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Background Patients with atopic dermatitis (AD) frequently use acupuncture (ACU) and osteopathic medicine (OM), although their therapeutic benefits are unclear. Aim To investigate the effectiveness of ACU and OM in patients with AD. Methods In a three-armed, single-centre, randomized controlled open explorative clinical trial, adult patients with AD received ACU, OM or no study intervention (control group; CG) plus routine care. Outcomes included disease severity (SCORing Atopic Dermatitis; SCORAD), itching intensity (visual analogue scale; VAS), frequency of topical corticosteroid (TCS) use over 7 days and cost-effectiveness. Endpoints were analysed by analysis of covariance adjusted for the respective baseline value and TCS use. Results Overall, 121 patients (92 women, 29 men) with a mean ± SD age of 31.4 ± 10.5 years were randomized. After 12 weeks, the adjusted means (95% CI) for ACU, OM and control were, respectively, 22.3 (18.3–26.3), 26.4 (22.6–30.2) and 23.7 (19.9–27.5) for SCORAD (P = 0.32); 27.9 (19.5–36.4), 35.0 (26.9–43.0) and 42.3 (34.7–50.0) for VAS itching (P < 0.05); and 2.3 (0.8–3.9), 1.9 (0.4–3.5) and 4.3 (2.6–6.0), for TCS use (P = 0.10). ACU and OM were not cost-effective compared with the CG. Conclusion Although no differences in disease severity were found, our findings indicate that ACU might reduce itching in patients with AD. Furthermore, ACU and OM showed a trend towards reducing TCS use.

During the COVID-19 pandemic, rehearsal and concert activities of professional orchestras and choirs were severely restricted based on the assumption of particularly high infection risks associated with wind instruments and singing. Therefore, our primary objective was to determine the incidence of SARS-CoV-2 infections in orchestra and choir musicians compared to controls. We also assessed influenza, flu, upper respiratory tract infections, and course of illness. Musicians from professional orchestras and choirs and controls from 23 institutions throughout Germany were included in a prospective cohort study. Data were collected from October 2020 to June 2021 by weekly online surveys. A mixed-effects cox proportional hazards model was used to assess the effect of exposure by professional activity on SARS-CoV-2 infection. In 1,097 participants (46.7 years (SD 10.3); 46.8% female; 705 orchestra, 154 choir, and 238 control subjects) 40 SARS-CoV-2 infections occurred. Cases per person-years were 0.06 in orchestras, 0.11 in choirs, and 0.03 in controls. Hazard ratios compared to controls were 1.74 (95% CI 0.58 to 5.25, p = 0.320) for orchestra musicians and 2.97 (0.87 to 10.28, p = 0.087) for choir singers. Infection source was suspected predominantly in private contexts. Disease courses were mild to moderate. Other respiratory infections were reported in 6.1% of study weeks in orchestras, 10.1% in choirs, and 8.0% in controls. Sick leave days of total study days were 0.5, 2.1 and 1.3%, respectively. This epidemiologic study during the pandemic in professional musicians indicates no increased risk of SARS-CoV-2 infections in orchestra musicians and a trend towards increased risk in choir singers compared to controls. However, the exact routes of infection could not be validated. If appropriate hygiene concepts are adhered to, safe orchestra and choir activity appears possible in pandemic times.

Zusammenfassung Hintergrund Wohnungslosigkeit ist Ausdruck und Folge einer komplexen Problemlage, die die medizinischen und sozialen Versorgungssysteme in Deutschland vor große Herausforderungen stellt. Etwa 3 Viertel der wohnungslosen Menschen leiden an psychischen Erkrankungen. Ziel dieser Studie war es, Assoziationen zwischen psychischen Erkrankungen und Wohnungslosigkeit zu untersuchen. Material und Methoden Es wurde eine Sekundärdatenanalyse von Patient*innendokumentationen eines Berliner Gesundheitszentrums für Obdachlose durchgeführt. In die explorative Studie eingeschlossen wurden Daten von 112 wohnungslosen Patient*innen, die dort zwischen den Jahren 2006 und 2020 versorgt wurden. Ergebnisse Bei 84,9 % der Patient*innen lagen psychische Erkrankungen bereits vor dem Beginn der Wohnungslosigkeit vor. Assoziiert mit einem frühen Beginn der Wohnungslosigkeit waren die Faktoren niedrige Schulbildung sowie Drogenabusus. Eine lange Dauer der Wohnungslosigkeit war mit den Faktoren Alkoholabusus sowie Haftaufenthalte assoziiert. Jede erneute Episode der Straßenobdachlosigkeit war mit einer durchschnittlichen Verlängerung der Dauer der Wohnungslosigkeit um 7,9 Monate assoziiert. Diskussion Da psychische Erkrankungen wichtige Einflussfaktoren für die Entstehung und Aufrechterhaltung von Wohnungslosigkeit sind, sollten vermehrt präventive Strategien sowie spezialisierte Angebote für diese vulnerable Gruppe geschaffen werden. Insbesondere wiederkehrende Episoden der Straßenobdachlosigkeit sollten so weit wie möglich verhindert werden. Der Zusammenhang zwischen Inhaftierungen und Wohnungslosigkeit legt nahe, dass eine intensivere Begleitung bei der Wiedereingliederung nach Haftentlassung erforderlich ist.

Background: Complementary and integrative medicine (CIM) is increasingly provided at uni-versity outpatient departments (OPDs) in Germany, but its scientific evaluation is sparse. Therefore, we aimed to investigate and evaluate feasibility, patients’ characteristics and com-plaints at a university’s CIM-OPD. Methods: A prospective evaluation included new patients without age restriction. At baseline, and after six and 12 months, patients filled out paper questionnaires. Patients rated their mean subjectively perceived severity of the main complaint within the last seven days on a numeri-cal rating scale (NRS) from 0=no complaints to 10=maximum complaints, their perceived re-silience capacity in everyday life within the last seven days (0=not resilient to 10=very resili-ent), and their contentment with the treatment (0=not content to 10=very content). Diagnoses were provided by physicians and coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. All data were analyzed descriptively. Results: During two years, 536 new patients (72.6% response, age (mean±SD and range) 49.6 ± 15.8 and 1 - 86 years, 75.7% female) chose to participate. The most frequent diagno-sis groups were neoplasms (C00-C97, n=143, 18.6%) and musculoskeletal diseases (M00-M99, n=137, 17.9%). In n=165 patients (30.8%) more than one diagnosis was provided. In a subgroup of 187 patients, who returned the questionnaire after 6 months, we compared base-line to 6-month values: severity of main complaint (mean±SD) 5.2 ± 2.6 changed to 3.9 ± 2.6; resilience capacity 5.1 ± 2.6 to 5.6 ± 2.4. After six months, respondents rated their content-ment with the treatment with (mean±SD) 7.7 ± 2.6. Data after 12 months (n=113) are compa-rable to data after 6 months. Conclusion: Patients of our CIM-OPD had a broad age range, were predominantly female and suffered mostly from oncologic-related complaints and musculoskeletal diseases. In the responding subgroup after six months, patients were content with the treatment. These re-sults should be verified by further prospective evaluations.

