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Purpose The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). Methods Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (α = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. Results Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (− 6.7%; 95% CI − 8.7%, − 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (− 20.9%; 95% CI − 24.7%, − 16.8%) and January 2021 (− 25.2%; 95% CI − 28.8%, − 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. Conclusion Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.

BACKGROUND: The incidence of early-onset (diagnosis before age 50) colorectal cancer (EO-CRC) is increasing in some high-income countries. The present study analyzed this trend in Germany. METHODS: The epidemiological data on the incidence of colorectal cancer (ICD-10 C18–C20) in the federal states of Germany were obtained from the German Center for Cancer Registry Data (ZfKD). The regions included were those with adequate documentation, according to the ZfKD criteria, for the years 1999–2018. Cases identified from death certificates alone were excluded. The data on mortality were derived from the official cause of death statistics. Time trends for persons aged 20–49 years were expressed as the average annual percentage change (AAPC) with 95% confidence interval. The incidence was stratified by sex, site (proximal colon, distal colon, rectum), 10-year age group (20– 29, 30– 39, 40– 49), and tumor size (T). RESULTS: EO-CRC accounted for 5.1% (9529 cases) of all colorectal cancers in the selected German regions. The EO-CRC incidence rose annually by 1.16% [0.51; 1.81] in men and 1.32% [0.80; 1.84] in women. The incidence of proximal colon cancer increased in both sexes (men: AAPC 3.26 [2.00; 4.53]; women: AAPC 2.99 [2.17; 3.83]), while the incidence of distal colon cancer remained unchanged. CONCLUSION: The incidence of EO-CRC in Germany is rising. The reasons are probably multifactorial, reflecting the changing prevalence of risk and protective factors to which one is exposed in the early years of life.

Due to the high burden of mental health issues among students at higher education institutions world-wide, animal-assisted interventions (AAIs) are being used to relieve student stress. The objective of this study was to systematically review of the effects of AAIs on the mental, physiological, and cognitive outcomes of higher education students. Randomized controlled trials using any unfamiliar animal as the sole intervention tool were included in this review. Study quality was assessed using the Cochrane Risk-of-Bias tool. Where possible, effect sizes (Hedges’ g) were pooled for individual outcomes using random-effects meta-analyses. Albatross plots were used to supplement the data synthesis. Of 2.494 identified studies, 35 were included. Almost all studies used dogs as the intervention animal. The quality of most included studies was rated as moderate. Studies showed an overall reduction of acute anxiety and stress. For other mental outcomes, studies showed smaller, but nonetheless beneficial effects. Studies showed no clear effect on physiological or cognitive outcomes. Strong methodological heterogeneity between studies limited the ability to draw clear conclusions.

AimWith the rapid advances in technology and data science, machine learning (ML) is being adopted by the health care sector; but there is a lack of literature addressing the health conditions targeted by the ML prediction models within primary health care (PHC). To fill this gap in knowledge, we conducted a systematic review following the PRISMA guidelines to identify the health conditions targeted by ML in PHC.MethodsWe searched the Cochrane Library, Web of Science, PubMed, Elsevier, BioRxiv, Association of Computing Machinery (ACM), and IEEE Xplore databases for studies published from January 1990 to January 2022. We included any primary study addressing ML diagnostic or prognostic predictive models that were supplied completely or partially by real-world PHC data. We performed literature screening, data extraction, and risk of bias assessment. Health conditions were categorized according to international classification of diseases. Extracted date were analyzed quantitatively and qualitatively.ResultsWe identified 109 studies investigating 42 health conditions. These studies included 273 ML prediction models supplied by the PHC data of 24.2 million participants from 19 countries. We found that 82% of the studies were retrospective. 76.6% of the studies reported diagnostic predictive ML models. 77% of all reported models aimed for models’ development without external validation. Risk of bias assessment revealed that 90.8% of the studies were of high or unclear risk of bias. The most frequently reported health conditions were Alzheimer’s disease and diabetes mellitus.ConclusionsTo the best of our knowledge, this is the first review to investigate the extent of the health conditions targeted by the ML prediction models within PHC settings. Our study provides an important summary on the presently available ML models in PHC, which can be used in further research and implementation efforts.

