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What you need to know• For mild to moderate acne, first-line treatment options include: i) a fixed combination of topical adapalene with topical benzoyl peroxide ii) a fixed combination of topical tretinoin with topical clindamyciniii) a fixed combination of topical benzoyl peroxide with topical clindamycin• For moderate to severe acne, first-line treatment options include: i) a fixed combination of topical adapalene with topical benzoyl peroxideii) a fixed combination of topical tretinoin with topical clindamycin iii) a fixed combination of topical adapalene with topical benzoyl peroxide, together with either oral lymecycline or oral doxycyclineiv) topical azelaic acid with either oral lymecycline or oral doxycycline•Topical or oral antibiotics should not be used as monotherapy or in combination with each other•Review treatment response at 12 weeks and options that include an antibiotic (topical or oral) should only be continued for more than 6 months in exceptional circumstances•Consider referral to a consultant dermatologist-led team if moderate to severe acne has failed to respond to a 12-week course of treatment that includes an oral antibiotic or if mild to moderate acne has failed to respond adequately to 2 different 12-week courses of treatment

Acne Vulgaris: Management , published on 25 June 2021, is a National Institute for Health and Care Excellence (NICE) guideline for patients with acne, their families and carers, their healthcare professionals, and commissioners.1 It does not consider neonatal acne. This article highlights parts of the guideline that cover skin care advice and first-line medication options in the management of acne. The guideline also covers further areas such as ‘Referral to specialist care’, ‘Oral isotretinoin’, Physical treatment’, ‘Relapse’, Maintenance treatment’, and ‘Management of acne-related scarring’, which will not be covered in this article. Acne vulgaris is one of the commonest inflammatory skin conditions, reported to create 3.5 million general practice consultations per year in the UK.2 It usually affects adolescents and young adults, and can last for several years. Acne vulgaris most commonly affects the face but chest, back, and shoulders may be involved. Lesions are a combination of non-inflammatory (comedones) and inflammatory lesions (papules, pustules, cysts, nodules), often leading to scarring. The committee agreed to grade acne vulgaris into ‘Mild to Moderate’ or ‘Moderate to Severe’ in order to conduct separate network meta-analysis, while accepting that acne lies along a continuum. This is easily accomplished in busy clinics and provides a baseline for assessing treatment response. Mild-to-moderate acne vulgaris includes patients who have one or more of

There has been little research into awareness of human papillomavirus (HPV) among dermatological out-patients, despite the fact that management of HPV infection causing genitoanal warts/cancer is part of the routine practice of dermato-venereologists. The aim of this study was to explore awareness of HPV among dermatological outpatients. A self-administered questionnaire was distributed to 360 consecutive attendees of a Munich dermatological outpatient clinic in November 2009. Of the total number of questionnaires, 77.2% were returned, and 69.7% (n=251, 51.8% females) were included in the analysis. 39.4% of the respondents had heard of HPV infection, and 23.9% of vaccination. Of those who had heard of HPV, 81.8% knew that HPV risk is associated with non-use condoms, number of sexual partners (77.8%), smoking (8.1%), and that HPV causes genital warts (65.7%), anal warts (39.4%) and cervical cancer (57.6%). HPV ignorance (never having heard of HPV) was predicted by being male (adjusted odds ratio=2.23, 95% confidence interval=1.32-3.80) and being a parent (adjusted odds ratio=2.11, 95% confidence interval=1.24-3.59). We conclude that dermatological outpatients have insufficient knowledge of HPV, its sequelae and prevention.

Background Sexually transmitted human papillomavirus (HPV) high-risk types cause carcinoma and low-risk types lead to warts of genitoanal area. Since the HPV vaccine has been introduced, awareness of HPV infection, prevention and health-related behaviour have not been studied in a large sample of young women in Germany. Objectives Assessment of awareness and health-related behaviour regarding HPV infection and prevention among young German females. Methods In 2010, a postal cross-sectional survey was conducted with a random representative sample size (n = 2000) of females aged 19–35 attending Germany’s largest (comprehensive) university, which was designed to obtain data about socio-demographics, the awareness of sexually transmitted HPV, genitoanal neoplasms and their prevention, HPV vaccine, immunisation and cervical cancer screening. Results Of the 547 (27.3%) participants, 69.1% had heard of HPV, 62.5% were aware of the vaccine, 14.4% were vaccinated and 6.9% reported a history of sexually transmitted infection, including HPV (2.7%). The HPV-related knowledge among those who had heard of it was high (75.1–99.7%), except of that HPV affects men (52.9%) and HPV’s causative role in genital (54.2%) and anal (35.6%) warts, and smoking (11.3%) as an HPV risk factor. The lower HPV knowledge score (

