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BACKGROUND Perception of psoriasis in the general population is characterized by knowledge deficits and prejudice against those affected. The extent and possible predictors of stigmatizing attitudes remain unclear. OBJECTIVES The aim was to assess prejudices and stigmatization of people with psoriasis and to identify sociodemographic and attitude-related variables accounting for stigmatization. METHODS Representative telephone surveys of 2004 (in 2017) and 2001 (in 2018) adults using a standardized questionnaire. Descriptive analyses were applied to living area, age, gender, educational status, general knowledge and attitudes about psoriasis. Logistic regression analyses were carried out to determine which variables are associated with the assessment of prejudices of 'others' against people with psoriasis. Those prejudices were specified by the following statements: 'they should take better care of themselves', 'don't want to touch people with psoriasis' and 'disgusted by psoriasis'. RESULTS The majority of those surveyed (74%) believe that people with psoriasis are disadvantaged. Similarly, a majority (69%) said that most people find psoriasis disgusting, do not want to touch people with psoriasis (59%) and think that people with psoriasis need to take better care of themselves (45%). 'Willing to enter a relationship with an affected person' (OR = 0.330, P = 0.029), higher age (OR = 1.027, P

Das gesetzliche Hautkrebsscreening (gHKS) beim Hautarzt oder Hausarzt wurde im Jahr 2008 in Deutschland eingefuhrt, um Hautkrebs fruher zu erkennen und die Patientenversorgung zu verbessern. Um den Erfolg des gHKS beurteilen zu konnen und die Inanspruchnahme zu erhohen, ist die Meinung der Bevolkerung uber den Zugang zum gHKS sehr relevant. Die Studie untersucht administrative und regionale Faktoren des Zugangs zum gHKS in Deutschland. Die Querschnitterhebung umfasste eine deutschlandweite Befragung von gesetzlich Krankenversicherten ab 18 Jahren. Die Befragten gaben telefonisch Auskunft uber ihren Zugang zum gHKS. Bei der statistischen Auswertung wurden anhand von soziodemografischen Variablen und den Fachgruppen der durchfuhrenden Arzte verschiedene Subgruppenanalysen durchgefuhrt. Von den 1015 Befragten nahmen 359 (35,4 %) schon einmal am gHKS teil. Vom Angebot erfahren haben die meisten (38,3 %) durch ihren Hausarzt. Ein groserer Anteil der Befragten mit gHKS-Erfahrung war beim Hautarzt (76 % vs. 24 % beim Hausarzt, p

Background Atopic dermatitis (AD) is one of the most common chronic inflammatory diseases of the skin. Rare large-scale data have been published on the prevalence of concomitant dermatoses. Objective To analyse the prevalence and cutaneous comorbidity of AD in Germany. Methods A cross-sectional study on voluntary whole-body skin checks by trained dermatologists in over 400 companies throughout Germany reflecting the adult working population was conducted. Prevalence ratios (PR) were calculated to compare dermatological comorbidity in employees with and without current AD. A logistic regression analysis controlling for age, sex and skin type revealed odds ratios (OR) of the occurrence of skin diseases in AD. Results A total of N = 118 939 people were examined between 2006 and 2017 (43.2% female, mean age 43.2 ± 10.7 years, min. age 16 years, max. age 70 years). AD (point prevalence) was identified in 1.45% (men: 1.50%, women 1.39%) and decreased significantly with age. Self-reported lifetime prevalence of AD was 4.95% (men: 3.72%, women: 6.55%). The following skin diseases were significantly more frequent in people with current AD: Contact dermatitis (PR: 3.38), hand eczema (PR: 4.62), exsiccation dermatosis (PR: 2.19), folliculitis (PR: 1.95) and port-wine stains (PR: 1.49). Among those, folliculitis was the most frequent (prevalence in AD 16.42%). Controlled for age, sex and skin type, AD was significantly associated with - among others - hand eczema (OR: 3.96; 95% CI: 2.95-5.32), contact dermatitis (OR: 2.97; 95% CI: 1.50-5.88) and exsiccation dermatosis (OR: 1.78; 95% CI: 1.30-2.44). Psoriasis was significantly less frequent in people with AD (OR: 0.61; 95% CI: 0.39-0.94). Conclusion In summary, cutaneous comorbidity is frequent and of great importance in people with AD, suggesting the need for comprehensive, dermatologically guided diagnostics in AD.

