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Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, Graziani F, Hobbs FDR, Huck O, Hummers E, Jepsen S, Kravtchenko O, Madianos P, Molina A, Ungan M, Vilaseca J, Windak A, Vinker S. Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe. Eur J Gen Pract 2024; 30:2320120. [PMID: 38511739 PMCID: PMC10962307 DOI: 10.1080/13814788.2024.2320120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing. OBJECTIVES To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD). METHODS The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings. RESULTS Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors. CONCLUSION Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah and the Hebrew University Medical Center, Jerusalem, Israel
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Iain Chapple
- Periodontal Research Group, and Birmingham NIHR Biomedical Research Centre in Inflammation, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Thomas Frese
- Institut für Allgemeinmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy
| | - F. D. Richard Hobbs
- Oxford Primary Care, Radcliffe Primary Care Building, ROQ, University of Oxford, Oxford, UK
| | - Olivier Huck
- Dental Faculty, University of Strasbourg, Strasbourg, France
| | - Eva Hummers
- Department of General Practice and Family Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | | | - Phoebus Madianos
- Department of Periodontology, Faculty of Dentistry, National & Kapodistrian University of Athens, Athens, Greece
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Josep Vilaseca
- Department of Medicine, University of Vic–Central Catalonia University, Vic, Spain
- Primary Health Care Service, Althaia Foundation–Healthcare and University Network, Manresa, Spain
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Poppleton A, Tsukagoshi S, Vinker S, Heritier F, Frappé P, Dupont F, Sigmund P, Iacob M, Vilaseca J, Ungan M, Aakjær Andersen C, Frese T, Halata D. World Organization of National Colleges, Academies and Academic Associations of General Practitioners and Family Physicians (WONCA) Europe position paper on the use of point-of-care ultrasound (POCUS) in primary care. Prim Health Care Res Dev 2024; 25:e21. [PMID: 38651341 DOI: 10.1017/s1463423624000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
| | | | | | | | - Paul Frappé
- Université Jean Monnet, Saint-Etienne, France
| | | | - Peter Sigmund
- Steirischen Akademie für Allgemeinmedizin, Graz, Austria
| | - Mihai Iacob
- Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | | | - Mehmet Ungan
- School of Medicine, Ankara University, Ankara, Turkey
| | | | - Thomas Frese
- University Halle-Wittenberg, Halle (Saale), Germany
- European General Practice Research Network, Halle-Wittenberg, Germany
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Wanner C, Schaeffner E, Frese T, Weber C, Stahl P, Scherg F, Burckhardt F, Opfermann U, Radowsky F, Mader F. [InspeCKD - Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices]. MMW Fortschr Med 2024; 166:9-17. [PMID: 38575833 DOI: 10.1007/s15006-024-3684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines. OBJECTIVES The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices. METHOD For the analysis of the use of CKD-relevant diagnostics, electronic patient records from German general practitioner practices were analyzed. Adults with hypertension and/or diabetes mellitus and/or cardiovascular disease with a documented observation period of at least one year were included in the study. RESULTS Data from a total of 448,837 patients from 1244 general practitioner practices were analyzed. 75.8% of patients had hypertension, 35.1% had cardiovascular disease, and 32.4% had diabetes mellitus. During a mean observation period of 1.7 years, serum creatinine was assessed at least once in 45.5% of patients. A urine dipstick test for albuminuria was performed in 7.9% of patients and in 0.4% of patients, urine albumin-to-creatine ratio (UACR) was measured. Laboratory diagnostics were initiated a little more frequently in high-risk patients compared to the overall cohort. CONCLUSIONS The study highlights that despite known risk factors, guideline compliant CKD screening is rarely performed in German general practitioner practices, which implicates the need to increase the awareness of early diagnosis of CKD in patients at risk.
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Affiliation(s)
- Christoph Wanner
- Abteilung klinische Studien und Epidemiologie, Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Deutschland.