This research addresses the assessment of adipose tissue (AT) and spatial distribution of visceral (VAT) and subcutaneous fat (SAT) in the trunk from standardized magnetic resonance imaging at 3 T, thereby demonstrating the feasibility of deep learning (DL)–based image segmentation in a large population-based cohort in Germany (five sites). Volume and distribution of AT play an essential role in the pathogenesis of insulin resistance, a risk factor of developing metabolic/cardiovascular diseases. Cross-validated training of the DL-segmentation model led to a mean Dice similarity coefficient of >0.94, corresponding to a mean absolute volume deviation of about 22 ml. SAT is significantly increased in women compared to men, whereas VAT is increased in males. Spatial distribution shows age- and body mass index–related displacements. DL-based image segmentation provides robust and fast quantification of AT (≈15 s per dataset versus 3 to 4 hours for manual processing) and assessment of its spatial distribution from magnetic resonance images in large cohort studies.

Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

Background: Diabetic polyneuropathy (DPN) is a common complication of diabetes, which presents with a loss of sensorimotor function or pain. This study assessed the effectiveness and safety of acupuncture as a treatment for DPN-related complaints. Methods: In this randomized controlled trial, patients with type II diabetes and symptoms of neuropathy in the lower limbs were included. A total of 12 acupuncture treatments were administered over 8 weeks. The waitlist control group received the same acupuncture treatment starting at week 16 (after baseline). Results: A total of 62 patients were randomized (acupuncture group n = 31; control group n = 31). The primary outcome was overall complaints, and it was reduced with a significant difference of 24.7 on a VAS (CI 95% 14.8;34.7, p < 0.001) between both groups in favor of acupuncture. Reductions were recorded for the secondary outcomes VAS pain, neuropathic pain symptom inventory (NPSI), emotional dimensions of pain, SF-12, and diabetic peripheral neuropathic pain impact (DPNPI) after the intervention and at the follow-ups in the acupuncture group. Adverse reactions were minor and transient. Conclusions: Acupuncture leads to a significant and lasting reduction in DPN-related complaints when compared to routine care and is well tolerated, with minor side effects.

Die Akupunktur ist ein Therapieverfahren der Chinesischen Medizin, das inzwischen auch in der westlichen Welt haufig eingesetzt wird. In den letzten beiden Jahrzehnten wurde die Akupunktur intensiv wissenschaftlich untersucht. Darstellung von Wirksamkeit, Therapiesicherheit und gesundheitsokonomischer Relevanz der Akupunktur bei chronischen Schmerzerkrankungen und Allergien. Im Rahmen einer Ubersichtsarbeit (narratives Review) wurde die relevante Literatur ausgesucht, vorgestellt und interpretiert. Akupunktur hat sich bei vielen chronischen Schmerzerkrankungen unter Routinebedingungen als wirksam erwiesen, so z. B. bei Kniegelenksschmerzen aufgrund von Arthrose, bei Migrane, Spannungskopfschmerz, chronischen Schmerzen der Lenden- und Halswirbelsaule, Schulterschmerzen, Dysmenorrhoe und Fibromyalgie. Auserdem zeigt sich bei den meisten Schmerzerkrankungen eine spezifische Wirksamkeit. Auch bei Patienten mit allergischen Erkrankungen ist Akupunktur wirksam. Akupunktur hat sich in den grosen klinischen Studien als relativ sicheres Therapieverfahren erwiesen, allerdings kommen in seltenen Fallen auch schwere Komplikationen vor (z. B. Pneumothorax-Falle, Hepatitis-Infektionen). In der Regel ist Akupunktur mit zusatzlichen Therapiekosten verbunden, gilt allerdings bei Schmerzerkrankungen als kosteneffektive Therapiestrategie. Diskussion: Als nichtpharmakologisches Verfahren kommt Akupunktur eine wachsende Bedeutung bei der Behandlung von chronischen Schmerzerkrankungen und Allergien zu. Sie wird daher zunehmend in aktuelle Therapieleitlinien aufgenommen. In weiteren Studien sollten die Wirksamkeit der Akupunktur bei weiteren Indikationen und die Wirkmechanismen der Akupunktur untersucht werden.

Hintergrund Die Akupunktur ist ein Therapieverfahren der Traditionellen Chinesischen Medizin, das inzwischen auch in der westlichen Welt häufig eingesetzt wird. In den letzten beiden Jahrzehnten wurde es intensiv wissenschaftlich untersucht. Ziel der Arbeit Darstellung von Wirksamkeit, Therapiesicherheit und gesundheitsökonomischer Relevanz der Akupunktur bei chronischen Schmerzerkrankungen und Allergien. Material und Methoden Im Rahmen einer Übersichtsarbeit (narratives Review) wird die relevante Literatur ausgesucht, vorgestellt und interpretiert. Ergebnisse Akupunktur hat sich bei vielen chronischen Schmerzerkrankungen unter Routinebedingungen als wirksam erwiesen, so z. B. bei Kniegelenksschmerzen aufgrund von Arthrose, bei Migräne, Spannungskopfschmerz, chronischen Schmerzen der Lenden- und Halswirbelsäule, Schulterschmerzen, Dysmenorrhö und Fibromyalgie. Außerdem zeigt sich bei den meisten Schmerzerkrankungen eine spezifische Wirksamkeit. Auch bei Patienten mit allergischen Erkrankungen ist Akupunktur wirksam. Akupunktur hat sich in den großen klinischen Studien als relativ sicheres Therapieverfahren erwiesen, allerdings kommen in seltenen Fällen auch schwere Komplikationen vor (z. B. Pneumothoraxfälle, Hepatitisinfektionen). In der Regel ist Akupunktur mit zusätzlichen Therapiekosten verbunden, gilt allerdings bei Schmerzerkrankungen als kosteneffektive Therapiestrategie. Diskussion Als nichtpharmakologischem Verfahren kommt Akupunktur eine wachsende Bedeutung bei der Behandlung von chronischen Schmerzerkrankungen und Allergien zu. Sie wird daher zunehmend in aktuelle Therapieleitlinien aufgenommen. In weiteren Studien sollte ihre Wirksamkeit bei weiteren Indikationen bestimmt werden. Die Wirkmechanismen sollten untersucht werden., Background: Acupuncture is a traditional Chinese medicine therapy method that is also frequently used in the western world. It has been the subject of intensive scientific research over the past two decades. Aim of the work: To describe the efficacy, therapy safety, and health economic relevance of acupuncture for chronic pain disorders and allergic diseases. Material and methods: In the context of a review (narrative review) the relevant literature was selected, presented, and interpreted. Results: Acupuncture is effective in chronic pain disorders such as chronic knee joint pain in osteoarthritis, migraine, tension headache, chronic lumbar spine pain, chronic cervical spine pain, shoulder pain, dysmenorrhea, and fibromyalgia under routine conditions. In addition, specific efficacy is shown in most chronic pain indications. Acupuncture is also effective in patients with allergic diseases. In large clinical studies, acupuncture has proven to be a relatively safe therapy, but severe complications (e.g. pneumothorax cases, hepatitis B) also occur in rare instances. Acupuncture is usually associated with higher therapy costs, but is considered a cost-effective treatment strategy for pain disorders. Discussion: As a nonpharmacological procedure, acupuncture is becoming increasingly important in pain and allergy therapy and is therefore increasingly included in current guidelines. In further studies, the efficacy of acupuncture should be determined in other indications and the mechanisms of action of this therapy method should be investigated.