Das Programm zur Fruherkennung von Hautkrebs in Deutschland dient der fruhzeitigen Identifizierung von Hauttumoren mit dem Ziel der risikoarmeren Entfernung und der Vermeidung einer Progression. Ziel der Studie ist es zu untersuchen, inwieweit im Zuge der Fruherkennungsuntersuchung auf Hautkrebs (HKS) auch primarpraventives Wissen vermittelt wird. Diese Fragestellung wurde aus Sicht von Screeningteilnehmern und Dermatologen untersucht. Der Anteil an entsprechend informierten Personen unter den Gescreenten wurde anhand einer Befragung einer reprasentativen Stichprobe der deutschen Standardbevolkerung von n = 1004 Personen ermittelt. Die Vermittlung von Informationen zu primarpraventivem Verhalten wurde anhand einer Befragung dermatologischer Praxen (n = 444) erfasst. Beide Erhebungen wurden deskriptiv ausgewertet. In der Allgemeinbevolkerung gab unter denjenigen Personen, die ein HKS bei sich durchfuhren liesen (n = 397), der Grosteil (74 %) an, dass im Zuge des Screenings Informationen uber den Schutz vor UV-Strahlen vermittelt wurden. Unter den Dermatologen, die das HKS anbieten (n = 424), gaben 70 % an, alle HKS-Teilnehmer uber Masnahmen zur Vorbeugung von Hautkrebs personlich zu informieren, 46 % gaben stets oder uberwiegend schriftliches Material im Anschluss an das HKS aus. Dem HKS kommt neben der sekundarpraventiven auch eine wichtige primarpraventive Funktion zu, wobei Verbesserungspotenzial besteht, da ca. ein Viertel der HKS-Teilnehmer keine Informationen zu praventivem Verhalten vom untersuchenden Arzt erhalt. Die Beantwortung der Frage, in welchem Umfang diese Informationen von den HKS-Teilnehmern tatsachlich umgesetzt werden, bedarf einer Langsschnittstudie.

ZusammenfassungHintergrund: Venenleiden sind häufig und medizinisch relevant. Fragestellungen: Wie ist die Versorgung der Venenkrankheiten in Deutschland, wie entwickelt sich der Bedarf? Methoden: Multisource-Analyse von Daten der GKV, des statistischen Bundesamtes sowie Primärstudien in Deutschland. Ergebnisse: In Deutschland leiden mind. 22% der Bevölkerung (18 Mio.) unter behandlungsbedürftigen Venenerkrankungen. Ambulant werden jährlich 4,1 Mio. phlebologische Behandlungen durchgeführt, stationär etwa 125 000 Fälle als Hauptdiagnose dokumentiert, davon ca. 88 500 mit Varizen der unteren Extremität und ca. 35 300 mit (Thrombo-)Phlebitis. Die Anzahl stationärer Behandlungen für Varizen ist in den letzten 10 Jahren um 16% zurückgegangen, in den letzten 17 Jahren um 47%, die Anzahl ambulanter phlebologischer Behandlungen in den letzten 5 Jahren jährlich um 5–10% gestiegen. Ambulant hauptversorgende Fachgruppen sind Chirurgen und Dermatologen, stationär versorgende Chirurgie, Dermatologie und Angiologie sowie Venenfachkliniken. Der Versorgungsbedarf wird zukünftig jährlich um 3–8% steigen. Die Zusatzweiterbildung „Phlebologie“ als Teil der qualitätsgesicherten Versorgung wurde in Deutschland 2016 von 3 049 Ärzten geführt. Fazit: Periphere Venenerkrankungen weisen einen hohen Versorgungsbedarf auf. Die Phlebologie stellt eine wichtige Säule der spezialisierten Versorgung dar.

The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system.

Background Dry skin is a frequent and multifaceted condition which can be associated with skin irritation, itch, patient discomfort and manifest skin disease. In spite of being frequent, little is known about the epidemiology of dry skin in the population. Objective To determine the prevalence of dry skin in the German adult population. Methods Data of 48 630 employed persons were assessed on a cross-sectional level in whole-body examinations by experienced dermatologists during company-based skin screenings conducted in 343 German companies. Next to the current dermatologic findings, age, gender, allergies, atopic diseases and the skin type were assessed. Results In total, n = 14 300 persons (29.4%) were rated as having xerotic skin. Older age but not gender was associated with xerosis. In the regression analyses controlling for age and gender, dry skin was a significant predictor for: axillary dermatitis (OR: 4.51; CI 2.70-7.54), atopic eczema (OR: 3.99; CI 3.42-4.65), exsiccation eczema (OR: 2.96; CI 2.40-3.65), psoriasis (OR: 1.57; CI 1.38-1.78), plantar warts (OR: 1.42; CI 1.26-1.60), seborrhoeic dermatitis (OR: 1.28; CI 1.16-1.42) and atopic disposition (OR: 1.17; CI 1.12-1.22). Conclusion Dry skin is a frequent condition in the adult general population and needs special attention. Known risk factors may facilitate identifying patients at risk for deterioration.