Background: Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods: The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] and a random 5% sample of screen-negatives were referred to colposcopy. Post hoc HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated. Results: In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%–95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00–1.21; PCR: 1.07, 95% CI, 1.00–1.27]. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99–1.00). NNC was highest for Pap cotesting. Conclusions: Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals. Impact: HPV stand-alone screening offers a better balance of benefits and harms than cotesting. See related commentary by Wentzensen and Clarke, p. 432

Summary Background HIV enhances human papillomavirus (HPV)-induced carcinogenesis. However, the contribution of HIV to cervical cancer burden at a population level has not been quantified. We aimed to investigate cervical cancer risk among women living with HIV and to estimate the global cervical cancer burden associated with HIV. Methods We did a systematic literature search and meta-analysis of five databases (PubMed, Embase, Global Health [ CABI.org ], Web of Science, and Global Index Medicus) to identify studies analysing the association between HIV infection and cervical cancer. We estimated the pooled risk of cervical cancer among women living with HIV across four continents (Africa, Asia, Europe, and North America). The risk ratio (RR) was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer to calculate the proportion of women living with HIV among women with cervical cancer and population attributable fractions and age-standardised incidence rates (ASIRs) of HIV-attributable cervical cancer. Findings 24 studies met our inclusion criteria, which included 236 127 women living with HIV. The pooled risk of cervical cancer was increased in women living with HIV (RR 6·07, 95% CI 4·40–8·37). Globally, 5·8% (95% CI 4·6–7·3) of new cervical cancer cases in 2018 (33 000 new cases, 95% CI 26 000–42 000) were diagnosed in women living with HIV and 4·9% (95% CI 3·6–6·4) were attributable to HIV infection (28 000 new cases, 20 000–36 000). The most affected regions were southern Africa and eastern Africa. In southern Africa, 63·8% (95% CI 58·9–68·1) of women with cervical cancer (9200 new cases, 95% CI 8500–9800) were living with HIV, as were 27·4% (23·7–31·7) of women in eastern Africa (14 000 new cases, 12 000–17 000). ASIRs of HIV-attributable cervical cancer were more than 20 per 100 000 in six countries, all in southern Africa and eastern Africa. Interpretation Women living with HIV have a significantly increased risk of cervical cancer. HPV vaccination and cervical cancer screening for women living with HIV are especially important for countries in southern Africa and eastern Africa, where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding WHO, US Agency for International Development, and US President's Emergency Plan for AIDS Relief.

BackgroundDue to the high burden of mental health issues among students at higher education institutions world-wide, animal-assisted interventions (AAIs) are being increasingly used to relieve student stress. The objective of this study was to systematically review of the effects of AAIs on the mental and cognitive health outcomes of higher education students.MethodsRandomized controlled trials using any unfamiliar animal as the sole intervention tool were included in the systematic review. Study quality was assessed using the Cochrane Risk-of-Bias tool. Where possible, effect sizes (Hedges’ g) were pooled for individual outcomes using random-effects meta-analyses. Albatross plots were used to supplement the data synthesis.ResultsOf 2.401 identified studies, 35 were included. Almost all studies used dogs as the intervention animal. The quality of most included studies was rated as moderate. Studies showed an overall reduction of acute anxiety (g= -0.57 (95%CI -1.45;0.31)) and stress. For other mental outcomes, studies showed an overall small reduction of negative affect (g= -0.47 (95%CI -1.46;0.52)), chronic stress (g= -0.23 (95%CI -0.57;0.11)) and depression, as well as small increases in arousal, happiness and positive affect (g= 0.06 (95%CI -0.78;0.90)). Studies showed no effect on heart rate and heart rate variability, a small reduction in salivary cortisol and mixed effects on blood pressure. No effect on cognitive outcomes was found.ConclusionOverall, evidence suggests that AAIs are effective at improving mental, but not physiological or cognitive outcomes of students. Strong methodological heterogeneity between studies limited the ability to draw clear conclusions.

Hauptrisikofaktor fur die Entstehung eines invasiven Zervixkarzinoms ist eine persistierende Infektion mit humanen Papillomviren (HPV). Die beiden High-Risk-Typen HPV 16 und 18 sind in fast allen Zervixkarzinomfallen nachweisbar. Weltweit ist Gebarmutterhalskrebs die vierthaufigste Krebserkrankung bei Frauen. Im Jahr 2018 starben rund 311.000 Frauen weltweit an einem invasiven Zervixkarzinom. Zur primaren Pravention einer HPV-Infektion gibt es seit dem Jahr 2006 die Moglichkeit einer HPV-Impfung. In Deutschland empfiehlt die Standige Impfkommission (STIKO) eine HPV-Impfung fur alle Jungen und Madchen im Alter von 9–14 Jahren. Im Jahr 2015 waren deutschlandweit jedoch nur rund 31,2 % aller 15-jahrigen Madchen vollstandig geimpft. Weltweit weisen schulbasierte HPV-Impfprogramme die hochsten Immunisierungsraten auf. Die Einfuhrung einer schulbasierten HPV-Impfung konnte auch in Deutschland dazu beitragen, die HPV-Impfquoten zu steigern, und somit langfristig die Reduktion von HPV-Infektionen und daraus resultierenden Karzinomen unterstutzen.