| | - Elke Schaeffner
- Institut für Public Health, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Thomas Frese
- Institut für Allgemeinmedizin, Universitätsklinikum Halle (Saale), Halle, Deutschland
| | | | - Philipp Stahl
- Hausärztliche Gemeinschaftspraxis Meinecke & Stahl, Burg, Deutschland
| | | | | | | | - Frank Radowsky
- Allgemeinmedizinische Praxis Radowsky, Leipzig, Deutschland
| | - Frederik Mader
- Internationale Hochschule, Erfurt, Gemeinschaftspraxis Nittendorf, Nittendorf, Deutschland
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Klee B, Costa D, Frese T, Knoechelmann A, Meyer G, Meyer T, Purschke O, Schildmann J, Steckelberg A, Mikolajczyk R. To Remind or Not to Remind During Recruitment? An Analysis of an Online Panel in Germany. Int J Public Health 2024; 69:1606770. [PMID: 38586472 PMCID: PMC10996063 DOI: 10.3389/ijph.2024.1606770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Objective: To explore the role of reminders in recruiting and maintaining participation in an online panel. Methods: 50,045 individuals from five German federal states were invited by regular mail to participate in the online study "Health-Related Beliefs and Healthcare Experiences in Germany." Those who did not respond to the first attempt received a postal reminder. Comparisons of sociodemographic characteristics and responses were made between first-attempt respondents and those who enrolled after the second letter. Results: After the initial letter, 2,216 (4.4%, 95%CI: 4.3%-4.6%) registered for the study; after a reminder 1,130 (2.5%, 2.3%-2.6% of those reminded) enrolled. Minor sociodemographic differences were observed between the groups and the content of the responses did not differ. Second-attempt respondents were less likely to participate in subsequent questionnaires: 67.3% of first-attempt vs. 43.3% of second-attempt respondents participated in their fourth survey. Recruitment costs were 79% higher for second-attempt respondents. Conclusion: While reminders increased the number of participants, lower cost-effectiveness and higher attrition of second-attempt respondents support the use of single invitation only for studies with a similar design to ours when the overall participation is low.
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Affiliation(s)
- Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Daniela Costa
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Thomas Frese
- Institute for General Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Anja Knoechelmann
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Thorsten Meyer
- Institute for Rehabilitation Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Oliver Purschke
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Sciences, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
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Moser K, Massag J, Frese T, Mikolajczyk R, Christoph J, Pushpa J, Straube J, Unverzagt S. German primary care data collection projects: a scoping review. BMJ Open 2024; 14:e074566. [PMID: 38382948 PMCID: PMC10882319 DOI: 10.1136/bmjopen-2023-074566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The widespread use of electronic health records (EHRs) has led to a growing number of large routine primary care data collection projects globally, making these records a valuable resource for health services and epidemiological and clinical research. This scoping review aims to comprehensively assess and compare strengths and limitations of all German primary care data collection projects and relevant research publications that extract data directly from practice management systems (PMS). METHODS A literature search was conducted in the electronic databases in May 2021 and in June 2022. The search string included terms related to general practice, routine data, and Germany. The retrieved studies were classified as applied studies and methodological studies, and categorised by type of research, subject area, sample of publications, disease category, or main medication analysed. RESULTS A total of 962 references were identified, with 241 studies included from six German projects in which databases are populated by EHRs from PMS. The projects exhibited significant heterogeneity in terms of size, data collection methods, and variables collected. The majority of the applied studies (n = 205, 85%) originated from one database with a primary focus on pharmacoepidemiological topics (n = 127, 52%) including prescription patterns (n = 68, 28%) and studies about treatment outcomes, compliance, and treatment effectiveness (n = 34, 14%). Epidemiological studies (n = 77, 32%) mainly focused on incidence and prevalence studies (n = 41, 17%) and risk and comorbidity analysis studies (n = 31, 12%). Only 10% (n = 23) of studies were in the field of health services research, such as hospitalisation. CONCLUSION The development and durability of primary care data collection projects in Germany is hindered by insufficient public funding, technical issues of data extraction, and strict data protection regulations. There is a need for further research and collaboration to improve the usability of EHRs for health services and research.
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Affiliation(s)
- Konstantin Moser
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Janka Massag
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Thomas Frese
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Rafael Mikolajczyk
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of Medical Epidemiology, Biometrics, and Informatics, Halle, Germany
| | - Jan Christoph
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Junior Research Group (Bio-)Medical Data Science, Halle, Germany
| | - Joshi Pushpa
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Johanna Straube
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
| | - Susanne Unverzagt
- Medical Faculty of the Martin Luther University Halle-Wittenberg, Institute of General Practice and Family Medicine, Halle, Germany
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Fischer C, Willscher E, Paschold L, Gottschick C, Klee B, Diexer S, Bosurgi L, Dutzmann J, Sedding D, Frese T, Girndt M, Hoell JI, Gekle M, Addo MM, Schulze Zur Wiesch J, Mikolajczyk R, Binder M, Schultheiß C. SARS-CoV-2 vaccination may mitigate dysregulation of IL-1/IL-18 and gastrointestinal symptoms of the post-COVID-19 condition. NPJ Vaccines 2024; 9:23. [PMID: 38316833 PMCID: PMC10844289 DOI: 10.1038/s41541-024-00815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
The rapid development of safe and effective vaccines helped to prevent severe disease courses after SARS-CoV-2 infection and to mitigate the progression of the COVID-19 pandemic. While there is evidence that vaccination may reduce the risk of developing post-COVID-19 conditions (PCC), this effect may depend on the viral variant. Therapeutic effects of post-infection vaccination have been discussed but the data for individuals with PCC remains inconclusive. In addition, extremely rare side effects after SARS-CoV-2 vaccination may resemble the heterogeneous PCC phenotype. Here, we analyze the plasma levels of 25 cytokines and SARS-CoV-2 directed antibodies in 540 individuals with or without PCC relative to one or two mRNA-based COVID-19 vaccinations as well as in 20 uninfected individuals one month after their initial mRNA-based COVID-19 vaccination. While none of the SARS-CoV-2 naïve individuals reported any persisting sequelae or exhibited PCC-like dysregulation of plasma cytokines, we detected lower levels of IL-1β and IL-18 in patients with ongoing PCC who received one or two vaccinations at a median of six months after infection as compared to unvaccinated PCC patients. This reduction correlated with less frequent reporting of persisting gastrointestinal symptoms. These data suggest that post-infection vaccination in patients with PCC might be beneficial in a subgroup of individuals displaying gastrointestinal symptoms.