Background Delivery of health care to psoriasis patients plays an important role in the field of dermatology. Following the 2014 WHO resolution and the 2016 WHO global report, there has been an increase in the awareness of psoriasis among the general public. However, the perception of psoriasis by the general population remains unclear. The goal of the present study was to investigate the perception and assessment of psoriasis among the German population. Patients and methods Representative telephone survey among 2,001 adults using a standardized questionnaire. Analyses with respect to place of residence, age, gender and level of education were conducted in a descriptive manner. Results Twenty-nine percent of participants were familiar with the term "Psoriasis"; 86 %, with the German designation "Schuppenflechte". Ninety-three percent considered the disease to be a significant burden for affected individuals; 59 % stated that there were effective drugs available for psoriasis; 9 % considered the disease to be communicable. Ten percent reported that they would not want to live in the same household as an affected individual; 23 % did not want to share the same swimming pool; and 27 % did not want to be in a personal relationship with someone affected. Twelve percent stated to be familiar with the WHO resolution on psoriasis; 6 % with the World Psoriasis Day; and 3 % with the "Bitte beruhren" ("Please touch") campaign. Conclusions Although a majority of the German population is familiar with the term "Schuppenflechte", there is a significant lack of knowledge about the disease as well as prejudice toward affected individuals. Further measures are required to improve the level of information and decrease stigmatization.

HINTERGRUND Die Versorgung der Psoriasis vulgaris nimmt in der Dermatologie einen wichtigen Stellenwert ein. Im Zuge der WHO-Resolution 2014 und des WHO Global Reports 2016 hat die offentliche Aufmerksamkeit fur die Psoriasis zugenommen. Unklar ist, wie Psoriasis in der Allgemeinbevolkerung wahrgenommen wird. Ziel ist die Erfassung der Wahrnehmung und Bewertung von Psoriasis in der Bevolkerung. PATIENTEN UND METHODEN Reprasentative Telefonumfrage mit 2001 Erwachsenen mittels eines standardisierten Fragebogens. Die Auswertungen erfolgten deskriptiv nach Region, Alter, Geschlecht und Bildungsstatus. ERGEBNISSE Die Begriffe Psoriasis bzw. Schuppenflechte waren 29 % bzw. 86 % der Befragten, bekannt. 93 % schatzten die Krankheit als sehr belastend fur die Betroffenen ein, 59 % nahmen an, dass es wirksame Medikamente gegen Schuppenflechte gibt und 9 % hielten diese Erkrankung fur ansteckend. 10 % wurden nicht mit einer betroffenen Person im Haushalt leben wollen, 23 % nicht mit Betroffenen ins Schwimmbad gehen und 27 % nicht in einer Partnerschaft sein. 12 % gaben an, die WHO-Resolution zur Psoriasis zu kennen, 6 % den Weltpsoriasistag und 3 % die Kampagne "Bitte beruhren". SCHLUSSFOLGERUNGEN Wenngleich einer Mehrheit in der deutschen Bevolkerung die Schuppenflechte bekannt ist, bestehen deutliche Wissensdefizite und teilweise Vorurteile gegenuber dieser Erkrankung. Weitergehende Masnahmen zur besseren Information und zur Minderung der Stigmatisierung sind notwendig.

Computational heat transfer analysis often involves moving fluxes which induce traveling fronts of phase change coupled to one or more field variables. Examples are the transient simulation of melting, welding or of additive manufacturing processes, where material changes its state and the controlling fields are temperature and structural deformation. One of the challenges for a numerical computation of these processes is their multi-scale nature with a highly localized zone of phase transition which may travel over a large domain of a body. Here, a transient local adaptation of the approximation, with not only a refinement at the phase front, but also a de-refinement in regions, where the front has past is of advantage because the de-refinement can assure a bounded number of degrees of freedom which is independent from the traveling length of the front. We present a computational model of this process which involves three novelties: a) a very low number of degrees of freedom which yet yields a comparatively high accuracy. The number of degrees of freedom is, additionally, kept practically constant throughout the duration of the simulation. This is achieved by means of the multi-level hp-finite element method. Its exponential convergence is verified for the first time against a semi-analytic, three-dimensional transient linear thermal benchmark with a traveling source term which models a laser beam. b) A hierarchical treatment of the state variables. To this end, the state of the material is managed on a separate, octree-like grid. This material grid may refine or coarsen independently of the discretization used for the temperature field. This methodology is verified against an analytic benchmark of a melting bar computed in three dimensions in which phase changes of the material occur on a rapidly advancing front. c) The combination of these technologies to demonstrate its potential for the computational modeling of selective laser melting processes. To this end, the computational methodology is extended by the finite cell method which allows for accurate simulations in an embedded domain setting. This opens the new modeling possibility that neither a scan vectors no a layer of material needs to conform to the discretization of the finite element mesh but can form only a fraction within the discretization of the field and state variables.