Inpatient healthcare demand is influenced by demographic changes; however, existing research mainly focuses on age-related conditions among older age groups and lacks empirical evidence. We aimed to identify important indicator diagnoses by group, which best characterise age-specific conditions and their demand of inpatient services in Germany. Data stem from the general hospital diagnosis-related group (DRG) statistics in Germany from 2005 to 2010. To identify the indicator diagnosis groups, we used frequency analyses of individual diagnoses and combined them into common diagnosis groups, stratified by age and gender. We identified indicator diagnoses by the highest number of cases of inpatient hospital treatments in 2010 or the largest change in cases between 2005 and 2010. The most common diagnosis groups were then ranked using different weights. Changes were quantified using linear regression. Across all ages, 13 diagnosis groups were identified as frequently reported hospitalisations such as injuries to the head (S00-S09) among patients aged 0 to 17 years, and ischemic heart diseases (I20-I25) among patients aged 18 to 64 years. As the number of hospitals decreased, the demand in inpatient services increased. From 75 years and above, males were more frequently inpatients than females, and overall length of stay in hospitals appeared to decrease. We empirically identified 13 diagnosis groups, which best describe the inpatient services utilised among various age groups in a ranked order. Findings from this study can provide a platform for determining future demand of inpatient services as well as the demographic-specific diagnoses that need attention.

Background Survival of colorectal cancer (CRC) has improved markedly but risk of an independent second primary cancer (SPC) increases. We determined incidence and potential risk factors of SPC following CRC. Methods We obtained data from 217,202 CRC cases (ICD-10 C18-C20, aged ≥20 years) diagnosed between 1990-2013 from the German Centre for Cancer Registry Data. Cancers arising in a distinct site (excluding non-melanoma skin cancer) and/or of a different histology group were classified as SPCs. Standardised incidence ratios (SIR) and 95% confidence intervals compared the excess risk to the general population, stratified by age, sex and CRC sub-site. Cox proportional hazards models identified potential risk factors of SPC. Results Following CRC (median age 70 years), 18,751 SPCs occurred (8.63%; median age 69 years). SPC incidence increased by 36% in males (SIR: 1.36 [1.34-1.38]), 46% in females (SIR: 1.46 [1.43-1.49]) and doubled for cases Conclusions CRC survivors have an increased risk of SPC, particularly due to age, sex and tumour size. Key messages Colorectal cancer survivors have an increased risk of a SPC. Age, sex and tumour size are associated risk factors.

Background Cervical cancer screening can be conducted with cytology and Human Papillomavirus (HPV) testing but few studies have compared the latter directly to concomitant testing (co-testing). We compared these strategies to determine appropriate screening. Methods Within a randomised population-based cohort study conducted around Mainz, Germany, eligible women (≥30 years) were screened via Pap smear, liquid-based cytology (LBC) and HPV testing (HC2) and HPV genotyped post hoc (PCR). These tests formed three strategies: cytology (Pap or LBC) and HPV (HC2 or PCR) stand-alone and co-testing. Screen positives and 5% negative women were invited to colposcopy. Absolute and relative sensitivity, specificity, false positive rates (FPR) and number needed to colposcopy to detect one lesion (NNC) were calculated. Estimates were crude and verification bias-adjusted using stratified sampling with bootstrapped confidence intervals. Results Of 2,627 screened women, cytology stand-alone demonstrated lowest sensitivities (47%) and highest specificities (97%-99%) while HPV stand-alone demonstrated higher sensitivities (79%-95%) but lower specificities (94%-95%). Co-testing increased sensitivity (84%-99%) but not specificity (92%-95%). Relative sensitivities were similar between crude and adjusted estimates, with greater detection via HPV-based strategies. Specificity of co-testing with LBC relative to HPV stand-alone was near unity (0.99, 95% CI 0.99-1.00) but significantly lower than unity with Pap co-testing. FPR and NNC were greatest under co-testing. Conclusions HPV stand-alone screening in women over 30 years appears appropriate over co-testing as a screening strategy. Key messages Co-testing for cervical cancer does not appear to add any benefit in detection and may introduce unnecessary harms compared to HPV stand-alone screening.