HINTERGRUND: Personen mit Migrationshintergrund (PmM) unterscheiden sich als Bevölkerungsgruppe hinsichtlich Morbidität, Mortalität und Inanspruchnahme des Gesundheitssystems meist von der autochthonen Bevölkerung, sie nehmen jedoch seltener an Gesundheitsstudien teil. Die Gruppe der PmM ist sehr heterogen, was in Studien bisher kaum berücksichtigt wird. ZIEL DER ARBEIT: Es werden soziodemografische Charakteristika der PmM in der NAKO Gesundheitsstudie (Alter, Geschlecht, Zeit seit Migration, Bildung) dargestellt. Zudem wird exemplarisch untersucht, ob der Migrationshintergrund mit der Nutzung des Angebots zur Früherkennung von Darmkrebs (Hämoccult-Test) zusammenhängt. METHODEN: Daten der ersten 101.816 Teilnehmenden der NAKO wurden deskriptiv und kartografisch ausgewertet. Die Zuweisung des Migrationshintergrunds erfolgte anhand der Definition des Statistischen Bundesamts und basiert auf Staatsangehörigkeit, Geburtsland, Einreisejahr und Geburtsland der Eltern. ERGEBNISSE: Der Anteil der PmM liegt bei 16,0 %. Die Verteilung über die 18 Studienzentren variiert zwischen 6 % (Neubrandenburg) und 33 % (Düsseldorf). Mit 153 Herkunftsländern sind in der NAKO die meisten Länder vertreten. Bei allen Variablen zeigen sich deutliche Unterschiede zwischen den verschiedenen Herkunftsregionen. Am Hämoccult-Test nehmen türkeistämmige Personen (OR = 0,67) und Aussiedler aus der ehemaligen Sowjetunion (OR = 0,60) seltener teil. PmM, die in Deutschland geboren sind, unterscheiden sich diesbezüglich nicht von der autochthonen Bevölkerung (OR = 0,99). DISKUSSION: PmM in der NAKO sind eine sehr heterogene Gruppe. Jedoch lassen sich aufgrund der Stichprobengröße einzelne Untergruppen der PmM hinsichtlich ihrer Herkunftsregion separat untersuchen. BACKGROUND: Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJEKTIVES: Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS: Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS: Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION: PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.

BACKGROUND: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. METHODS: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014–2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/ financial changes (controlling for various covariates). RESULTS: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0–27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. CONCLUSION: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.

During the COVID-19 pandemic, rehearsal and concert activities of professional orchestras and choirs were severely restricted based on the assumption of particularly high infection risks associated with wind instruments and singing. Therefore, our primary objective was to determine the incidence of SARS-CoV-2 infections in orchestra and choir musicians compared to controls. We also assessed influenza, flu, upper respiratory tract infections, and course of illness. Musicians from professional orchestras and choirs and controls from 23 institutions throughout Germany were included in a prospective cohort study. Data were collected from October 2020 to June 2021 by weekly online surveys. A mixed-effects cox proportional hazards model was used to assess the effect of exposure by professional activity on SARS-CoV-2 infection. In 1,097 participants (46.7 years (SD 10.3); 46.8% female; 705 orchestra, 154 choir, and 238 control subjects) 40 SARS-CoV-2 infections occurred. Cases per person-years were 0.06 in orchestras, 0.11 in choirs, and 0.03 in controls. Hazard ratios compared to controls were 1.74 (95% CI 0.58 to 5.25, p = 0.320) for orchestra musicians and 2.97 (0.87 to 10.28, p = 0.087) for choir singers. Infection source was suspected predominantly in private contexts. Disease courses were mild to moderate. Other respiratory infections were reported in 6.1% of study weeks in orchestras, 10.1% in choirs, and 8.0% in controls. Sick leave days of total study days were 0.5, 2.1 and 1.3%, respectively. This epidemiologic study during the pandemic in professional musicians indicates no increased risk of SARS-CoV-2 infections in orchestra musicians and a trend towards increased risk in choir singers compared to controls. However, the exact routes of infection could not be validated. If appropriate hygiene concepts are adhered to, safe orchestra and choir activity appears possible in pandemic times.