Zusammenfassung Ziel der Studie Bislang gibt es nur wenige Erkenntnisse darüber, welchen Einfluss individuelle soziodemografische Merkmale des Patienten auf die Arztwahl haben und welche Rolle die patientenseitige Mobilität dabei einnimmt. Ziel der Studie war primär die Analyse patientenseitiger Entscheidungsmuster zur Arztwahl unter Berücksichtigung soziodemografischer Merkmale sowie Aspekte der Patientenmobilität. Methodik Es wurde eine multizentrische Querschnittsstudie bei niedergelassenen bzw. am Universitätsklinikum Hamburg-Eppendorf ambulant tätigen Dermatologen durchgeführt. Psoriasis- und Wundpatienten wurden zu ihrem Arztwahlverhalten befragt. Die Datenauswertung erfolgte anhand deskriptiver und multivariater Verfahren. Ergebnisse Daten von 309 Patienten (50,5% männlich, mittleres Alter 58,3 Jahre) wurden analysiert. 211 wurden in der Ambulanz des Universitätsklinikums rekrutiert, 98 bei niedergelassenen Dermatologen. Die Entscheidung, welcher Arzt aufgesucht wird, wird von der Einschätzung der Kompetenz des Arztes, seinem Leistungsangebot sowie dem Arzt-Patienten-Verhältnis beeinflusst. Die Aussicht auf eine bessere Therapie sowie eine Verschlechterung der Lebensqualität erhöhen die Bereitschaft, einen längeren Weg zum Arzt in Kauf zu nehmen. Schlussfolgerung Die Ergebnisse haben ein komplexes Arztwahlverhalten der Patienten gezeigt. Die Kompetenz des Arztes sowie sein Leistungsangebot haben dabei besonders Einfluss auf die Entscheidung des Patienten. Oftmals zeigte sich, dass Patienten dann auch dazu bereit wären, längere Wege zum Arzt zurückzulegen, als eigentlich notwendig wären.

This contribution presents a hierarchical multigrid approach for the solution of large-scale finite cell problems on both uniform grids and multi-level h p -discretizations. The proposed scheme takes advantage of the hierarchical basis functions utilized in the finite cell method and the multi-level h p -method, which is attributed to the use of high-order integrated Legendre basis functions and overlay meshes, to yield a simple and elegant multigrid scheme . This simplicity is reflected in the fact that transitioning between multigrid levels only involves the inclusion or exclusion of specific basis functions. All restriction and prolongation operators, therefore, reduce to binary matrices that do not need to be explicitly assembled or applied, saving computational time and memory. Elementwise and patchwise additive Schwarz smoothing techniques are used to mitigate the influence of the cut cells on the conditioning of the linear systems, while maintaining the parallelizability of the solver. The effectiveness of the scheme is numerically verified in various examples and convergence rates that are independent of the cut configuration, mesh size, refinement level and, in certain scenarios, even the polynomial order are shown. A series of numerical examples demonstrate the applicability of the scheme for solving large immersed systems with multiple millions and even billions of unknowns on massively parallel machines.

Chronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline-based wound care. The aim of this study was to investigate the validity of the Wound-QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound-QoL and two other QoL questionnaires (European Quality of Life-5 Dimensions, EQ-5D, and Freiburg Life Quality Assessment for wounds, FLQA-wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty-seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17-96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound-QoL showed good internal consistency, with high Cronbach's alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ-5D (range = 0.5-0.7) and FLQA-wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound-QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.

The finite cell method (FCM) is a fictitious domain approach that greatly simplifies simulations involving complex structures. Recently, the FCM has been applied to contact problems. The current study continues in this field by extending the concept of weakly enforced boundary conditions to inequality constraints for frictionless contact. Furthermore, it formalizes an approach that automatically recovers high-order contact surfaces of (implicitly defined) embedded geometries by means of an extended Marching Cubes algorithm. To further improve the accuracy of the discretization, irregularities at the boundary of contact zones are treated with multi-level $$hp$$ -refinements. Numerical results and a systematic study of h-, p- and hp-refinements show that the FCM can efficiently provide accurate results for problems involving contact.

The multi-level hp-refinement scheme is a powerful extension of the finite element method that allows local mesh adaptation without the trouble of constraining hanging nodes. This is achieved through hierarchical high-order overlay meshes, a hp-scheme based on spatial refinement by superposition. An efficient parallelization of this method using standard domain decomposition approaches in combination with ghost elements faces the challenge of a large basis function support resulting from the overlay structure and is in many cases not feasible. In this contribution, a parallelization strategy for the multi-level hp-scheme is presented that is adapted to the scheme's simple hierarchical structure. By distributing the computational domain among processes on the granularity of the active leaf elements and utilizing shared mesh data structures, good parallel performance is achieved, as redundant computations on ghost elements are avoided. We show the scheme's parallel scalability for problems with a few hundred elements per process. Furthermore, the scheme is used in conjunction with the finite cell method to perform numerical simulations on domains of complex shape., Comment: 24 pages, 16 figures