Approximately 80% of lung cancer cases in Germany are attributable to smoking. Patients with a lung cancer diagnosis may remain at increased risk of developing smoking-related second primary cancers (SPCs).Anonymous data from 11 population-based cancer registries covering approximately 50% of the German population were pooled for the analysis. Included patients were diagnosed with having an index lung cancer between 2002 and 2013, aged 30 to 99 years old at diagnosis, and survived for at least 6 months. We calculated standardized incidence ratios (SIRs)-stratified by age, sex, region, and period-comparing the incidence of smoking-related and other SPCs to the general population.Of the 135,589 lung cancer survivors (68.2% male; mean follow-up 30.8 mo) analyzed, 5298 developed an SPC. In males, the risk was particularly high for SPCs of the larynx (SIR = 3.70, 95% confidence interval [CI]: 3.14-4.34), pharynx (3.17, 2.61-3.81), and oral cavity (2.86, 2.38-3.41). For females, SIRs were notably elevated for the esophagus (4.66, 3.15-6.66), oral cavity (3.14, 2.03-4.63), and urinary tract (2.68, 2.04-3.45). When combining all smoking-related cancer sites, SIR was 1.41 in males (95% CI: 1.36-1.47) and 1.81 in females (95% CI: 1.68-1.94). We observed that males had a 1.46-fold (95% CI: 1.37-1.56) and females a 1.33-fold (95% CI: 1.20-1.47) increased risk for smoking-related compared with other cancers.Patients with primary lung cancer were at increased risk for developing a smoking-related SPC. Therefore, the advantages of increased patient surveillance and the benefits of smoking cessation strategies should be considered.

Aims Annual opportunistic screening for cervical carcinoma has been done in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as this guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The second part of this short summary deals with the triage, treatment and follow-up care of cervical dysplasia. With regard to those women who do not participate in screening, the guideline authors recommend sending out repeat invitation letters or an HPV self-collection kit. Colposcopy should be carried out for further investigation if cytology findings are Pap II-p and HPV test results are positive or if the results of an HPV 16 or HPV 18 screening test are positive. A single abnormal Pap smear should be triaged and investigated using HPV testing or p16/Ki67 dual staining.

Zusammenfassung Hintergrund Die aktuelle SARS-CoV-2-Pandemie erfordert hohe Durchimpfungsraten von chronisch Kranken gegen Influenza, um das Gesundheitssystem nicht zusatzlich zu belasten. Trotz klarer Evidenz fur Sicherheit und Wirksamkeit der Influenza-Impfung sind die Impfquoten in den vergangenen Jahren international auf insuffizientem Niveau verblieben. Der Hausarzt hat eine zentrale Bedeutung fur die Versorgung dieser Population. Ziel dieser systematischen Ubersichtsarbeit war daher die Evaluation verschiedener Masnahmen in der Allgemeinmedizin zur Steigerung der saisonalen Influenza-Impfquoten bei chronisch Kranken unter Berucksichtigung verschiedener internationaler Gesundheitssysteme. Methoden Eine systematische Literaturrecherche wurde in MEDLINE, CENTRAL, EMBASE und ERIC sowie manuell in Studienregistern und Literaturlisten durchgefuhrt. Dabei wurden ausschlieslich randomisierte kontrollierte Studien berucksichtigt. Die Methodik wurde im Vorfeld in einem Studienprotokoll festgelegt (PROSPERO CRD42018114163). Ergebnisse Insgesamt wurden 14 Studien im Rahmen eines nationalen Gesundheitsdienstes (Grosbritannien), einer staatlichen (Australien) und sozialen (Schweiz) Krankenversicherung und eines privaten Gesundheitssystems (USA) in unsere Ubersichtsarbeit eingeschlossen. Analoge Patientenerinnerungen und automatisierte Arzterinnerungen sowie Veranderungen der beruflichen Rollen fuhrten ausschlieslich im privaten Gesundheitssystem zu einem deutlichen Anstieg der Influenzaimpfquoten. Im nationalen Gesundheitsdienst konnte keine der analysierten Interventionen einen signifikanten Anstieg der Impfquoten erreichen, wobei im nationalen Gesundheitsdienst Grosbritanniens verhaltnismasig gute Basisimpfraten gegen Influenza bereits vor Durchfuhrung der Studien interventionsunabhangig vorlagen. Fortbildungsveranstaltungen fur Praxisteams und Erinnerungs-SMS zeigten in den sozialen und staatlichen Krankenversicherungssystemen der Schweiz und in Australien gute Resultate. Schlussfolgerungen In Deutschland konnten vor allem Fortbildungsveranstaltungen fur medizinische Teams und sowie zentral organisierte Einladungs- und Monitoringsysteme zur Verbesserung der Impfquoten bei chronisch Kranken geeignet sein. Eine staatliche Kostenubernahme der Impfkosten scheint in verschiedenen Gesundheitssystemen fur eine gute Basisimpfquote gegen Influenza bei Indikationspatienten zu sorgen.