Background: The model for integrated care (IC) of those seriously mentally ill patients insured with the DAK-Gesundheit health insurance and various Betriebskrankenkassen (members of the VAG Mitte) from the regions Berlin, Brandenburg, Lower Saxony and Bremen allows a complex treatment in the outpatient setting which consists of psychiatrists, general practitioners and clinicians, psychiatric nursing, sociotherapy (only in Berlin), internal medicine quality circles, orientation on treatment guidelines and conceptual consensus with the relevant care clinics. The aim of the evaluation is to illustrate the health economic effects of IC. Methods: In the period from 2006 to 2010 insured members of the DAK-Gesundheit and other involved health insurance companies with a serious mental illness, a significant impairment of social functioning and the need to be treated to avoid or substitute an in-hospital stay were included in the integrated care. The cost perspective was that of the statutory health insurance companies. For the health economic evaluation, the utilisation of continuous IC over 18 months was compared to the last 18 months prior to the inclusion in IC. The clinical findings were gathered quarterly during the IC using CGI (Clinical Global Impressions) and GAF (Global Assessment of Functioning Scale). Results: A total of 1 364 patients receiving IC in 66 doctor's practices were documented (of those, 286 had diagnoses of ICD-10 F2, 724 ICD-10 F32-F39). The median age was 48.8 years, 69% were female. 24% had their own source of income, 40% were on the pension, and the rest of the patients were receiving transfer benefits in some form. In 54% of the cases IC was used to avoid an in-hospital stay, in 46% of the cases to substitute an in-hospital stay. The degree of the CGI was 5.5 on average at the time of inclusion and the GAF score was 36.5 on average. The 226 patients with continuous documentation over 18 months were included in the health economic analysis. The number of days spent in hospital was lower during the IC period as compared to the 18 months prior to IV (11.8 vs. 28.6 days, p, Hintergrund: Das Modell der Integrierten Versorgung (IV) schwer psychisch Kranker f��r Versicherte der DAK-Gesundheit und verschiedener Betriebskrankenkassen (Mitglieder der BKK VAG Mitte) der Regionen Berlin, Brandenburg, Niedersachsen und Bremen erm��glicht eine ambulante Komplexbehandlung bestehend aus psychiatrischen Fach��rzten, Haus- und Klinik��rzten, psychiatrischer Fachpflege, Soziotherapie (nur Berlin), inner��rztliche Qualit��tszirkelarbeit, Orientierung an Behandlungspfaden und konzeptioneller Abstimmung mit den zust��ndigen Versorgungskliniken. Ziel der Evaluation war die Darstellung der gesundheits��konomischen Auswirkungen der IV. Methodik: Im Zeitraum zwischen 2006 und 2010 wurden Versicherte der DAK-Gesundheit und der beteiligten Betriebskrankenkassen mit einer schweren psychischen Erkrankung, einer deutlichen Beeintr��chtigung des sozialen Funktionsniveaus und der Erfordernis einer krankenhausvermeidenden oder krankenhausersetzenden Behandlung in die IV eingeschlossen. Die Kostenperspektive war diejenige der Gesetzlichen Krankenversicherung. F��r die gesundheits��konomische Auswertung wurde die Inanspruchnahme ��ber 18 Monate kontinuierliche IV-Behandlung mit den letzten 18 Monaten vor Einschluss in die IV verglichen. Der klinische Befund wurde w��hrend der IV quartalsweise mit globaler Schweregrad- (CGI) und Funktionsbeurteilung (GAF) erhoben. Ergebnisse: Insgesamt wurden 1.364 Patienten mit IV-Behandlung in 66 Arztpraxen dokumentiert (davon 286 ICD-10 F2, 724 ICD-10 F32-F39). Das Durchschnittsalter betrug 48,8 Jahre, 69 % waren weiblich. 24 % verf��gten ��ber ein eigenes Einkommen, 40 % bezogen Rente, die ��brigen Patienten Transferleistungen verschiedener Art. In 54 % der F��lle wurde IV klinikvermeidend, in 46 % klinikersetzend eingesetzt. Der CGI-Schweregrad betrug bei Einschluss durchschnittlich 5,4, der GAF-Score 36,5. In die gesundheits��konomische Analyse wurden die 226 Patienten mit kontinuierlicher Dokumentation ��ber 18 Monate eingeschlossen. Die Anzahl der Krankenhaustage war in 18 Monaten w��hrend IV niedriger als in 18 Monaten vor IV (11,8 vs. 28,6 Tage, p < 0,001), die Ausgaben f��r station��re Behandlung signifikant geringer (5.929 �� 13.837 Euro vs. 2.458 �� 6.940 Euro, p < 0,001), die Gesamtausgaben ver��nderten sich jedoch nicht signifikant (7.777 �� 14.263 Euro vs. 7.321 �� 7.910 Euro, p = 0,65). Die erhebliche Einsparung bei den station��ren Ausgaben wurde durch die Mehrausgaben bei Medikamenten und die Ausgaben der ambulanten Komplexleistungen kompensiert. Analoge Ergebnisse erbrachte die Analyse der 2 Subgruppen der Patienten mit Schizophrenie/ schizoaffektiver St��rung (n = 66, 40,9 vs. 17,9 Tage, p = 0,03; station��re Ausgaben 9.009 �� 15.677 Euro vs. 3.650 �� 8.486 Euro, p = 0,02; Gesamtausgaben 11.789 �� 15.975 Euro vs. 9.623 �� 9.262 Euro, p = 0,33) und mit unipolarer Depression (n = 90, 29,8 vs. 9,8 Tage, p = 0,006; station��re Ausgaben 5.664 �� 14.921 Euro vs. 1.967 �� 5.276 Euro, p = 0,02; Gesamtausgaben 7.146 �� 15.164 Euro vs. 6.234 �� 6.292 Euro, p = 0,57). Schlussfolgerung: Das IV-Modell konnte durch ein komplexes ambulantes Leistungsangebot die station��re Inanspruchnahme deutlich senken und eine Gewichtsverlagerung in eine niedrigschwellige umfassende Versorgungsstruktur realisieren, ohne dass dies aus GKV-Perspektive mit einer Kostensteigerung verbunden war. F��r eine detaillierte Darstellung klinischer Effekte sind weitere Studien erforderlich.

Implications for the academic and interpersonal development of children and adolescents underpin a global political consensus to maintain in-classroom teaching during the ongoing COVID-19 pandemic. In support of this aim, the WHO and UNICEF have called for schools around the globe to be made safer from the risk of COVID-19 transmission. Detailed guidance is needed on how this goal can be successfully implemented in a wide variety of educational settings in order to effectively mitigate impacts on the health of students, staff, their families, and society. This review provides a comprehensive synthesis of current scientific evidence and emerging standards in relation to the use of layered prevention strategies (involving masks, distancing, and ventilation), setting out the basis for their implementation in the school environment. In the presence of increasingly infectious SARS-Cov-2 variants, in-classroom teaching can only be safely maintained through a layered strategy combining multiple protective measures. The precise measures that are needed at any point in time depend upon a number of dynamic factors, including the specific threat-level posed by the circulating variant, the level of community infection, and the political acceptability of the resultant risk. By consistently implementing appropriate prophylaxis measures, evidence shows that the risk of infection from in-classroom teaching can be dramatically reduced. Current studies indicate that wearing high-quality masks and regular testing are amongst the most important measures in preventing infection transmission; whilst effective natural and mechanical ventilation systems have been shown to reduce infection risks in classrooms by over 80%.