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Affiliation(s)
- Claudia Fischer
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland
- Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University, and University Hospital Basel, Basel, Switzerland
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Lidia Bosurgi
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Protozoa Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jochen Dutzmann
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Jessica I Hoell
- Pediatric Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Michael Gekle
- Julius Bernstein-Institute of Physiology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Braunschweig, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development (IIRVD), Hamburg, Germany
| | | | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, (Saale), Germany
| | - Mascha Binder
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland
- Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University, and University Hospital Basel, Basel, Switzerland
| | - Christoph Schultheiß
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland.
- Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University, and University Hospital Basel, Basel, Switzerland.
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Soler JK, Buono N, Cardillo E, Frese T, Vinker S, Ungan M. The fractured lens: a controversial revision of the International Classification of Primary Care. Front Med (Lausanne) 2024; 10:1230987. [PMID: 38274446 PMCID: PMC10808642 DOI: 10.3389/fmed.2023.1230987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background The International Classification of Primary Care (ICPC) has represented the international standard reduction for measuring the content of primary care for over 30 years. In the process of its third revision, its authors, the Wonca International Classification Committee (WICC), delegated a major part of the technical work to a purposely formed Consortium. However, in the process of such revision, standard classification principles and rules have been inconsistently applied with the result that ICPC-3 has been published with major errors and an inconsistent structure. Objectives To formally describe and critically appraise the revision process of ICPC-3. Methods The formal review of ICPC-3 performed by an expert group within WICC and commissioned by the Executive Council of Wonca Europe is presented in abridged form. Results ICPC-3 as currently presented introduces major departures from formal classification principles and rules, besides other major errors and inconsistencies, all of which are listed and described. Conclusion Major changes in ICPC-3 defy categorisation and conceptualisation standards. ICPC-3 now represents an untested departure from international standard presentations, without a formal academic base. The direct inclusion of measures of functioning in a classification of reasons for encounter and health problems fails to address the dichotomy of these domains, the boundaries of and relationships between which are not satisfactorily resolved by the system. Analysis of ICPC-3 data will require the development and implementation of alternative, as yet undefined, models of the relationships between disease and health. By including different domains without resolving ambiguity, and by splitting function from other body systems, ICPC-3 becomes an internally fractured instrument.
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Affiliation(s)
| | - Nicola Buono
- Department of General Practice, ICPC Club Italia, Caserta, Italy
| | - Elena Cardillo
- Institute of Informatics and Telematics, National Research Council, Rende, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Leumit Health Services, Tel Aviv, Israel
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Türkiye
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Zülke AE, Pabst A, Luppa M, Roehr S, Seidling H, Oey A, Cardona MI, Blotenberg I, Bauer A, Weise S, Zöllinger I, Sanftenberg L, Brettschneider C, Döhring J, Lunden L, Czock D, Haefeli WE, Wiese B, Hoffmann W, Frese T, Gensichen J, König H, Kaduszkiewicz H, Thyrian JR, Riedel‐Heller SG. A multidomain intervention against cognitive decline in an at-risk-population in Germany: Results from the cluster-randomized AgeWell.de trial. Alzheimers Dement 2024; 20:615-628. [PMID: 37768074 PMCID: PMC10917033 DOI: 10.1002/alz.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION We investigated the effectiveness of a multidomain intervention to preserve cognitive function in older adults at risk for dementia in Germany in a cluster-randomized trial. METHODS Individuals with a Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk score ≥ 9 aged 60 to 77 years were recruited. After randomization of their general practitioner (GP), patients received a multidomain intervention (including optimization of nutrition and medication, and physical, social, and cognitive activity) or general health advice and GP treatment as usual over 24 months. Primary outcome was global cognitive performance (composite z score, based on domain-specific neuropsychological tests). RESULTS Of 1030 participants at baseline, n = 819 completed the 24-month follow-up assessment. No differences regarding global cognitive performance (average marginal effect = 0.010, 95% confidence interval: -0.113, 0.133) were found between groups at follow-up. Perceived restrictions in intervention conduct by the COVID-19 pandemic did not impact intervention effectiveness. DISCUSSION The intervention did not improve global cognitive performance. HIGHLIGHTS Overall, no intervention effects on global cognitive performance were detected. The multidomain intervention improved health-related quality of life in the total sample. In women, the multidomain intervention reduced depressive symptoms. The intervention was completed during the COVID-19 pandemic.