This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany. Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003–2006). The communities (n = 1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation. Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29–1.49), for mortality risk 1.54 (95% CI 1.41–1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22–1.38) and in women 1.19 (95% CI 1.11–1.27); for mortality risk we found 1.57 (95% CI 1.40–1.76) in men and 1.34 (95% CI 1.19–1.51) in women. Area-based deprivation is significantly associated with cancer risk in Bavaria.

OBJECTIVES: Individual health status is influenced by individual social characteristics (age, gender, income usw.) and by the social characteristics of the regional environment in which the person lives. This is true also for lung cancer and colon cancer, two of the most common cancer sites in Germany. No systematic review about the social and regional distribution of lung cancer and colon cancer has been published in German-speaking countries yet. However, it could allow us to deepen the discussion regarding explanations of cancer risks and potential interventions. METHODS: Lung cancer and colon cancer have been selected because they are the two most common gender-independent cancer sites in Germany. A systematic literature search has been conducted via the Medline database using PubMed. 2 groups of regional differences have been distinguished, first by socio-economic characteristics (e. g., average household income) and second by urban vs. rural characteristics. The publications have then been analysed in a systematic way. RESULTS: 17 publications could be found, just 2 of them are from a German-speaking country (one each from Germany and Switzerland). The results concerning incidence and mortality can be summarised in the following way: The risks for lung cancer increase with decreasing socio-economic status of the region, but no clear association could be found for colon cancer. Some studies include information on urban-rural differences. They show that the risks for lung cancer are higher in urban as compared to rural areas; for colon cancer, again, no clear associations could be found. CONCLUSION: The review shows that some studies have already looked at social and regional differences in lung cancer and colon cancer, and that these associations have hardly been discussed in German-speaking countries as yet. We still do not know why lung cancer risks are especially high in low status regions, even if individual smoking is accounted for. The answer could probably be provided by risks such as air pollution. Therefore, a balanced strategy for reducing health inequalities should not just focus on improving individual health behaviour, but also on reducing the regional risks factors.

SUMMARY Purpose: A short HIV/AIDS risk behaviour knowledge index based on questions about HIV transmission and prevention of HIV infection during sexual intercourse and intravenous drug use is proposed and implemented for an HIV average risk population in Munich. Methods: Knowledge levels about HIV/AIDS risk behaviour was assessed in a group of people (n=210) in sexually active age range of 18-49 years which was at an average risk of contracting HIV. Four questions about HIV transmission by unprotected vaginal, anal, or oral sexual intercourse, and by needle sharing, and two questions about HIV prevention by condom use, and the single use of needles and syringes were chosen from ten others for making a four level risk behaviour knowledge index (HIV/AIDS Transmission through Sex and Intravenous Drug Use, HATSIDU) internally consistent according to Cronbach's alpha. Results: HATSIDU index (mean 3.0, SD±1.18) was not associated (p>0.05) with sex and marital status, but depended (p Conclusion: The HATSIDU is a simple and usable index for the assessment of HIV/AIDS risk behaviour knowledge in a population with an average risk of HIV infection. Key words: HIV/AIDS, risk behaviour knowledge INTRODUCTION Knowledge about HIV/AIDS is one usable indirect criterion for the assessment of behavioural risk and preventative behaviour regarding HIV infection. HIV/AIDS knowledge has been investigated in various populations, for example school students (1, 2), adolescents (3), migrant farm workers (4), pregnant women (5), the mentally ill (6), and also in a group of intravenous drug users (IDUs) who have a high risk of contracting HIV (7). The HIV/AIDS risk behaviour knowledge scale was first developed by Kelly et al. (1989) (8) using a group of students, and homosexual men (men who have sex with men, MSM). The assessment of HIV knowledge or HIV risk behaviour knowledge in population is usually performed by summing up correct answers to questions about HIV transmission and prevention according to age, gender, national, social, and educational status in a knowledge score (4, 6, 8). The summing up of correct answers to questions about the possibility of HIV transmission by sexual intercourse, intravenous drug sharing, from an infected mother to her child, by hand shaking, or by using public places assumes that all questions are of equal significance and the answers fall in the same rank of importance. Therefore, respondents who correctly answered questions about HIV transmission by sex and drug use but gave incorrect answers for questions about kissing and hand shaking, would receive the same summed knowledge score as the respondents who failed in questions about HIV transmission by sex and intravenous drug use but answered correctly on kissing and hand contact, for example. Because of the equality of all items in constructing a summed knowledge score, HIV/AIDS knowledge can be investigated, but it is not really useful for the assessment of risk behaviour knowledge regarding HIV/AIDS. Assessment of risk behaviour knowledge means that ignorance of some risks has more impact on risk behaviour than others. For example, ignorance about condom use cannot be equated with misconceptions about HIV transmission through hairdressing or by the use of public toilets. Since 2004, 26 European Union/European Economic Area countries with exception of Poland and Estonia have been reporting statistics regarding transmission routes of HIV infection (9). HIV incidence in EU/EEA decreased in 2009 (5.7/100,000 population) compared to 2004 (6.5/100,000) and was accompanied by a 40% decrease of intravenous transmission of HIV by intravenous drug users (IDUs), but by a 24% increase in homosexually (MSM) transmitted HIV. …