BackgroundWe investigated the uptake of opportunistic cervical cancer screening (CCS) and other risk factors and their association with cervical cancer in Germany in a case-control study.Methods and findingsWe recruited incident cases of cervical cancer (ICD-10 C53) diagnosed between 2012 and 2016 and matched with three population-based controls, based on age and region of residence. Cases and controls reported their CCS participation during the past ten years (frequent: every three years; no or infrequent: less than every three years) and other relevant variables. We fitted conditional logistic regression models, reporting odds ratios (OR) and 95% confidence intervals (95% CI). We report overall and stratified analyses by histologic group (squamous cell-SCC, and adenocarcinoma-AC), T category (T1 and T2+), and age (ConclusionAlthough women who frequently attended CCS were less likely to develop cervical cancer, especially larger tumours, the high proportion of cases who had been frequently screened prior to diagnosis underscores the need to investigate the quality of cytology and treatment of precancerous lesions in Germany.

Human papillomaviruses (HPVs) can cause both benign and malignant tumors. To date, more than 200 HPV types have been discovered, of which 12 are currently classified as high risk for cervical cancer. HPV types that affect the anogenital tract are sexually transmitted. Since 2006, prophylactic HPV vaccines have been available and should be administered before first sexual contact.HPVs infect epithelial cells and are worldwide the most common sexually transmitted viruses. Apart from cervical cancer, HPVs cause other anogenital cancers such as vulvar, vaginal, and anal cancer but also oropharyngeal cancer (or head and neck cancers). HPV types 16 and 18 are also found at these sites. HPV types 6 and 11 are associated with genital warts; other HPV types can cause harmless skin warts.HPV vaccines are safe and highly effective, if they are administered before exposure to HPV. Systematic reviews and meta-analyses have shown that HPV vaccination effectively prevents HPV infection, but also precancerous lesions of the anogenital tract and genital warts. Recent vaccination data also demonstrate reductions in cervical cancer incidence.The uptake rates of HPV vaccination vary worldwide by program and acceptance. In comparison to other European countries, Germany has a low uptake rate. The Standing Committee on Vaccination (STIKO) recommends HPV vaccinations for all girls and boys ages 9 to 14 years in Germany. In 2018, only half of all 18-year-old girls in Germany were completely immunized against HPV.Organized vaccination programs, whether population-based or school-based, are necessary in order to increase vaccination uptake rates.Humane Papillomviren (HPV) verursachen benigne und maligne Tumorerkrankungen. Bisher wurden mehr als 200 HPV-Typen entdeckt, von denen aktuell 12 als Hochrisiko für das Zervixkarzinom klassifiziert werden. HPV-Typen, die den Anogenitaltrakt befallen, werden sexuell übertragen. Seit 2006 sind prophylaktische HPV-Impfstoffe erhältlich. Die Impfung soll vor dem ersten sexuellen Kontakt erfolgen.HPV infizieren Epithelzellen und sind die häufigsten sexuell übertragenen Viren weltweit. Neben dem Zervixkarzinom verursachen HPV auch andere anogenitale Tumore, wie Vulva‑, Vagina- und Analkarzinom, aber auch Oropharynxkarzinome. Vor allem die Hochrisiko-HPV-Typen 16 und 18 werden hier gefunden. Des Weiteren sind die HPV-Typen 6 und 11 ursächlich für die Entstehung von genitalen Warzen. Aber auch harmlose Hautwarzen werden von HPV verursacht.HPV-Impfstoffe sind sicher und hochwirksam, wenn vor der Impfung noch keine HPV-Infektion vorliegt. Systematische Reviews und Metaanalysen haben gezeigt, dass die HPV-Impfung eine HPV-Infektion, aber auch präkanzeröse Läsionen im Anogenitaltrakt und Genitalwarzen wirksam verhindert. Mittlerweile liegen erste direkte Hinweise vor, dass die HPV-Impfung die Inzidenz des Zervixkarzinoms reduziert.Die Impfquoten variieren weltweit je nach Impfprogramm und Akzeptanz des HPV-Impfstoffs in der Bevölkerung. Deutschland hat im Vergleich zu anderen europäischen Ländern niedrige Impfquoten. Die Ständige Impfkommission (STIKO) empfiehlt die HPV-Impfung in Deutschland für alle Mädchen und Jungen im Alter von 9 bis 14 Jahren. Im Jahr 2018 waren nur die Hälfte aller 18-jährigen Mädchen in Deutschland vollständig gegen HPV geimpft.Organisierte Impfprogramme, bevölkerungsbezogen oder schulbasiert, sind notwendig, um hohe Impfquoten zu erreichen.

