientiousness as well as high neuroticism and increased frailty levels. The quality of the studies included was quite high., Conclusions: This knowledge may assist in identifying individuals at risk for increased frailty levels (i.e., particularly individuals with low conscientiousness and high neuroticism). Efforts to increase conscientiousness and reduce neuroticism may assist in postponing frailty. Future studies are required to elucidate the underlying mechanisms. Prospero registration number: CRD42020193100., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The aim was to give an overview of longitudinal observational studies investigating the determinants of healthcare use explicitly using the Andersen model. To this end, three electronic databases (Medline, PsycINFO and CINAHL) were searched (and an additional hand search was performed). Longitudinal observational studies examining the determinants of healthcare use (outpatient physician services and hospital stays) based on the Andersen model were included, whereas disease-specific samples were excluded. Study quality was evaluated. The selection of studies, extraction of data and assessment of the studies were conducted by two reviewers. The following determinants of healthcare use were displayed based on the (extended) Andersen model: predisposing characteristics, enabling resources, need factors and psychosocial factors. In sum, n = 10 longitudinal studies have been included in our systematic review. The included studies particularly showed a longitudinal association between increased needs and higher healthcare use. Study quality was rather high. However, several studies did not conduct robustness checks or clarify the handling of missing data. In conclusion, this systematic review adds to our current understanding of the factors associated with healthcare use (mainly based on cross-sectional studies). It showed mixed evidence with regard to the association between predisposing characteristics, enabling resources and healthcare use longitudinally. In contrast, increased need factors (in particular, self-rated health and chronic conditions) were almost consistently associated with increased healthcare use. This knowledge may assist in managing healthcare use. Since most of the studies were conducted in North America or Europe, future longitudinal studies from other regions are urgently required.

Background: The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2., Methods: Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21-22 April 2020, N = 976; wave 16: 7-8 July 2020, N = 977; wave 38: 9-10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19., Results: 65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves., Conclusions: The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic., (© 2021. The Author(s).)

Purpose: To clarify the prevalence and determinants of fear of COVID-19 among homeless individuals during the COVID-19 pandemic., Patients and Methods: Data were taken from the Hamburg survey of homeless individuals (n=150) covering homeless adults in Hamburg, Germany. Multiple linear regressions were used. Beyond sociodemographic and lifestyle-related independent variables, COVID-19-related factors were also used as independent variables., Results: In sum, 56.2% of homeless individuals reported no fear of COVID-19, 23.8% reported a little fear of COVID-19, 9.2% reported some fear of COVID-19 and 10.8% reported severe fear of COVID-19. Regressions showed that an increased fear of COVID-19 was significantly associated with younger age (β=-.01, p<0.05), absence of chronic alcohol consume (β=-.55, p<0.01), an increased perceived own risk of getting infected with the coronavirus one day (β=0.42, p<0.001) and a higher agreement that a diagnosis of the coronavirus would ruin his/her life (β=0.13, p<0.01)., Conclusion: Given the poor hygienic conditions and their increased vulnerability, data surprisingly suggest a quite low fear of COVID-19 among homeless individuals. Efforts may be beneficial which contribute to thinking rationally about COVID-19 among homeless people, since low levels of fear of COVID-19 may contribute to careless behavior and can lead to super-spreading events., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Hajek et al.)

Purpose: Obesity is associated with adverse health outcomes and can result in feelings of loneliness or social isolation, for example due to stigmatization. These factors are in turn associated with morbidity and mortality. Thus far, a systematic review is lacking with regard to the association between obesity, social isolation and loneliness. Therefore, our aim was to fill this gap in knowledge., Materials and Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies examining the link between obesity and loneliness or social isolation were included. Disease-specific samples were excluded., Results: In sum, six studies have been included. While some studies point to an association between obesity and increased loneliness levels, it should be acknowledged that findings are mixed. Study quality was quite high., Conclusion: This systematic review showed that the literature is inconclusive and incomplete. Further research is required to shed further light on these associations. Moreover, studies from countries outside Europe, based on longitudinal data and using objective assessments of obesity, are urgently required. Gender differences should be further explored., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Hajek et al.)