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Affiliation(s)
- Andrea E. Zülke
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Alexander Pabst
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Melanie Luppa
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Susanne Roehr
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
- School of PsychologyMassey UniversityManawatū CampusPalmerston NorthNew Zealand
- Global Brain Health Institute (GBHI)Trinity College DublinDublinIreland
| | - Hanna Seidling
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Anke Oey
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Maria Isabel Cardona
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
| | - Alexander Bauer
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Solveig Weise
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Linda Sanftenberg
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Christian Brettschneider
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Laura Lunden
- Institute of General PracticeUniversity of KielKielGermany
| | - David Czock
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and PharmacoepidemiologyHeidelberg University HospitalHeidelbergGermany
| | - Birgitt Wiese
- Institute for General PracticeWork Group Medical Statistics and IT‐InfrastructureHannover Medical SchoolHannoverGermany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Thomas Frese
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Jochen Gensichen
- Institute of General Practice/Family MedicineUniversity Hospital of LMU MunichMunichGermany
| | - Hans‐Helmut König
- University Medical Center Hamburg‐EppendorfDepartment of Health Economics and Health Service ResearchHamburgGermany
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE)Rostock/GreifswaldGreifswaldGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
- Faculty V–Faculty of Life SciencesUniversity of SiegenSiegenGermany
| | - Steffi G. Riedel‐Heller
- Institute of Social MedicineOccupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
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9
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Wittmann FG, Pabst A, Zülke A, Luppa M, Blotenberg I, Cardona MI, Bauer A, Fuchs S, Zöllinger I, Sanftenberg L, Brettschneider C, Döhring J, Lunden L, Czock D, Wiese B, Thyrian JR, Hoffmann W, Frese T, Gensichen J, König HH, Kaduszkiewicz H, Riedel-Heller SG. Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men - Secondary Analysis of the AgeWell.de-trial. J Prev Alzheimers Dis 2024; 11:348-355. [PMID: 38374741 DOI: 10.14283/jpad.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Differences between women and men matter in the prevalence and risk factors of dementia. We aimed to examine potential sex differences regarding the effectiveness by running a secondary analysis of the AgeWell.de trial, a cluster-randomized multicenter multi-domain lifestyle intervention to reduce cognitive decline. METHODS Intention-to-treat analyses of women (n=433) and men (n=386) aged 60 to 77 years were used for models including interactions between intervention group allocation and sex followed by subgroup analysis stratified by sex on primary and secondary outcomes. Further, the same procedure was repeated for age groups (60-69 vs. 70-77) within sex-specific subgroups to assess the effectiveness in different age groups. TRIAL REGISTRATION German Clinical Trials Register (ref. number: DRKS00013555). RESULTS No differences were found between women and men in the effectiveness of the intervention on cognitive performance. However, women benefitted from the intervention regarding depressive symptoms while men did not. Health-related quality of life was enhanced for younger intervention participants (60-69 years) in both women and men. CONCLUSION The AgeWell.de intervention was able to improve depressive symptoms in women and health-related quality of life in younger participants. Female participants between 60 and 69 years benefited the most. Results support the need of better individually targeted lifestyle interventions for older adults.
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Affiliation(s)
- F G Wittmann
- Felix G. Wittmann, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Phillip-Rosenthal-Str. 55, 04103 Leipzig, Germany, E-Mail:
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10
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Buchholz M, Zöllinger I, Thyrian JR, Luppa M, Zülke A, Döhring J, Lunden L, Sanftenberg L, Brettschneider C, Czock D, Frese T, Gensichen J, Hoffmann W, Kaduszkiewicz H, König HH, Wiese B, Riedel-Heller SG, Blotenberg I. Factors Associated with Lower Social Activity in German Older Adults at Increased Risk of Dementia: A Cross-Sectional Analysis. J Alzheimers Dis 2024; 98:1443-1455. [PMID: 38607756 DOI: 10.3233/jad-231226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Background Studies demonstrate associations between low social activity in older adults and cognitive decline. Little has been investigated regarding which factors are associated with low social activity in older adults at increased risk of dementia. Objective We investigate which sociodemographic, psychological, health-related, and environmental factors are associated with low social activity in older adults at increased risk of dementia. Additionally, we describe the stages of health behavior change, the types of social activities, and the duration of the current level of social activity. Methods We used baseline data of 1,015 participants from the AgeWell.de trial. We conducted logistic and Poisson regression analyses to investigate factors associated with low social activity. We report descriptive statistics on the stages of change in the sample, the types of social activities most frequently pursued, and the duration of the current level of social activity. Results Lower income, non-usage of public transport, depressive symptoms, cognitive, mobility, and hearing impairment were negatively associated with social activity. The majority of the sample was in the maintenance stage, followed by the precontemplation stage. The most common social activities were traveling and hobbies with others. Participants have maintained their current level of social activity for several years. Conclusions We identified a lack of resources (income, transport), depressive symptoms and poorer health (cognitive, mobility and hearing impairment) as barriers to social activity. Interventions promoting social activity in older adults at risk of dementia may specifically target individuals with these risk factors. Low-threshold opportunities for social activity may be particularly beneficial.