Formålet med dette studie var at evaluere knap 1000 patienters oplevelse af kvalitet og inddragelse af behandling (kronikeromsorg) 6 år efter screening for diabetes. Patienterne blev rekrutteret fra den danske del af det internationale studie ADDITION, som fokuserer på tidlig opsporing og intensiv behandling af diabetes i almen praksis. Studiet undersøger, om der er forskelle i oplevelsen af kronikeromsorgen mellem en gruppe, som modtog intensiv behandling efter diagnosen, og en kontrolgruppe, men der blev ikke fundet forskelle. Kvalitet og inddragelse blev vurderet ud fra spørgeskemaet ’Patient Assessment of Chronic Illness Care’ (PACIC), som omhandler 1) patientaktivering, 2) organisering af behandling/beslutningsstøtte, 3) målsætning/individuel tilpasning, 4) problemløsning/kontekst og 5) followup/koordination. Den gennemsnitlige PACIC-score (mindst 1 og højst 5) for alle deltagere var 2,4. Deltagerne scorede højest (3,3) på organisering af behandling/beslutningsstøtte og lavest (2,1) på followup/koordination. De gennemsnitlige PACIC-scores ligger lavere sammenlignet med andre studier af diabetes og hjerterehabilitering. Samlet set synes den intensive forebyggende behandling ikke at påvirke oplevelsen af kvalitet i behandlingen, hverken positivt eller negativt. OBJECTIVES: To describe perceptions of chronic care among diabetes patients 6 years after diagnosis by screening and to examine the impact of intensive treatment on patients' perceptions of chronic care.METHODS: The ADDITION-Denmark (2001-2006) trial compared the effects of intensive multifactorial therapy (IT) with routine care (RC) among individuals with screen-detected diabetes. Perceptions of chronic care were assessed using the Patient Assessment of Chronic Illness Care (PACIC) measure after 6-year follow-up (n = 937). Analysis was by intention-to-treat, accounting for clustering by general practice.RESULTS: The mean (SD) summary PACIC score was 2.4 (0.79) in the RC and 2.4 (0.82) in the IT group. The highest mean (SD) PACIC subscale score was for Delivery System Design/Decision Support [RC: 3.2 (0.95), IT: 3.3 (0.91)] and the lowest was for Follow-up/Coordination [RC: 2.1 (0.84), IT: 2.1 (0.87)]. Perceptions of chronic care did not differ between trial groups.CONCLUSIONS: Compared to RC, an intensive multifactorial intervention was not associated with differences in perceptions of chronic care among patients with screen-detected diabetes after 6 years. Intensive treatment does not adversely affect perceptions of chronic care early in the course of the disease. However, there is potentially room for improvement in some aspects of chronic care.