Objectives: The aim of this study was to assess penile cancer incidence, clinical characteristics, treatment options, transparency of clinical quality, and relative survival based on data from the clinical cancer registry. Subjects and Methods: A total of 898 patients with tumours of the penis were diagnosed and analysed in the period from 2000 to 2018; they were documented in the 4 regional clinical cancer registries and summarized in the Command Office of these 4 registries. Results: The standardized incidence rate increased from 0.86 in 2000 to 2.67 in 2018. Most tumours were located at the glans (42.9%) followed by the prepuce (19.5%) and corpus penis (6.9%); they were classified into pT1a/pT1b (20.0%/7.0%), pT2 (23.5%), pT3 (12.4%), and pT4 (0.8%). In only 32.0% of all documented cases, a stage-related lymphadenectomy (LND) was carried out. Negative surgical margins were found in only 70% and the Rx status in 15.1%. Primary metastasis was detected in pN1 (5.1%), pN2 (3.9%), pN3 (3.1%), and M1 status in 3.0%, respectively. The predominant therapy was surgery in 78.3%. The proportion of penile partial resections was significantly (p = 0.0045) regredient over the control period. Adjuvant chemotherapy was performed in 4.7%, adjuvant external-beam radiotherapy in 3.0%. The 5-year relative overall survival rate was 74.7% and ranged from 108.0% (stage 0) to 17.1% (stage IV). A total of 29 hospitals performed tumour operations. Conclusions: The multitude of clinical and epidemiological variables available in clinical cancer registries allows a safe assessment of tumour dynamics themselves, as well as good quality of transparency and broadly acceptable guideline adherence. Deviations from the accepted level of evidence were found in the grading definition, in the high quota of positive surgical margins, in the defensive indication position to the glans resurfacing/reconstruction and diagnostical LND. Based on these relevant findings in the database combined with the low frequency of the tumour in area/clinics/year, we recommended establishing SCCP reference clinics. This work is the first time that European standardized rate-based cancer registry data on penile cancer from Germany has been communicated.

Introduction Assuming that motivation is the key to initiate and sustain beneficial health behaviors, the aim of this systematic review was to analyze the effects of school-based physical activity interventions on a variety of motivational outcomes towards PA in school-aged children and adolescents. Methods A comprehensive literature search was carried out in six electronic databases to identify randomized controlled trials and quasi-experimental trials examining the effects of PA interventions implemented during the regular school day, e.g., during physical education lessons or lunch breaks. Primary outcomes of interest were students' motivation, basic psychological needs, goal orientation, enjoyment, and motivational teaching climate in physical education. Meta-analyses were conducted for these outcomes using Comprehensive Meta-analysis software. Secondarily, intervention effects on students' PA behaviors were examined and the findings summarized narratively. Methodological quality of studies was evaluated using the Cochrane Collaboration's tool for assessing risk of bias for randomized trials; certainty of evidence on outcome level was evaluated using the GRADE approach. Results In total, 57 studies carried out between 2001 and 2018 were included in this review. Sixteen individual meta-analyses were performed and revealed significant pooled effects for the outcomes enjoyment (g = 0.310), perceived autonomy (g = 0.152), identified regulation (g = 0.378), intrinsic motivation (g = 0.419), self-determination index (g = 0.672), task/mastery climate (g = 0.254), ego/performance climate (g = −0.438), autonomy supportive climate (g = 0.262), task goal orientation (g = 1.370), ego goal orientation (g = −0.188). The narrative data synthesis indicated an increase in students' PA behavior. The overall risk of bias was high across all studies and certainty of evidence of meta-analyzed outcomes ranged from very low to moderate. Moderate certainty of evidence was found for ego/performance climate and ego goal orientation. Conclusions: Meta-analyses suggest that school-based PA interventions may be effective in increasing a variety of motivational outcomes. However, the certainty of evidence was limited in the majority of outcomes. Further research is needed to identify effective intervention strategies that increase students’ motivation towards PA. info:eu-repo/semantics/publishedVersion