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Affiliation(s)
- Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Isabel Zöllinger
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- University of Siegen, Faculty V: School of Life Sciences, Siegen, Germany
| | - Melanie Luppa
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Andrea Zülke
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, Kiel, Germany
| | - Laura Lunden
- Institute of General Practice, University of Kiel, Kiel, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Ludwig Maximilian University Hospital, Ludwig Maximilian University Munich (LMU), Munich, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- MHH Information Technology, Hannover Medical School, Hannover, Germany
| | - Steffi G Riedel-Heller
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
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11
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Schwenker R, Dietrich CE, Hirpa S, Nothacker M, Smedslund G, Frese T, Unverzagt S. Motivational interviewing for substance use reduction. Cochrane Database Syst Rev 2023; 12:CD008063. [PMID: 38084817 PMCID: PMC10714668 DOI: 10.1002/14651858.cd008063.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance-use disorder. Motivational interviewing (MI) is a client-centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This review updates the 2011 version by Smedslund and colleagues. OBJECTIVES To assess the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment. SEARCH METHODS We searched 18 electronic databases, six websites, four mailing lists, and the reference lists of included studies and reviews. The last search dates were in February 2021 and November 2022. SELECTION CRITERIA We included randomised controlled trials with individuals using drugs, alcohol, or both. Interventions were MI or motivational enhancement therapy (MET), delivered individually and face to face. Eligible control interventions were no intervention, treatment as usual, assessment and feedback, or other active intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane, and assessed the certainty of evidence with GRADE. We conducted meta-analyses for the three outcomes (extent of substance use, readiness to change, retention in treatment) at four time points (post-intervention, short-, medium-, and long-term follow-up). MAIN RESULTS We included 93 studies with 22,776 participants. MI was delivered in one to nine sessions. Session durations varied, from as little as 10 minutes to as long as 148 minutes per session, across included studies. Study settings included inpatient and outpatient clinics, universities, army recruitment centres, veterans' health centres, and prisons. We judged 69 studies to be at high risk of bias in at least one domain and 24 studies to be at low or unclear risk. Comparing MI to no intervention revealed a small to moderate effect of MI in substance use post-intervention (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) 0.07 to 0.89; I2 = 75%; 6 studies, 471 participants; low-certainty evidence). The effect was weaker at short-term follow-up (SMD 0.20, 95% CI 0.12 to 0.28; 19 studies, 3351 participants; very low-certainty evidence). This comparison revealed a difference in favour of MI at medium-term follow-up (SMD 0.12, 95% CI 0.05 to 0.20; 16 studies, 3137 participants; low-certainty evidence) and no difference at long-term follow-up (SMD 0.12, 95% CI -0.00 to 0.25; 9 studies, 1525 participants; very low-certainty evidence). There was no difference in readiness to change (SMD 0.05, 95% CI -0.11 to 0.22; 5 studies, 1495 participants; very low-certainty evidence). Retention in treatment was slightly higher with MI (SMD 0.26, 95% CI -0.00 to 0.52; 2 studies, 427 participants; very low-certainty evidence). Comparing MI to treatment as usual revealed a very small negative effect in substance use post-intervention (SMD -0.14, 95% CI -0.27 to -0.02; 5 studies, 976 participants; very low-certainty evidence). There was no difference at short-term follow-up (SMD 0.07, 95% CI -0.03 to 0.17; 14 studies, 3066 participants), a very small benefit of MI at medium-term follow-up (SMD 0.12, 95% CI 0.02 to 0.22; 9 studies, 1624 participants), and no difference at long-term follow-up (SMD 0.06, 95% CI -0.05 to 0.17; 8 studies, 1449 participants), all with low-certainty evidence. There was no difference in readiness to change (SMD 0.06, 95% CI -0.27 to 0.39; 2 studies, 150 participants) and retention in treatment (SMD -0.09, 95% CI -0.34 to 0.16; 5 studies, 1295 participants), both with very low-certainty evidence. Comparing MI to assessment and feedback revealed no difference in substance use at short-term follow-up (SMD 0.09, 95% CI -0.05 to 0.23; 7 studies, 854 participants; low-certainty evidence). A small benefit for MI was shown at medium-term (SMD 0.24, 95% CI 0.08 to 0.40; 6 studies, 688 participants) and long-term follow-up (SMD 0.24, 95% CI 0.07 to 0.41; 3 studies, 448 participants), both with moderate-certainty evidence. None of the studies in this comparison measured substance use at the post-intervention time point, readiness to change, and retention in treatment. Comparing MI to another active intervention revealed no difference in substance use at any follow-up time point, all with low-certainty evidence: post-intervention (SMD 0.07, 95% CI -0.15 to 0.29; 3 studies, 338 participants); short-term (SMD 0.05, 95% CI -0.03 to 0.13; 18 studies, 2795 participants); medium-term (SMD 0.08, 95% CI -0.01 to 0.17; 15 studies, 2352 participants); and long-term follow-up (SMD 0.03, 95% CI -0.07 to 0.13; 10 studies, 1908 participants). There was no difference in readiness to change (SMD 0.15, 95% CI -0.00 to 0.30; 5 studies, 988 participants; low-certainty evidence) and retention in treatment (SMD -0.04, 95% CI -0.23 to 0.14; 12 studies, 1945 participants; moderate-certainty evidence). We downgraded the certainty of evidence due to inconsistency, study limitations, publication bias, and imprecision. AUTHORS' CONCLUSIONS Motivational interviewing may reduce substance use compared with no intervention up to a short follow-up period. MI probably reduces substance use slightly compared with assessment and feedback over medium- and long-term periods. MI may make little to no difference to substance use compared to treatment as usual and another active intervention. It is unclear if MI has an effect on readiness to change and retention in treatment. The studies included in this review were heterogeneous in many respects, including the characteristics of participants, substance(s) used, and interventions. Given the widespread use of MI and the many studies examining MI, it is very important that counsellors adhere to and report quality conditions so that only studies in which the intervention implemented was actually MI are included in evidence syntheses and systematic reviews. Overall, we have moderate to no confidence in the evidence, which forces us to be careful about our conclusions. Consequently, future studies are likely to change the findings and conclusions of this review.
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Affiliation(s)
- Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Carla Emilia Dietrich
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Selamawit Hirpa
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany, Berlin, c/o Philipps University Marburg, Berlin & Marburg, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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Diexer S, Klee B, Gottschick C, Xu C, Broda A, Purschke O, Binder M, Frese T, Girndt M, Hoell JI, Moor I, Gekle M, Mikolajczyk R. Association between virus variants, vaccination, previous infections, and post-COVID-19 risk. Int J Infect Dis 2023; 136:14-21. [PMID: 37634619 DOI: 10.1016/j.ijid.2023.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVES The SARS-CoV-2 Omicron variant has spread rapidly and has been the dominant variant since 2022. The course of acute infection, in a vaccinated population, with Omicron is milder compared with earlier variants. However, little is known about how the occurrence of long-term symptoms after Omicron infection compared with other variants is modulated by previous infections and/or vaccinations. METHODS Participants of the DigiHero study provided information about their SARS-CoV-2 infections, vaccinations, and symptoms 12 or more weeks after infection (post-COVID-19 condition - PCC). RESULTS Participants infected with wildtype SARS-CoV-2 had the highest PCC risk (adjusted odds ratio [aOR] 6.44, 95% confidence interval (CI): 5.49; 7.56), followed by participants infected with Alpha and Delta compared with the reference group (individuals infected with Omicron having received three or more vaccinations). Among those infected with a specific variant, the number of preceding vaccinations was not associated with a risk reduction for PCC, whereas previous infection was strongly associated with a lower PCC risk (aOR 0.14, 95% CI 0.07; 0.25). CONCLUSIONS While infection with Omicron is less likely to result in PCC compared with previous variants, lack of protection by vaccination suggests a substantial challenge for the healthcare system during the early endemic period. In the midterm, the protective effects of previous infections can reduce the burden of PCC.
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Affiliation(s)
- Sophie Diexer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Chao Xu
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Broda
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Oliver Purschke
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Haematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jessica I Hoell
- Paediatric Haematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute for Medical Sociology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Gekle
- Julius-Bernstein-Institute of Physiology, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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13
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Klee B, Diexer S, Sarajan MH, Glaser N, Binder M, Frese T, Girndt M, Sedding D, Hoell JI, Moor I, Gekle M, Mikolajczyk R, Gottschick C. Regional Differences in Uptake of Vaccination against COVID-19 and Influenza in Germany: Results from the DigiHero Cohort. Vaccines (Basel) 2023; 11:1640. [PMID: 38005973 PMCID: PMC10674575 DOI: 10.3390/vaccines11111640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
During the COVID-19 pandemic in Germany, vaccination uptake exhibited considerable regional disparities. To assess the factors contributing to this variation, we examined the association of sociodemographic variables with COVID-19, COVID-19 booster, and influenza vaccination status within a cohort of 37,078 participants from 13 German federal states in the digital health cohort study commonly known as DigiHero. Our findings revealed variations in vaccination rates based on sociodemographic factors. However, these factors had limited explanatory power regarding regional differences in vaccine uptake. In contrast, we found substantial correlations between regional support of specific parties during the last local elections and the vaccination uptake at the level of each administrative district. In conclusion, sociodemographic factors alone did not suffice to explain the regional disparities in vaccine uptake. Political stances can play a major role, although the current investigation did not assess individual political orientations but rather used only an ecological approach.