The field of dermatological comorbidity in psoriasis is only passively explored with contradictory results. Objective of this study was to further investigate the complex field of psoriasis and associated skin diseases by identifying skin comorbidity patterns in an extensive cohort of employees in Germany. Retrospective analysis of data deriving from occupational skin cancer screenings was conducted. From 2001 to 2014 German employees between 16 and 70 years from different branches underwent single whole-body screenings by trained dermatologists in their companies. All dermatological findings and need for treatment were documented. Point prevalence rates and their 95% confidence intervals were computed. Logistic regression analysis was performed to calculate odds ratios (OR) of single dermatological diseases to occur together with psoriasis controlled for age and sex. Data from 138,930 persons (56.5% male, mean age 43.2) were evaluated. Psoriasis point prevalence was 2.0%. Of those 20.6% had unmet treatment needs of their disease. Onychomycosis was the most frequent dermatological comorbidity with a prevalence of 7.8%. Regression analysis found rosacea (OR = 1.40, 95% CI 1.13-1.72) and telangiectasia (OR = 1.25, 95% CI 1.10-1.41) to be significantly associated with psoriasis. 17.2% of psoriasis patients had at least one further finding requiring treatment. The highest treatment needs were found for onychomycosis (3.4%), tinea pedis (3.1%), and verruca plantaris (1.0%). It can be concluded that persons with psoriasis are at increased risk to suffer from comorbid skin diseases, which should be considered in treatment regimens. Particular attention should be paid to fungal diseases of the feet.

We present an easy treatment of (multi-level) hanging nodes in hp -finite elements in two dimensions. Its simplicity is due to the fact that the connectivity matrices can directly be computed in a row-wise fashion. This is achieved by treating a global degree of freedom as a local degree of freedom on each element in an appropriate union of elements. This forms a type of support which is larger than the one used in the conventional approach and generalizes the recently presented multi-level hp -method. Our method requires the global degrees of freedom to be derived from tensor-product shape functions. It supports refinements of general quadrilaterals and curvilinear elements since refinements are performed on the reference element. While the method can be applied most efficiently if the subdivision leads to a paraxial subset of the reference element, also non-paraxial refinements are supported. Numerical experiments compare the new approach with respect to accuracy and the conditioning of the resulting linear system. We conclude that this new approach achieves nearly the same properties as the conventional approach in all investigated examples and provides an excellent trade-off between implementational complexity and solvability.

BACKGROUND: Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES: To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS: In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS: In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS: Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

Background Due to the increasing incidence of skin cancer, programmes for the prevention of skin cancer have been developed and implemented in Germany. However, utilization of skin cancer screenings shows marked regional differences. Reasons and predictors of such variations are unclear. Objectives The objective of the study is to identify predictors for regional use of skin cancer screening variations in Germany. Methods Analysis of the population set of ambulatory claims data (2009-2015) of the statutory health insurances (SHI) in Germany (70.2 million people in 2015). Skin cancer screening utilization rate was determined on county level. Descriptive, cluster and multivariate analyses were performed to identify spatial patterns in skin cancer screening utilization. Results Overall, 6.5-7.9 million people participated in skin cancer screenings. Utilization rates of people ≥35 years of age were 9.74% (2009) and 10.96% (2015). Marked regional variations were identified between the counties. Dermatologists in Saxony and Westphalia-Lippe as well as general practitioners in Lower Saxony and North Rhine showed particularly high utilization rates. Multiple regression analyses demonstrated e.g. positive associations between the skin cancer screening utilization rates and employees with higher vocational qualifications and shorter travel time by car to the nearest major urban centre. Conclusion Utilization rates of skin cancer screening vary largely in Germany with specific spatial patterns. Multivariate analyses demonstrate associations with socio-economic and geographical determinants. The results indicate the importance of health policy measures. These should be used in a more targeted manner in the regions in order to increase utilization of skin cancer screening.

The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are willing to bypass the nearest physician. It was conducted according to the PRISMA extension for scoping reviews (PRISMA-ScR). Three databases (PubMed/Medline, ScienceDirect, and Ovid Medline) were searched, focusing on articles in which distance influenced the choice of physician. In all, 1,308 articles were accessed, and 17 selected for final review. First, we extracted methods for assessing distance traveled and bypassing. Second, we identified determinants that directly influence the traveled distance and transferred all into a conceptual framework. The center of this framework is the individual “willingness-to-go”, which reflects the willingness of patients to accept additional distances. Our findings can support studies on patient mobility and physician choice, which are essential for examining both the distribution and use of medical services, as well as for adequate need related planning.

Treatment of patients with malignant melanoma includes informing the patients about their rights regarding social/disability benefits. In particular, every patient has the right to rehabilitation treatment according to SGB V and IX (SGB: Sozialgesetzbuch; Social Security Code) and to an examination regarding the classification of the disability.The present study examines the extent to which patients with invasive malignant melanoma are informed after initial diagnosis about their social rights to medical rehabilitation measures and the classification of disability.In the course of a survey in 2014, n = 1800 German dermatological practices were contacted and provided a standardized questionnaire on several care-relevant questions, including the aforementioned ones.Evaluable questionnaires were submitted by n = 424 practices. In all, 52% of dermatologists stated that they regularly provided information on the right to rehabilitation, 15% sometimes, 41% rarely or never. Furthermore, 44% of dermatologists regularly, 17% sometimes and 38% rarely or never informed their patients about the classification of disability. Relevant differences were found in regional comparisons.Practicing dermatologists seem to transfer the information requirement to the clinics involved in the treatment. It would be beneficial if the information were also provided again by the dermatologists in private practice. In view of the known limited capacity to receive new information from patients with newly diagnosed melanoma, repeated counselling appears to be more patient-friendly.