IntroductionPeripheral arterial tonometry (PAT) is an operator-independent and non-invasive measurement method to assess microvascular endothelial function in the fingertips. PAT-derived measures of endothelial function were associated with type 2 diabetes in cross-sectional studies. However, longitudinal studies are lacking. The study aims to investigate the association of two PAT-derived endothelial function parameters reactive hyperemia index (RHI) and mean baseline amplitude (MBA) with follow-up glucose and insulin parameters and the development of (pre)diabetes and type 2 diabetes.Research design and methodsThe study included 673 participants initially without diabetes (328 men and 345 women) aged 52–71 years from the prospective population-based Cooperative Health Research in the Region of Augsburg F4/FF4 cohort study conducted in Southern Germany (baseline examination F4: 2006–2008; follow-up FF4: 2013–2014). An oral glucose tolerance test was performed at baseline and follow-up to define type 2 diabetes, prediabetes, fasting glucose, fasting insulin, 2-hour glucose, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of beta-cell function and hemoglobin A1c.ResultsIn multivariable adjusted logistic/linear regression models, a 1 SD increase in baseline RHI was inversely associated with incident type 2 diabetes (OR 0.69 (95% CI 0.48 to 0.97)) as well as with fasting insulin (β −0.069 (95% CI −0.131 to −0.007)) and HOMA-IR (β −0.072 (95% CI −0.133 to −0.010)) at follow-up in participants with initial normoglycemia. A 1 SD increase in baseline MBA was positively associated with incident (pre)diabetes (OR 1.62 (95% CI 1.25 to 2.11)) and fasting glucose (β 0.096 (95% CI 0.047 to 0.146)) at follow-up in participants with initial normoglycemia.ConclusionsMicrovascular endothelial dysfunction seems to be involved in the development of early derangements in glucose metabolism and insulin resistance and could thereby trigger the development of prediabetes and type 2 diabetes.

Background: The contribution of HIV infection to cervical cancer burden at a population-level has not been systematically quantified. We aimed to investigate cervical cancer risk among women living with HIV (WLHIV), and to estimate the global cervical cancer burden associated with HIV. Methods: We conducted a systematic literature search and a meta-analysis to estimate the pooled risk ratio (RR) of cervical cancer among WLHIV. The RR was combined with country-specific UNAIDS estimates of HIV prevalence and GLOBOCAN 2018 estimates of cervical cancer, to calculate the proportion of WLHIV among women with cervical cancer, as well as population attributable fractions and age-standardized incidence rates (ASIR) of HIV-attributable cervical cancer. Findings: In all, 24 studies met our inclusion criteria including a total of 236 127 WLHIV, providing a pooled cervical cancer RR of 6·07 (95% CI, 4·40–8·37). Globally, 5·8% (33 000) of all cervical cancers in 2018 were diagnosed in WLHIV and 4·9% (28 000 cases) were attributable to HIV infection. The most affected regions were eastern and southern Africa, and western and central Africa where 35·5% (24 000) and 10·0% (4 300) of cervical cancers were diagnosed among WLHIV, respectively. ASIRs of HIV-attributable cervical cancer were over 20 per 100 000 in 6 countries, all in eastern and southern Africa. Interpretation: WLHIV have a significantly elevated risk of cervical cancer. HPV vaccination and cervical cancer screening for WLHIV are particularly critical for sub-Saharan African countries where a substantial HIV-attributable cervical cancer burden has added to the existing cervical cancer burden. Funding: Support for this project was provided by the World Health Organization (WHO) through funding made possible by United States Agency for International Development (USAID) under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The contents in this article are the sole responsibility of the authors, and do not necessarily represent the decisions, policy or views of WHO, IARC, USAID, PEPFAR or the United States Government. Conflict of Interest: DS: Nothing to declare LFT: Nothing to declare KKL: Nothing to declare IB: Nothing to declare AIK: Nothing to declare ASVS: Nothing to declare DAM: Nothing to declare SLG: Nothing to declare SJK: Nothing to declare ASW: Nothing to declare RB: Nothing to declare GC: Nothing to declare NB: Nothing to declare SD: Nothing to declare