Homelessness is an expression and consequence of a complex problem situation that poses major challenges to the medical and social care systems in Germany. About three quarters of homeless people suffer from mental illness. The aim of this study was to investigate associations between mental illness and homelessness.A secondary data analysis of patients' records from a Berlin health center for homeless people was conducted. Data from 112 homeless patients who received care at the center between the years 2006 and 2020 were included in the explorative study.Mental illness was present in 84.9% of patients before the onset of homelessness. The factors associated with an early onset of homelessness were low school education and drug abuse. A long duration of homelessness was associated with the factors alcohol abuse as well as imprisonment. Each new episode of street homelessness was associated with an average increase in the duration of homelessness by 7.9 months.Since mental illnesses are important factors influencing the development and maintenance of homelessness, preventive strategies as well as specialized services for this vulnerable group need to be increasingly created. In particular, recurring episodes of street homelessness should be prevented as far as possible. The link between imprisonment and homelessness suggests that more intensive support is needed for reintegration after release from prison.HINTERGRUND: Wohnungslosigkeit ist Ausdruck und Folge einer komplexen Problemlage, die die medizinischen und sozialen Versorgungssysteme in Deutschland vor große Herausforderungen stellt. Etwa 3 Viertel der wohnungslosen Menschen leiden an psychischen Erkrankungen. Ziel dieser Studie war es, Assoziationen zwischen psychischen Erkrankungen und Wohnungslosigkeit zu untersuchen.Es wurde eine Sekundärdatenanalyse von Patient*innendokumentationen eines Berliner Gesundheitszentrums für Obdachlose durchgeführt. In die explorative Studie eingeschlossen wurden Daten von 112 wohnungslosen Patient*innen, die dort zwischen den Jahren 2006 und 2020 versorgt wurden.Bei 84,9 % der Patient*innen lagen psychische Erkrankungen bereits vor dem Beginn der Wohnungslosigkeit vor. Assoziiert mit einem frühen Beginn der Wohnungslosigkeit waren die Faktoren niedrige Schulbildung sowie Drogenabusus. Eine lange Dauer der Wohnungslosigkeit war mit den Faktoren Alkoholabusus sowie Haftaufenthalte assoziiert. Jede erneute Episode der Straßenobdachlosigkeit war mit einer durchschnittlichen Verlängerung der Dauer der Wohnungslosigkeit um 7,9 Monate assoziiert.Da psychische Erkrankungen wichtige Einflussfaktoren für die Entstehung und Aufrechterhaltung von Wohnungslosigkeit sind, sollten vermehrt präventive Strategien sowie spezialisierte Angebote für diese vulnerable Gruppe geschaffen werden. Insbesondere wiederkehrende Episoden der Straßenobdachlosigkeit sollten so weit wie möglich verhindert werden. Der Zusammenhang zwischen Inhaftierungen und Wohnungslosigkeit legt nahe, dass eine intensivere Begleitung bei der Wiedereingliederung nach Haftentlassung erforderlich ist.

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

The new coronavirus (COVID-19) pandemic and the resulting response measures have led to severe limitations of people’s exercise possibilities with diminished physical activity (PA) and increased sedentary behavior (SB). Since for migrant groups in Germany, no data is available, this study aimed to investigate factors associated with changes in PA and SB in a sample of Turkish descent. Participants of a prospective cohort study (adults of Turkish descent, living in Berlin, Germany) completed a questionnaire regarding COVID-19 related topics including PA and SB since February 2020. Changes in PA and SB were described, and sociodemographic, migrant-related, and health-related predictors of PA decrease and SB increase were determined using multivariable regression analyses. Of 106 participants, 69% reported a decline of PA, 36% reported an increase in SB. PA decrease and SB increase seemed to be associated with inactivity before the pandemic as well as with the female sex. SB increase appeared to be additionally associated with educational level and BMI. The COVID-19 pandemic and the response measures had persistent detrimental effects on this migrant population. Since sufficient PA before the pandemic had the strongest association with maintaining PA and SB during the crisis, the German government and public health professionals should prioritize PA promotion in this vulnerable group.

Purpose Musicians’ practice and performance routines reportedly lead to musculoskeletal complaints and disorders (MCD) that impact their wellbeing and performance abilities. This systematic review aims to assess the prevalence, risk factors, prevention and effectiveness of treatments for MCD in professional musicians and consider the methodological quality of the included studies. Methods A systematic literature search was performed in December 2017 using electronic databases and supplemented by a hand search. Case–control studies, cohort studies, cross-sectional studies, interventional studies and case reports investigating the prevalence, risk factors, prevention or treatment effects of MCD in professional musicians or music students (age ≥ 16 years) were included. Quality assessments of the included studies were performed using an adapted version of the “Study Quality Assessment Tools” from the National Heart, Lung, and Blood Institute. Results One case–control study, 6 cohort studies, 62 cross-sectional studies, 12 interventional studies and 28 case reports were included and assessed for methodological quality. The study designs, terminology, and outcomes were heterogeneous, as the analyses mostly did not control for major confounders, and the definition of exposure was often vague. Therefore, evidence that being a professional musician is a risk factor for MCD as well as the causal relationship between these factors remains low despite the fact that a large number of studies have been performed. Conclusions Studies with high internal and external validity regarding the prevalence, risk factors and effectiveness of the prevention or treatment of MCD in professional musicians are still missing. Further high-quality observational and interventional studies are required. Electronic supplementary material The online version of this article (10.1007/s00420-019-01467-8) contains supplementary material, which is available to authorized users.