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Affiliation(s)
- Bianca Klee
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
| | - Myka Harun Sarajan
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
| | - Nadine Glaser
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Haematology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany;
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany;
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany;
| | - Daniel Sedding
- Mid-German Heart Centre, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany;
| | - Jessica I. Hoell
- Paediatric Haematology and Oncology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany;
| | - Irene Moor
- Institute for Medical Sociology, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany;
| | - Michael Gekle
- Julius-Bernstein-Institute of Physiology, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 6, 06110 Halle (Saale), Germany;
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; (B.K.); (S.D.); (M.H.S.); (N.G.)
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Kroeber ES, Frese T, Kantelhardt EJ, Nanuppakrankijkun B, Ngeh Ngeh E, Schrimpf A, Tamire M, Unverzagt S. Randomized Controlled Trials on Chronic Obstructive Pulmonary Disease in Africa: A Systematic Review. Chronic Obstr Pulm Dis 2023; 10:422-436. [PMID: 37450850 DOI: 10.15326/jcopdf.2023.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Background The rising burden of chronic obstructive pulmonary disease (COPD) in African countries is attributed to the growing and aging of the populations, lifestyles, and environmental changes. This systematic review aims to map the available evidence on COPD interventions in Africa. Methods We performed a systematic search in 6 databases (including local African databases) and registries with updates through January 2022. We included randomized controlled trials (RCTs) that included patients diagnosed with COPD and were conducted in Africa, studying outcomes on acute respiratory episodes and rates, physical and functional abilities, and adverse events. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study quality was assessed using the Cochrane risk of bias tool. We primarily summarized the results in narrative form. Results Out of 1594 identified publications, we included 18 studies with a total of 1504 participants, conducted in Egypt, South Africa, and Tunisia. Eight studies investigated interventions for patients in stable phases treated in outpatient settings, and 10 included patients with acute COPD exacerbations treated in emergency or intensive care settings. The interventions mainly included ventilatory support and pharmacological and rehabilitative interventions. Reported treatment effects were heterogeneous, ranging from no beneficial effects to clinically relevant benefits. Conclusions The included studies were conducted in countries with high infrastructural development and half of them were set in intensive care units. Despite the paucity of RCTs on COPD management, research activities have been increasing over the last several years.
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Affiliation(s)
- Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Benjarong Nanuppakrankijkun
- Institute of General Practice and Family Medicine, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Etienne Ngeh Ngeh
- Department of Physiotherapy, Regional Hospital Bamenda, North-West Region, Bamenda, Cameroon
- Research Organization for Health Education and Rehabilitation-Cameroon, Bamenda, Cameroon
- African Regional Community, Guidelines International Network, Bamenda, Cameroon
| | - Anne Schrimpf
- Faculty of Medicine, Department of General Practice, University of Leipzig, Leipzig, Germany
| | - Mulugeta Tamire
- School of Public Health, Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Interdisciplinary Center for Health Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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15
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Markert J, Niemann J, Starke D, Frese T, Meyer G, Mikolajczyk R, Schildmann J, Steckelberg A, Knöchelmann A. [Pre-existing Mental Disorders and Depressiveness in the Second Wave of the SARS-CoV-2-Pandemic - The Role of Pandemic-Associated Stressors]. Psychother Psychosom Med Psychol 2023; 73:396-404. [PMID: 37500066 DOI: 10.1055/a-2105-3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The second wave of the SARS-CoV-2 pandemic was characterized by drastic restrictions. From previous pandemics as well as from the first wave, it is known that especially individuals with a history of mental disorders may be highly vulnerable to develop poor mental health. Therefore, this paper examines the association of prior mental disorders (PMD) and depressiveness in the 2nd pandemic wave, considering general stress, perceived isolation, perception of political measures to curb the pandemic, fears regarding consequences of the pandemic and changes in the employment and income situation. A cross-sectional analysis was conducted with data of 812 participants of the health related beliefs and health care experiences in Germany study (HeReCa). The association between PMD and depressiveness was studied by means of weighted (for education and age) logistic regression, adjusted for the named variables as well as sociodemographic characteristics. Individuals with PMD displayed substantially more often higher depressiveness than individuals without PMD (OR: 25.1; 95% CI: 11.0-57.3). This association decreased partially by accounting for higher general stress and stress from isolation. Lack of partnership, low income, and male sex were associated with higher depressiveness, but only marginally changed the association of PMD and depressiveness. Overall, during the pandemic, persons with PMD were more likely to develop higher depressiveness than persons without. It is strongly advised to provide care for mental illness in pandemic times, which can be completed by E-Mental-Health or professional support for coping with stress.