Eine zytologische Untersuchung zur Fruherkennung des Zervixkarzinoms wird in Deutschland seit 1971 angeboten. Frauen ab einem Alter von 20 Jahren haben die Moglichkeit, jedes Jahr einen Pap-Abstrich durchfuhren zulassen. Ein organisiertes Screeningprogramm sowie personliche Einladungen fehlen bisher. Die Inzidenzrate des Zervixkarzinoms ist in den Jahrzehnten nach Einfuhrung der Krebsfruherkennungsuntersuchung (KFU) stark zuruckgegangen, in den letzten Jahren stagniert die Inzidenzrate jedoch. Ursachlich fur die Entstehung eines Zervixkarzinoms ist eine persistierende Infektion mit Hochrisikotypen des Humanen Papillomvirus (HPV). Seit einigen Jahren sind HPV-Tests fur das Zervixkarzinomscreening von der amerikanischen Food and Drug Administration (FDA) zugelassen. Des Weiteren wird seit 2006 eine HPV-Impfung zur Primarpravention angeboten. Im Rahmen des Nationalen Krebsplans wurde in Deutschland die Umsetzung der Europaischen Leitlinie fur das Zervixkarzinomscreening bearbeitet und 2013 im Krebsfruherkennungs- und -registergesetz gesetzlich verankert. Der Gemeinsame Bundesausschuss (G-BA) wurde mit der Umsetzung und Implementierung eines organisierten Zervixkarzinomscreenings beauftragt. Im April 2018 veroffentlichte der G‑BA aktualisierte Eckpunkte fur die Umsetzung eines organisierten flachendeckenden Screeningprogramms in Deutschland. Wahrend das jahrliche zytologische Screening fur Frauen zwischen 20 und 34 Jahren weitergefuhrt wird, erhalten Frauen ab 35 Jahren kunftig alle 3 Jahre eine Kombinationsuntersuchung, bestehend aus dem Pap-Abstrich und einem HPV-Test. Frauen zwischen 20 und 60 Jahren sollen alle 5 Jahre von ihrer Krankenkasse angeschrieben werden und eine Informationsbroschure erhalten. Nach einer Ubergangsphase von mindestens 6 Jahren soll das neue Programm evaluiert werden.

Background Breast cancer remains the most common cancer among women worldwide. Autologous breast reconstruction may contribute toward restoring body image and improving quality of life after mastectomy. This systematic literature review describes differences in the quality and type of studies investigating autologous breast reconstruction techniques over time. Methods MEDLINE was searched for articles related to the surgical techniques, namely, TRAM, LADO, DIEP, and SGAP/IGAP, for the periods 1970 to 2007 and 2008 to 2010. The quality and type of studies were compared across the two time periods. Full-texts were evaluated according to prespecified quality criteria. Results The MEDLINE searches yielded 1,057 articles for review; of them, 517 articles were excluded, and 314 had a completed quality criteria checklist and hence were included; of these 314 articles, 206 articles investigated TRAM flaps, 85 investigated LADO flaps, 74 investigated DIEP flaps, and 6 investigated SGAP/IGAP flaps. A total of 218 articles were published between 1970 and 2007 compared to 96 articles published between 2008 and 2010. The comparison of quality scores between the two time periods showed a shift toward higher scores in the period 2008 to 2010. The DIEP technique was investigated more frequently between 2008 and 2010 than between 1970 and 2007, whereas the percentage of articles focusing on the TRAM flap decreased. The percentage of articles investigating the LADO and SGAP/IGAP techniques remained constant across the time periods. Conclusions Results relating to the methodological quality of articles on breast reconstruction with autologous tissue show that the quality of publications has improved with time, whereas research interests concerning the type of surgical technique investigated have changed in focus.

Background In 2008, a nationwide skin cancer screening (SCS) program was implemented in Germany. However, participation rates remain low. Objective The overall objective of the HELIOS study is to identify subgroup-specific invitation and communication strategies to increase informed SCS participation in Germany. Methods Focus group discussions will be performed in Erlangen, Germany, to explore potential invitation and communication strategies as well as possible barriers and motivating factors to participate in SCS. Male and female patients of different age groups who have already been diagnosed with skin cancer, as well as participants without a prior diagnosis of skin cancer, will be invited. Based on these results, an online questionnaire will be developed to identify subgroup-specific invitation strategies. A random sample of 2500 persons from the general population aged >35 years from the Munich area will be contacted to complete the questionnaire. Besides descriptive analysis, multinomial logistic regression will be performed. Additionally, a cluster analysis will be conducted to discover patterns or similarities among the participants. Results Recruitment for the focus group studies started in February 2021 and is ongoing. As of August 2021, we have enrolled 39 participants. We expect to end enrollment in the qualitative study in September 2021 and to finish the analysis in December 2021. The second part of the study will then start in January 2022. Conclusions The results of this project will enable us to derive improved and more efficient invitation and communication strategies for SCS. These may be implemented in the future to facilitate increased SCS uptake and early skin cancer detection. International Registered Report Identifier (IRRID) DERR1-10.2196/31860