Background Art therapy is a form of complementary therapy to treat a wide variety of health problems. Existing studies examining the effects of art therapy differ substantially regarding content and setting of the intervention, as well as their included populations, outcomes, and methodology. The aim of this review is to evaluate the overall effectiveness of active visual art therapy, used across different treatment indications and settings, on various patient outcomes. Methods We will include randomised controlled studies with an active art therapy intervention, defined as any form of creative expression involving a medium (such as paint etc.) to be actively applied or shaped by the patient in an artistic or expressive form, compared to any type of control. Any treatment indication and patient group will be included. A systematic literature search of the Cochrane Library, EMBASE (via Ovid), MEDLINE (via Ovid), CINAHL, ERIC, APA PsycArticles, APA PsycInfo, and PSYNDEX (all via EBSCOHost), ClinicalTrials.gov and the WHO’s International Clinical Trials Registry Platform (ICTRP) will be conducted. Psychological, cognitive, somatic and economic outcomes will be used. Based on the number, quality and outcome heterogeneity of the selected studies, a meta-analysis might be conducted, or the data synthesis will be performed narratively only. Heterogeneity will be assessed by calculating the p-value for the chi2 test and the I2 statistic. Subgroup analyses and meta-regressions are planned. Discussion This systematic review will provide a concise overview of current knowledge of the effectiveness of art therapy. Results have the potential to (1) inform existing treatment guidelines and clinical practice decisions, (2) provide insights to the therapy’s mechanism of change, and (3) generate hypothesis that can serve as a starting point for future randomised controlled studies. Systematic review registration PROSPERO ID CRD42021233272

Music performance anxiety (MPA) is one of the most common disorders among professional musicians, nevertheless, little is known about the disease. With this systematic review, prevalence, risk factors and treatment procedures for MPA were assessed, and for the first time, quality assessments were carried out for all studies using standardized assessment tools. A systematic literature search was conducted via search algorithms in the databases MEDLINE, EMBASE, CINAHL, PsycArticles, PsycInfo and ERIC. Included were case reports, case–control, cohort, cross-sectional and intervention studies examining professional musicians with MPA. For quality assessment, adapted tools of the National Heart, Lung, and Blood Institute were used. A total of 43 studies were included (10 case reports, 21 intervention, 11 cross-sectional, one cohort study). Quality ratings ranged from −11 to 6 out of a maximum of 15/16 points for cross-sectional/cohort studies and −4 to 11 out of 18 points for intervention studies. The prevalence of MPA was between 16.5% and 60%. More women than men were affected and musicians older than 45–50 years reported less MPA than younger musicians. Regarding treatment cognitive behavioural therapy (CBT) andβ-blockers were most often researched with beneficial results for CBT. However, studies with adequate control groups for CBT interventions are needed to clarify its efficacy. Studies showed methodological weaknesses, especially in the selection of participants, recording of influencing factors, blinding of interventions, randomization of participants and analysis of comorbidity. Recommendations for further research are made.

The study aims to evaluate the prevalence of depression and the severity of depressive symptoms among primary care patients, who are high utilizers (HU) of health care resources. A cross-sectional, two-stage design was applied to screen for depression using the Brief Psychiatric Health Questionnaire and the Diagnostic Expert System for Psychiatric Disorders. A total of 38 primary care physicians accredited to practice in Berlin and Potsdam in Germany participated in the study. A total of 1,775 patients participated, 507 were identified as HU, 182 (36%) of these were depressed compared to 81 (11%) of the typical utilizers (p < 0.001). The depression score was higher and acute suicidality was more prevalent in HU than in typical utilizers (p < 0.001). Our results suggest that HU represent a population with a high prevalence of depression in primary care and should be considered for routine depression screening.

Aim To use a Delphi-panel-based assessment of the effectiveness of different non-pharmaceutical interventions (NPI) in order to retrospectively approximate and to prospectively predict the SARS-CoV-2 pandemic progression via a SEIR model (susceptible, exposed, infectious, removed). Methods We applied an evidence-educated Delphi-panel approach to elicit the impact of NPIs on the SARS-CoV-2 transmission rate R0 in Germany. Effectiveness was defined as the product of efficacy and compliance. A discrete, deterministic SEIR model with time step of 1 day, a latency period of 1.8 days, duration of infectiousness of 5 days, and a share of the total population of 15% assumed to be protected by immunity was developed in order to estimate the impact of selected NPI measures on the course of the pandemic. The model was populated with the Delphi-panel results and varied in sensitivity analyses. Results Efficacy and compliance estimates for the three most effective NPIs were as follows: test and isolate 49% (efficacy)/78% (compliance), keeping distance 42%/74%, personal protection masks (cloth masks or other face masks) 33%/79%. Applying all NPI effectiveness estimates to the SEIR model resulted in a valid replication of reported occurrence of the German SARS-CoV-2 pandemic. A combination of four NPIs at consented compliance rates might curb the CoViD-19 pandemic. Conclusion Employing an evidence-educated Delphi-panel approach can support SARS-CoV-2 modelling. Future curbing scenarios require a combination of NPIs. A Delphi-panel-based NPI assessment and modelling might support public health policy decision making by informing sequence and number of needed public health measures.

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

BACKGROUND: Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJECTIVES: Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS: Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS: Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION: PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.

Perfluoroalkyl substances (PFASs) are a complex group of man-made chemicals with high stability and mobility leading to ubiquitous environmental contamination and accumulation in the food chain. In human serum/plasma samples, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are the lead compounds. They are immunotoxic in experimental animals, and epidemiological studies provided evidence of a diminished production of vaccine antibodies in young children. However, information on children of the first year of age is missing but relevant, as they have a relatively high exposure if breastfed, and may have a higher susceptibility as their immune system is developing. In a cross-sectional study with 101 healthy 1-year-old children, internal levels of persistent organic pollutants and a broad panel of biological parameters were investigated at the end of the 1990s. Additional analysis of PFASs resulted in plasma levels (mean ± SD) of PFOA and PFOS of 3.8 ± 1.1 and 6.8 ± 3.4 µg/L, respectively, in the 21 formula-fed children, and of 16.8 ± 6.6 and 15.2 ± 6.9 µg/L in the 80 children exclusively breastfed for at least 4 months. The study revealed significant associations between levels of PFOA, but not of PFOS, and adjusted levels of vaccine antibodies against Haemophilus influenza type b (Hib, r = 0.32), tetanus (r = 0.25) and diphtheria (r = 0.23), with no observed adverse effect concentrations (NOAECs) determined by fitting a ‘knee’ function of 12.2, 16.9 and 16.2 µg/L, respectively. The effect size (means for PFOA quintiles Q1 vs. Q5) was quantified to be − 86, − 54 and − 53%, respectively. Furthermore, levels of PFOA were inversely associated with the interferon gamma (IFNɣ) production of ex-vivo lymphocytes after stimulation with tetanus and diphtheria toxoid, with an effect size of − 64 and − 59% (means Q1 vs. Q5), respectively. The study revealed no influence of PFOA and PFOS on infections during the first year of life and on levels of cholesterol. Our results confirmed the negative associations of PFAS levels and parameters of immune response observed in other epidemiological studies, with high consistency as well as comparable NOAECs and effects sizes for the three vaccine antibodies investigated, but for PFOA only. Due to reduction of background levels of PFASs during the last 20 years, children in Germany nowadays breastfed for a long duration are for the most part not expected to reach PFOA levels at the end of the breastfeeding period above the NOAECs determined. Electronic supplementary material The online version of this article (10.1007/s00204-020-02715-4) contains supplementary material, which is available to authorized users.