AIMS: To examine the association between health status, diabetes-specific quality of life (QoL) and glycaemic control among individuals with type 2 diabetes.METHODS: 1876 individuals with screen-detected diabetes and a mean age of 66 years underwent assessment of self-reported health status (SF-36), diabetes-specific QoL (the Audit of Diabetes Dependent Quality of Life (ADDQoL19)) and glycated haemoglobin (HbA1c) at five years post-diagnosis in the ADDITION-Europe trial. Multivariable linear regression was used to quantify the cross-sectional association between health status, diabetes-specific QoL and HbA1c, adjusting for age, sex, education, alcohol consumption, physical activity, BMI, intake of any glucose-lowering drugs, and trial arm.RESULTS: The mean (SD) SF-36 physical and mental health summary scores were 46.2 (10.4) and 54.6 (8.6), respectively. The median average weighted impact ADDQoL score was -0.32 (IQR -0.89 to -0.06), indicating an overall negative impact of diabetes on QoL. Individuals who reported a negative impact of diabetes on their QoL had higher HbA1c levels at five years after diagnosis compared with those who reported a positive or no impact of diabetes (b-coefficient [95% CI]: b=0.2 [0.1, 0.3]). Physical and mental health summary SF-36 scores were not significantly associated with HbA1c in multivariable analysis.CONCLUSIONS: Diabetes-specific QoL but not health status was independently associated with HbA1c. Practitioners should take account of the complex relationship between diabetes-specific QoL and glucose, particularly with regard to dietary behaviour. Future research should attempt to elucidate via which pathways this association might act.

In Germany, immigrants from Former Soviet Union (FSU) countries represent one of the largest immigrant groups. Some FSU countries face the highest HIV prevalence in the region of Eastern Europe and Central Asia. However, the HIV knowledge, attitude and behavioral intent have not been investigated in FSU immigrants compared to the native population yet. A cross-sectional anonymous survey among 1,205 FSU immigrants and 435 native Germans (aged 18–65 years) in Bavaria. Data analysis from the participating 435 (36 %) immigrants and 334 (76.8 %) natives showed that the immigrants were less knowledgeable (p

Objective Previous research from other countries shows a positive association between cancer risk and regional deprivation. This study explores this association for lung and colorectal cancers in Germany. Method Regional deprivation was assessed by the ‘Bavarian Index of Multiple Deprivation’. Cancer data were provided by the Cancer Registry of Bavaria (2003–2006). The association between cancer risk and regional deprivation was evaluated by multilevel Poisson regression analysis. Results Crude incidence and mortality rates (per 1000 people) in the least deprived areas were 1.46 and 0.92 for lung cancer, 2.82 and 0.69 for colorectal cancer. For lung cancer, the age-adjusted relative risk (RR) for incidence in the most deprived districts (compared with the least deprived) in men was 1.41 (95% CI: 1.28–1.54), for mortality 1.59 (95% CI: 1.40–1.80); in women, an elevated RR was seen for mortality (1.24, 95% CI: 1.06–1.46). For colorectal cancer, the RR for incidence (men: 1.31, 95% CI: 1.17–1.46; women: 1.25, 95% CI: 1.12–1.40) and mortality (men: 1.51, 95% CI: 1.28–1.80; women: 1.49, 95% CI: 1.26–1.77) was always highest in the most deprived districts. Conclusion At the district level in Bavaria, the risk for lung and colorectal cancers mostly increases with increasing regional deprivation.

Background There is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes. Methods ADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40–69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression. Results Participants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increases in plasma vitamin C were observed in women (beta-coefficient [95% CI]: beta = −5.52 [−9.81, -1.22]) and in those with screen-detected diabetes (beta = 6.09 [1.74, 10.43]). Younger age predicted a greater reduction in fat (beta = −0.43 [−0.72, -0.13]) and energy intake (beta = −6.62 [−13.2, -0.05]). Patients with screen-detected diabetes (beta = 74.2 [27.92, 120.41]) reported a greater increase in fruit intake. There were no significant predictors of change in self-reported physical activity. Beliefs about behaviour change and diabetes did not predict behaviour change. Conclusions Older patients, men and those with a longer duration of diabetes may need more intensive support for dietary change. We recommend that future studies use objective measurement of health behaviours and that researchers add predictors beyond the individual level. Our results support a focus on establishing healthy lifestyle changes early in the diabetes disease trajectory.