Introduction: A previous systematic review published in 2012 focused on the use of health services based on the Andersen model. Extending this review, we will exclusively focus on systematically synthesising longitudinal studies examining the determinants of healthcare use based on the Andersen model. Therefore, our aim of this systematic review is to provide an overview of longitudinal observational studies investigating the predictors of healthcare use explicitly using this model., Methods and Analysis: We will search three electronic databases (Medline, PsycINFO and CINAHL). Furthermore, reference lists will be searched manually. Longitudinal observational studies will be investigating the determinants of healthcare use (in terms of use of outpatient physician services (like general practitioner's visits or specialist visits in total) and hospitalisation). We will exclude disease-specific samples. Data extraction will focus on methods (eg, assessment of healthcare use), sample characteristics and main findings. A suitable tool will be used to assess the study quality. Study selection, data extraction and evaluation of study quality will be conducted by two reviewers. The findings will be presented by means of figures, summary tables, narrative summaries and meta-analysis (if possible)., Ethics and Dissemination: No primary data will be collected. Therefore, approval by an ethics committee is not required. Our findings are planned to be published in a peer-reviewed journal., Prospero Registration Number: CRD42020193198., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Some empirical studies have identified an association between informal caregiving for adults and loneliness or social isolation. However, there is a lack of a review systematically synthesising empirical studies that have examined these associations. Hence, the aim of this systematic review is to provide an overview of evidence from observational studies., Methods and Analysis: Three electronic databases (Medline, PsycINFO, CINAHL) will be searched (presumably in May 2021), and reference lists of included studies will be searched manually. Cross-sectional and longitudinal observational studies examining the association between informal caregiving for adults and loneliness or social isolation will be included. Studies focusing on grandchildren care or private care for chronically ill children will be excluded. Data extraction will include information related to study design, definition and measurement of informal caregiving, loneliness and social isolation, sample characteristics, statistical analysis and main results. The quality of the studies will be evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers will perform the selection of studies, data extraction and assessment of study quality. Figures and tables will be used to summarise and report results. A narrative summary of the findings will be provided. If data permit, a meta-analysis will be conducted., Ethics and Dissemination: No primary data will be collected. Therefore, approval by an ethics committee is not required. We plan to publish our findings in a peer-reviewed journal., Prospero Registration Number: CRD42020193099., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To identify the determinants of health care use among homeless individuals., Methods: Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates., Results: Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99])., Conclusions: Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.

Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over-or, more likely-underuse of dental services and could enrich the inequality discussion in dental services research.

(1) Background: The COVID-19 pandemic is accompanied by various societal and economic challenges. Furthermore, it is associated with major health challenges. Oral health is a key component of health. Therefore, both curative and preventive dental visits are important during pandemics. Since there is a lack of nationally representative studies focusing on postponed dental visits and their correlates during the COVID-19 pandemic, we aimed to fill this gap in knowledge; (2) Methods: Cross-sectional data (wave 17) were collected from a nationally representative online-survey (COVID-19 Snapshot Monitoring in Germany (COSMO)) conducted in July 2020. The analytical sample consisted of 974 individuals (average age was 45.9 years (SD: 16.5, from 18 to 74 years)). The outcome measure was postponed dental visits since March 2020 (yes; no) due to the COVID-19 pandemic. Furthermore, the type of postponed dental visits was recorded (check-up/regular dental examination; pain/dental complaints; planned therapy); (3) Results: 22% of participants reported to have postponed dental visits due to the COVID-19 pandemic since March 2020, whereas 78% of individuals did not report postponed visits ("no, attended as planned": 29.2%; "no, examining pending": 44.9%; "no, other reasons": 3.9%). Among individuals who reported postponed dental visits, 72% postponed a "check-up/regular dental examination", whereas 8.4% postponed a dental visit despite "pain/dental complaints" and 19.6% postponed "planned therapy". Furthermore, multiple logistic regressions showed that the likelihood of postponed dental visits was positively associated with being younger (aged 65 and older, OR: 0.43, 95% CI: 0.22-0.85; compared to individuals 18 to 29 years), and higher affect regarding COVID-19 (OR: 1.36, 95% CI: 1.13-1.64); (4) Conclusions: Our study showed that more than one out of five individuals postponed a dental visit-particularly check-ups and regular dental examination-due to the COVID-19 pandemic since March 2020. Several correlates of these postponed visits have been identified. This may help identify and address individuals at risk for deterioration of oral health amplified by postponed dental visits.

Background: No systematic review exists synthesizing studies examining the association between personality factors and use of cancer screenings. Hence, the aim of this systematic review is to provide an overview of empirical findings from observational studies investigating the link between personality factors (in terms of agreeableness, conscientiousness, extraversion, neuroticism and openness to experience) and use of cancer screenings., Methods: Medline, PsycInfo and CINAHL were searched using predefined search terms. Observational studies examining the link between personality factors and use of cancer screenings using validated tools were included. Study selection, data extraction, and quality assessment were performed by two reviewers., Results: In total, n = 11 studies were included in our systematic review. There is mostly inconclusive evidence regarding the link between agreeableness, neuroticism, openness to experience and the use of cancer screenings. Clearer evidence was identified for an association between increased extraversion and an increased use of cancer screenings. Moreover, the majority of studies identified a link between increased conscientiousness and an increased use of cancer screenings., Discussion: Studies indicate that personality factors, particularly an increased extraversion and increased conscientiousness, are associated with an increased use of cancer screenings. This knowledge may be beneficial to address individuals at risk for underuse., Prospero Registration Number: CRD42020176830., Competing Interests: The authors have declared that no competing interests exist.