The skin cancer screening program in Germany is used for early identification of skin tumours with the aim of a lower-risk removal and avoidance of progression.The aim of the study is to investigate the extent to which skin cancer screening (SCS) has an additional effect on dissemination of information on primary prevention.This question was examined from the point of view of screening participants and dermatologists. The proportion of appropriately informed persons among persons who have been screened was determined based on a survey of a representative sample of the German standard population of 1004 persons; the provision of information on primary preventive behaviour was based on a survey of dermatological practices (n = 444). Both surveys were evaluated descriptively.Of those who underwent SCS (n = 397), the majority (74%) stated that information on protection against UV radiation was provided during the screening. Among dermatologists offering SCS (n = 424), 70% stated that they personally informed all SCS participants about measures preventing skin cancer, and 46% always or predominantly provided written material after conducting SCS.In addition to secondary prevention, SCS also has an important primary preventive function; however there is potential for improvement, since about a quarter of the SCS participants do not receive any information on preventive behaviour from the examining physician. The extent to which this information is actually applied by the SCS participants should be investigated in a longitudinal study.

One main challenge of the h p -version of the finite element method is the high implementational complexity of the method resulting from the added need of handling hanging nodes appropriately. The multi-level h p -formulation–recently introduced for two-dimensional applications–aims at alleviating these difficulties without compromising the approximation quality. This is achieved by changing from the conventional refine-by-replacement approach to a refine-by-superposition idea. The current work shows that the multi-level h p -approach can be extended naturally to three-dimensional refinement without increasing the complexity of the rule set ensuring linear independence and compatibility of the shape functions. In this way, a three-dimensional h p -refinement scheme is formulated, in which hanging nodes are avoided by definition. This ease of complexity allows for a highly flexible discretization kernel featuring arbitrary irregular meshes and a continuous refinement and coarsening throughout the simulation runtime. Different numerical examples demonstrate that–even in the presence of singularities–this novel refinement scheme yields exponential convergence with respect to both, the number of unknowns and the computational time. It is further shown that the refinement scheme is able to capture complex solution features that demand for three-dimensional refinement patterns. The dynamic discretization properties of the approach are demonstrated by continuously refining and coarsening the mesh during the simulation runtime to keep the refinement zone local to a moving singularity. Finally, it is shown that the high approximation power of the multi-level h p -scheme also carries over to curved geometries common in engineering practice without a significant detrimental effect on the conditioning of the stiffness matrix.

Summary Discretization-induced oscillations in the load–displacement curve are a well-known problem for simulations of cohesive crack growth with finite elements. The problem results from an insufficient resolution of the complex stress state within the cohesive zone ahead of the crack tip. This work demonstrates that the hp-version of the finite element method is ideally suited to resolve this complex and localized solution characteristic with high accuracy and low computational effort. To this end, we formulate a local and hierarchic mesh refinement scheme that follows dynamically the propagating crack tip. In this way, the usually applied static a priori mesh refinement along the complete potential crack path is avoided, which significantly reduces the size of the numerical problem. Studying systematically the influence of h-refinement, p-refinement, and hp-refinement, we demonstrate why the suggested hp-formulation allows to capture accurately the complex stress state at the crack front preventing artificial snap-through and snap-back effects. This allows to decrease significantly the number of degrees of freedom and the simulation runtime. Furthermore, we show that by combining this idea with the finite cell method, the crack propagation within complex domains can be simulated efficiently without resolving the geometry by the mesh. Copyright © 2016 John Wiley & Sons, Ltd.

This paper presents an efficient and accurate method for the integration of discontinuous functions on a background mesh in three dimensions. This task is important in computational mechanics applications where internal interfaces are present in the computational domain. The proposed method creates boundary-conforming integration subcells for composed numerical quadrature, even in the presence of sharp geometric features (e.g. edges or vertices). Similar to the octree procedure, the algorithm subdivides the cut elements into eight octants. However, the octant nodes are moved onto the interface, which allows for a robust resolution of the intersection topology in the element while maintaining algorithmic simplicity. Numerical examples demonstrate that the method is able to deliver highly accurate domain integrals with a minimal number of quadrature points. Further examples show that the proposed method provides a viable alternative to standard octree-based approaches when combined with the Finite Cell Method.