Background: With the absence of immunization, public health interventions are the basis for curbing the spread of the SARS-CoV-2 virus. Evidence of impact of non-pharmaceutical interventions (NPI) on SARS-CoV-2 spread in Germany is scarce. The objectives of this study were to use a Delphi-panel based assessment of the effectiveness of different COVID-19 specific prevention measures in order to retrospectively approximate and to prospectively predict the SARS-CoV-2 pandemic progression via a SEIR model (SEIR: Susceptible - Exposed - Infectious - Removed). The SEIR model will be made available with a modifiable user interface. Methods: We applied an evidence-educated Delphi-panel approach to elicit the impact of NPIs being discussed in Germany on the SARS-CoV-2 transmission rate R0. Initial estimates were discussed and agreed upon in two Delphi stages resulting in a final set of average efficacy and compliance estimates for each NPI. Effectiveness was defined as the product of efficacy and compliance. A discrete, deterministic SEIR model with time step of 1 day, a latency period of 1.·8 days, duration of infectiousness of 5 days, and a share of the total population of 15% assumed to be protected by immunity was developed in order to estimate the impact of selected NPI measures on pandemic course. The model was populated with the Delphi-panel results and varied in sensitivity analyses. Results: Efficacy and compliance estimates were obtained as follows (ranked by effectiveness): test and isolate 49% (efficacy)/78% (compliance), keeping distance 42%/74%, personal protection masks (cloth masks or other face masks) 33%/79%, ban of large public events 26%/96%, contact reduction 33%/59%, closure of non-essential stores 10%/97%, closure of schools 10%/100%, working from home 12%/66%, closure of restaurants 8%/96%, and improved hand hygiene 7%/54%. Applying these NPI effectiveness estimates to the SEIR model resulted in a valid replication of reported occurrence of the German SARS-CoV-2 pandemic. Conclusion: Employing an evidence-educated Delphi-panel approach for generating NPI effectiveness estimates is feasible and could help to generate model simulations with close replication of reported infected cases in Germany. Future curbing scenarios require a combination of NPIs. A Delphi-panel based NPI assessment and modelling might support public health policy decision making by informing sequence and number of needed public health measures. Funding Statement: None. Declaration of Interests: None declared. Ethics Approval Statement: Not applicable.

BACKGROUND: Infectious diseases continue to play an important role for disease perception, health-economic considerations and public health in Germany. In recent years, infectious diseases have been linked to the development of non-communicable diseases. Analyses of the German National Cohort (GNC) may provide deeper insights into this issue and pave the way for new targeted approaches in disease prevention. OBJECTIVES: The aim was to describe the tools used to assess infectious diseases and to present initial data on infectious disease frequencies, as well as to relate the GNC assessment tools to data collection methods in other studies in Germany. METHODS: As part of the baseline examination, questions regarding infectious diseases were administered using both an interview and a self-administered touchscreen questionnaire. Data from the initial 101,787 GNC participants were analysed. RESULTS: In the interview, 0.2% (HIV/AIDS) to 8.6% (shingles) of respondents reported ever having a medical diagnosis of shingles, postherpetic neuralgia (in cases where shingles was reported), hepatitis B/C, HIV/AIDS, tuberculosis or sepsis if treated in hospital. In the questionnaire, 12% (cystitis) to 81% (upper respiratory tract infections) of respondents reported having experienced at least one occurrence of upper or lower respiratory tract infections, gastrointestinal infections, cystitis or fever within the past 12 months. OUTLOOK: The cross-sectional analyses of data and tools presented here – for example on determinants of susceptibility to self-reported infections – can be anticipated from the year 2021 onward. Beyond that, more extensive research into infectious disease epidemiology will follow, particularly once analyses of GNC biological materials have been performed. HINTERGRUND: Infektionen spielen für das Krankheitsempfinden, für gesundheitsökonomische Überlegungen sowie Public Health in Deutschland weiterhin eine wichtige Rolle. Sie wurden in den letzten Jahren außerdem mit der Entstehung von nichtübertragbaren Erkrankungen in Zusammenhang gebracht. Die NAKO Gesundheitsstudie kann Erkenntnisse auf diesem Gebiet vertiefen und damit zielgenaueren präventiven Ansätzen den Weg bereiten. ZIEL: Die infektionsbezogenen Erhebungsinstrumente sollen beschrieben und in Bezug zu Erhebungsarten anderer deutscher Studien gesetzt werden. Zudem werden erste Daten zur Häufigkeit von Infektionskrankheiten berichtet. METHODEN: Fragen zu Infektionskrankheiten wurden in der NAKO-Basiserhebung sowohl im Interview als auch im Selbstausfüllerfragebogen (Touchscreen) gestellt. Es wurden die Daten der ersten 101.787 Teilnehmenden ausgewertet. ERGEBNISSE: Das Auftreten von Herpes Zoster (HZ), Post-Zoster-Neuralgie (bei Angabe von HZ), Hepatitis B/C, HIV/Aids und Tuberkulose im Sinne einer ärztlichen Diagnose bzw. von Sepsis als Grund für eine stationäre Behandlung wurde von 0,2 % (HIV/Aids) bis 8,6 % (HZ) der Befragten im Interview angegeben. Im Touchscreenmodul wurde das mindestens einmalige Auftreten einer Infektion der oberen Atemwege (IOA), der unteren Atemwege, des Magen-Darm-Traktes, der Harnblase oder von Fieber in den letzten 12 Monaten von 12 % (Zystitis) bis 81 % (IOA) berichtet. AUSBLICK: Weitere Ergebnisse anhand von Daten aus den hier vorgestellten Fragebögen sind im Querschnittsdesign – beispielsweise zu Determinanten der Anfälligkeit für selbst berichtete Infektionen – ab 2021 zu erwarten. Die Bearbeitung darüber hinausgehender Forschungsfragen der Infektionsepidemiologie wird insbesondere nach Analysen von NAKO-Bioproben möglich sein.