Abstract. Background: The aim of this study was to develop and validate a specific Patient Benefit Index (PBI) version for the treatment of peripheral arterial disease (PAD). Patients and methods: A non-interventional longitudinal development study was conducted. The first phase comprised a qualitative pre-study with n = 50 patients, in which the PBI was adapted for peripheral arterial disease. The resulting Patient Benefit Index for peripheral arterial disease (PBI-PAD) was validated in the second phase at two points of measurement. The total PBI-PAD score was calculated by weighting item-wise the achievement of treatment goals with the initially assessed needs. Feasibility, internal consistency, and construct validity were analysed and the generic three level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and the disease-specific instrument Vascular Quality of Life Questionnaire (VascuQoL) were used for convergent validation. Results: In the pre-study, the PBI-PAD, consisting of 12 items, was developed. N = 103 patients participated in the main study. At T2, data were available for n = 57 patients. Mean age was 71.0 years ± 9.1 and 66.7 % of the participants were male. The amount of missing values of the PBI-PAD score was low (< 4.0 %) and no relevant floor effects were observed. Both parts of the PBI (needs at T1 and benefits at T2) were internally consistent with Cronbach’s alpha > 0.7. PBI-PAD total score correlated significantly with the T2-T1-differences of the EuroQol-visual analogue scale (EQ VAS) (r = 0.4, p = 0.007) and the Vascular Quality of Life Questionnaire (r = 0.5, p < 0.001). Conclusions: The PBI-PAD is a feasible, internally consistent, and valid instrument to assess patient-relevant benefits in PAD patients receiving minimally invasive treatment or surgical procedures. It can be recommended for use in routine care as well as in clinical studies.

Contact problems in solid mechanics are traditionally solved using the h -version of the finite element method. The constraints are enforced along the surfaces of e.g. elastic bodies under consideration. Standard constraint algorithms include penalty methods, Lagrange multiplier methods and combinations thereof. For complex scenarios, a major part of the solution time is taken up by operations to identify points that come into contact. This paper presents a novel approach to model frictionless contact using high order finite elements. Here, we employ an especially designed material model that is inserted into two- respectively three-dimensional regions surrounding contacting bodies. Contact constraints are thus enforced on the same manifold as the accompanying structural problem. The application of the current material formulation leads to a regularization of the Karush-Kuhn-Tucker conditions. Our formulation can be classified as a barrier-type method. Results are obtained for two- and three-dimensional problems, including a Hertzian contact problem. Comparisons to a commercial FEA package are provided. The proposed formulation works well for non-matching discretizations on adjacent contact interfaces and handles self-contact naturally. Since the non-penetrating conditions are solved in a physically consistent manner, there is no need for an explicit contact search.

The implementation of $$hp$$hp-adaptivity is challenging as hanging nodes, edges, and faces have to be constrained to ensure compatibility of the shape functions. For this reason, most $$hp$$hp-code frameworks restrict themselves to $$1$$1-irregular meshes to ease the implementational effort. This work alleviates these difficulties by introducing a new formulation for high-order mesh adaptivity that provides full local $$hp$$hp-refinement capabilities at a comparably small implementational effort. Its main idea is the extension of the $$hp$$hp-$$d$$d-method such that it allows for high-order overlay meshes yielding a hierarchical, multi-level $$hp$$hp-formulation of the Finite Element Method. This concept enables intuitive refinement and coarsening procedures, while linear independence and compatibility of the shape functions are guaranteed by construction. The proposed method is demonstrated to achieve exponential rates of convergence--both in terms of degrees of freedom and in run-time--for problems with non-smooth solutions. Furthermore, the scheme is used alongside the Finite Cell Method to simulate the heat flow around moving objects on a non-conforming background mesh and is combined with an energy-based refinement indicator for automatic $$hp$$hp-adaptivity.

BACKGROUND UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P

Background Though psoriasis poses a substantial chronic socio-economic burden, few studies have addressed the economic impact in Germany. Objectives The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective. Methods A cross-sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardised questionnaires of illness-related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non-parametric tests. Results Complete data were obtained from 1,158 patients in 132 centres. Annual average costs for patients with psoriasis: Total costs € 5,543 ± € 8,044, systemic treatment costs (paid by the statutory health insurances (SHI)) € 3,733 ± € 7,322, out-of-pocket costs € 224 ± € 406, total SHI costs € 4,940 ± € 7,533, direct costs € 5,164 ± € 7,581 and indirect costs € 379 ± € 2,087. Significant higher costs in male and significant lower costs in 65+-year-old patients were found. Conclusions Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out-of-pocket and indirect costs towards systemic drug costs. This article is protected by copyright. All rights reserved.