BACKGROUND: Data on self-reported cardiovascular and metabolic diseases are available for the first 100,000 participants of the population-based German National Cohort (GNC, NAKO Gesundheitsstudie). OBJECTIVES: To describe assessment methods and the frequency of self-reported cardiovascular and metabolic diseases in the German National Cohort. MATERIALS AND METHODS: Using a computer-based, standardized personal interview, 101,806 participants (20–75 years, 46% men) from 18 nationwide study centres were asked to use a predefined list to report medical conditions ever diagnosed by a physician, including cardiovascular or metabolic diseases. For the latter, we calculated sex-stratified relative frequencies and compared these with reference data. RESULTS: With regard to cardiovascular diseases, 3.5% of men and 0.8% of women reported to have ever been diagnosed with a myocardial infarction, 4.8% and 1.5% with angina pectoris, 3.5% and 2.5% with heart failure, 10.1% and 10.4% with cardiac arrhythmia, 2.7% and 1.8% with claudicatio intermittens, and 34.6% and 27.0% with arterial hypertension. The frequencies of self-reported diagnosed metabolic diseases were 8.1% and 5.8% for diabetes mellitus, 28.6% and 24.5% for hyperlipidaemia, 7.9% and 2.4% for gout, and 10.1% and 34.3% for thyroid diseases. Observed disease frequencies were lower than reference data for Germany. CONCLUSIONS: In the German National Cohort, self-reported cardiovascular and metabolic diseases diagnosed by a physician are assessed from all participants, therefore representing a data source for future cardio-metabolic research in this cohort. HINTERGRUND: Aus der NAKO Gesundheitsstudie, der größten deutschen bevölkerungsbasierten Studie zur Gesundheit, liegen die Daten zu selbst berichteten kardiovaskulären und metabolischen Erkrankungen der ersten ca. 100.000 Teilnehmenden vor. ZIEL: Beschreibung der Methoden zur Erhebung sowie Berechnung der Häufigkeit kardiovaskulärer und metabolischer Erkrankungen in der NAKO. MATERIAL UND METHODEN: 101.806 Teilnehmende (20–75 Jahre, 46 % Männer) aus 18 bundesweiten Studienzentren wurden in einem computergestützten, standardisierten persönlichen Interview gebeten, anhand einer vorgegebenen Liste anzugeben, welche Erkrankungen bei ihnen jemals ärztlich diagnostiziert wurden, darunter auch kardiovaskuläre und metabolische Erkrankungen. Für Letztere wurden deren geschlechtsspezifische relative Häufigkeiten berechnet und diese mit Referenzzahlen verglichen. ERGEBNISSE: Bezogen auf die kardiovaskulären Erkrankungen berichteten 3,5 % der Männer und 0,8 % der Frauen, jemals einen Herzinfarkt diagnostiziert bekommen zu haben, 4,8 % bzw. 1,5 % eine Angina pectoris, 3,5 % bzw. 2,5 % eine Herzinsuffizienz, 10,1 % bzw. 10,4 % Herzrhythmusstörungen, 2,7 % bzw. 1,8 % eine Claudicatio intermittens und 34,6 % bzw. 27,0 % eine arterielle Hypertonie. Die Häufigkeit berichteter diagnostizierter metabolischer Erkrankungen lag bei 8,1 % bzw. 5,8 % für Diabetes mellitus, bei 28,6 % bzw. 24,5 % für Hyperlipidämie, bei 7,9 % bzw. 2,4 % für Gicht und bei 10,1 % bzw. 34,3 % für Schilddrüsenerkrankungen. Die beobachteten Häufigkeiten lagen insgesamt etwas niedriger als Vergleichsdaten für Deutschland. DISKUSSION: Die NAKO erhebt von allen Teilnehmenden selbst berichtete, ärztlich diagnostizierte kardiovaskuläre und metabolische Erkrankungen und stellt damit eine Datenressource für weitergehende kardiometabolische Forschungsfragestellungen dar.

Physical activity (PA) in youth tends to decline with increasing age, while sedentary behaviour including screen time (ST) increases. There are adolescents, however, whose PA and ST do not follow this pattern. The aim of this study is (i) to examine trajectories in PA and ST from grade 7&ndash, 9 among students in Berlin, and (ii) to investigate the relationship of these trajectories with individual factors and school type. For the present analyses, changes in students&rsquo, PA and ST across three time points from 7th to 9th grade were assessed via self-report questionnaires. Positive and negative trajectories were defined for both PA (positive: increasing or consistently high, negative: decreasing or consistently low) and ST (vice versa). Multivariable logistic regression analyses were performed to identify possible predictors of PA and ST trajectories. In total, 2122 students were included (50.2% girls, mean age 12.5 (standard deviation 0.7) years). Compared to grade 7, less students of grade 9 fulfilled PA and ST recommendations (PA: 9.4% vs. 13.2%, ST: 19.4% vs. 25.0%). The positive PA trajectory included 44% of all students (63% boys), while the positive ST trajectory included 21% of all students (30% boys). Being a boy was significantly associated with a positive PA trajectory, while being a girl, having a high socioeconomic status, and attending a high school, were significantly associated with a positive ST trajectory. Different PA and ST trajectories among adolescents should be taken into account when implementing prevention programs for this target group.

Aims The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) aims to assess its current clinical value. Methods and results The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non-randomized control group). The primary endpoint is all-cause mortality; the co-primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost-effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12-lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions The EU-CERT-ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.

Objectives: Deep vein thrombosis (DVT) is a major health-care burden in Europe, but exact estimates are lacking. This study reports results from the PREFER venous thromboembolism (VTE) study concerning health-related quality of life (HrQoL) and mortality of patients with DVT. Methods: PREFER VTE was a prospective, observational study, conducted in 7 European countries, designed to provide data concerning treatment patterns, resource utilization, mortality, and QoL. First-time or recurrent patients with DVT were followed at 1, 3, 6, and 12 months. Health-related QoL—as measured by the EuroQoL 5-Dimension 5-Level instrument ( EQ-5D-5L)—was analyzed using Tobit regression with repeated measures, assessing the impact of baseline characteristics stratified by cancer activity. Mortality was analyzed using logistic regression. Results: At baseline, patients with DVT had a 0.14 lower EQ-5D-5L index score (0.72 for total sample) compared to the reference UK population (0.85). The EQ-5D-5L index score improved from baseline to 12 months in patients with active cancer (from 0.70 to 0.79) and those without (0.72-0.87); 7.3% died within a year, a 5.2% excess mortality compared to the age- and gender-adfjusted general population. The 12-month mortality rate of DVT varied between 2.9% in the pooled data from Germany, Switzerland, or Austria and 15.4% in Italy. Furthermore, the mortality rate differed between patients with active cancer and those without (42.9% vs 4.7%). Conclusions: Deep vein thrombosis is associated with a substantial burden of illness in terms of HrQoL at baseline, which following treatment normalizes after 12 months and has a significant mortality rate. In addition, active cancer has a significant impact on mortality and the HrQoL of patients with DVT.