Background The relationship between atopic conditions and carcinoma of the skin has been described inconsistently. Population-based data providing information on atopic diseases as well as on skin-cancer are sparse. Objective To determine the correlation between atopy and prevalence of precanceroses, nonmelanoma skin-cancer and malignant melanoma (MM), while taking into account known risk factors for skin cancer. Methods Data from occupational skin cancer screenings were analysed in a cross-sectional study. Dermatologists performed whole body examinations and collected medical histories. Subjects comprised all employees (16 to 70 years) examined from 2006 to 2014. ‘Atopy’ was defined by clinical screening diagnosis and/or by participant-reported, pre-existing atopic dermatitis, allergic asthma or other specified allergies confirmed by a physician. Tentative screening diagnoses of skin cancer related to actinic keratosis, basal cell carcinoma and malignant melanoma. Results The study cohort comprised 90,265 employees (mean age 43 ± 11 years, 58.5% male), 30.7% of whom were ever diagnosed with an atopic disease. Persons with atopic conditions recorded in their medical history and at the time of screening had a significantly lower prevalence of actinic keratosis (AK), basal cell carcinoma (BCC) and MM. After controlling for age, sex and relevant risk factors (skin type, childhood sun burns), atopy remained significantly protective against BCC (OR 0.77) and MM (OR 0.53). Conclusion Design limitations of the study include that all findings of skin cancer were based on clinical examination only and must therefore be considered tentative diagnoses. Furthermore, owing to the cross-sectional study design, causal pathways cannot be proven. However, analyses of data from such a large and general population-based cohort afford valuable insights into the relationship of atopic diseases and skin cancer. They provide the grounds for prospective cohort studies to evaluate and dissect the underlying mechanism. This article is protected by copyright. All rights reserved.

The recently introduced Finite Cell Method (FCM) combines the fictitious domain idea with the benefits of high-order Finite Elements. While previous publications concentrated on single-field applications, this paper demonstrates that the advantages of the method carry over to the multi-physical context of linear thermoelasticity. The ability of the method to converge with exponential rates is illustrated in detail with a benchmark problem. A second example shows that the Finite Cell Method correctly captures the thermoelastic state of a complex problem from engineering practice. Both examples additionally verify that, also for two-field problems, Dirichlet boundary conditions can be weakly imposed on non-conforming meshes by the proposed extension of Nitsche’s Method.

The Finite Cell Method (FCM) is an embedded domain method, which combines the fictitious domain approach with high-order finite elements, adaptive integration, and weak imposition of unfitted Dirichlet boundary conditions. For smooth problems, FCM has been shown to achieve exponential rates of convergence in energy norm, while its structured cell grid guarantees simple mesh generation irrespective of the geometric complexity involved. The present contribution first unhinges the FCM concept from a special high-order basis. Several benchmarks of linear elasticity and a complex proximal femur bone with inhomogeneous material demonstrate that for small deformation analysis, FCM works equally well with basis functions of the p-version of the finite element method or high-order B-splines. Turning to large deformation analysis, it is then illustrated that a straightforward geometrically nonlinear FCM formulation leads to the loss of uniqueness of the deformation map in the fictitious domain. Therefore, a modified FCM formulation is introduced, based on repeated deformation resetting, which assumes for the fictitious domain the deformation-free reference configuration after each Newton iteration. Numerical experiments show that this intervention allows for stable nonlinear FCM analysis, preserving the full range of advantages of linear elastic FCM, in particular exponential rates of convergence. Finally, the weak imposition of unfitted Dirichlet boundary conditions via the penalty method, the robustness of FCM under severe mesh distortion, and the large deformation analysis of a complex voxel-based metal foam are addressed.

Background Safety and efficacy of new treatments are analyzed in clinical trials but their capacity to show potential effects of long-term treatment and more than short latency of onset is limited. To meet this challenge, patient registries (of treatments or diseases) collect prospective data of real-world patients in daily practice without tight selection of patients. Objective The aim of this article was to identify existing psoriasis patient registries by published articles and evaluation of monitored treatment classes, patients, research questions addressed, and measurement instruments implemented. Materials & Methods A systematic review of Medline (PubMed) and Embase (Ovid) databases for publications on psoriasis patient registries, including cross-validation was conducted October 2015. Results 14 patient registries for long-term observation of psoriasis patients in real-world care were identified. Registries were established since 2005, the majority is located in Europe. The number of published studies from single registries ranged from 1 to 10. Most registries include patients treated by conventional systemics as well as biologics. The number of patients analyzed ranged from 35 to >12 000 patients. The publications mostly addressed safety issues or treatment outcomes, followed by baseline description, drug survival, predictor analyses, and treatment patterns. Conclusion A variety of local, national, and international patient registries collect longitudinal data on (systemic) psoriasis treatment. The number of publications reflect the main registry objectives of safety and effectiveness, with additional therapy-related investigations being addressed as well. Based on the information from publications, the combination of data from these registries will involve many methodological challenges. To gain comparability and combinability of cohorts and data across registries, further harmonization of data collection is demanded.

In order to cope with accidents beyond the design basis within German nuclear power plants which possibly lead to relevant radiological consequences, the utilities as well as the competent authorities exist emergency organisations. The efficiency, capacity for teamwork and preparedness of such organisations should be tested by regular, efficient exercise activities. Such activities can suitably be based on scenarios which provide challenging tasks for all units of the respective emergency organisation. Thus, the demonstration and further development of the efficiency of the respective organisational structures, including their ability to collaborate, is promoted.