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Affiliation(s)
- Jenny Markert
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Jana Niemann
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Dagmar Starke
- Akademie für Öffentliches Gesundheitswesen in Düsseldorf
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften (PZG), Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Anke Steckelberg
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Anja Knöchelmann
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften (PZG), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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Zöllinger I, Bauer A, Blotenberg I, Brettschneider C, Buchholz M, Czock D, Döhring J, Escales C, Fankhaenel T, Frese T, Hoffmann W, Kaduszkiewicz H, König HH, Luppa M, Oey A, Pabst A, Sanftenberg L, Thyrian JR, Weiss J, Wendel F, Wiese B, Riedel-Heller SG, Gensichen J. Associations of Depressive Symptoms with Subjective Cognitive Decline in Elderly People-A Cross-Sectional Analysis from the AgeWell.de-Study. J Clin Med 2023; 12:5205. [PMID: 37629244 PMCID: PMC10455560 DOI: 10.3390/jcm12165205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
To develop effective dementia prevention strategies, it is necessary to understand risk factors, associated factors and early signs of dementia. Subjective cognitive decline (SCD) is the earliest form of dementia. The aim of this study is to assess depression as a factor that is significantly associated with SCD. The data of 1030 general practitioner patients from the AgeWell.de-study (60-77 years; CAIDE dementia risk score ≥ 9) were analysed. A descriptive analysis was conducted using validated instruments like the Geriatric depression scale (GDS), Lubben social network scale (LSNS-6) and education classes according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations). A multivariate regression model with the dependent variable SCD was calculated. Of the 1030 participants, 5.9% had depressive symptoms and 31.3% SCD. The group with depressive symptoms showed significantly higher body-mass-index (p = 0.005), lower education class (p = 0.022), lower LSNS-6 score (p < 0.001), higher sports activity (p < 0.001), and more sleeping problems (p = 0.026). In the regression model a higher GDS-score [Odds ratio (OR): 1.219 (p < 0.001)], more sleeping problems [OR: 1.550 (p = 0.017)] and higher education class [middle/high: OR: 1.474/1.875 (p = 0.037/0.004)] were significantly associated with SCD. This study identified depressive symptoms, sleeping problems, and higher education classes as factors associated with SCD, which can represent an early form of dementia.
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Affiliation(s)
- Isabel Zöllinger
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Thomas Fankhaenel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany; (A.B.); (T.F.); (T.F.)
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany; (J.D.); (C.E.); (H.K.)
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (C.B.); (H.-H.K.)
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Anke Oey
- State Health Department of Lower Saxony, 30449 Hannover, Germany;
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany; (I.B.); (M.B.); (W.H.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | - Julian Weiss
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Flora Wendel
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, 30625 Hannover, Germany;
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (M.L.); (A.P.); (S.G.R.-H.)
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany; (L.S.); (J.W.); (F.W.); (J.G.)
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Golla A, Saal S, Meyer G, Frese T, Mikolajczyk R, Richter M, Schildmann J, Steckelberg A, Mau W. [Comprehension and Perspectives of the Need for Medical Rehabilitation - Results of a German Online Survey]. Rehabilitation (Stuttg) 2023; 62:197-206. [PMID: 36806190 DOI: 10.1055/a-1998-6673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND In Germany, medical rehabilitation usually requires an application of the persons in need. Therefore, these persons have to understand what rehabilitation is and in what case they need this type of health care service. In addition to people with health problems, their close persons (e. g. family members) should also have rehabilitation-related knowledge. Since there is only limited data on the perspective towards medical rehabilitation services, a survey was conducted. METHOD In September 2020, we invited 2,401 registered participants (age: 18-79 years) of a population-based online panel study to participate in an online survey. The cross-sectional survey asked about the understanding of need, subjective information as well as attitudes and expectations towards medical rehabilitation services. We analysed the data descriptively, taking into account the participants' rehabilitation experience and health impairment. In a subgroup analysis, the potential factors influencing the subjective need for rehabilitation were tested using logistic regression. RESULTS Data from 1,464 persons (Ø age: 52.5±14.5 years; 55% non-male) were analysed, 44% of the participants considered themselves to be "rather well" or "very well" informed about medical rehabilitation. The majority associated a need for rehabilitation with the access requirements related to service providers. In case of an emerging need for rehabilitation, family doctors would be the first point of contact. The participants mainly had function-oriented expectations of rehabilitation services and a majority prefer inpatient rehabilitation if necessary. Among 383 persons with long lasting and pronounced health-related impairment, the concrete individual need for rehabilitation was associated by a higher subjective degree of impairment as well as their own previous rehabilitation experience and rehabilitation experience in their personal social environment. CONCLUSION Despite an overall good understanding of the need for rehabilitation, different rehabilitation views were found in certain population groups. In order to improve the general understanding of rehabilitation in the public and particularly in close persons, adequate dissemination of low-threshold, population-based rehabilitation information is recommended.
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Affiliation(s)
- André Golla
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Susanne Saal
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Matthias Richter
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Anke Steckelberg
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Deutschland
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Marx Y, Bauer A, Unverzagt S, Stark U, Frese T. Instruments in general practice to identify and to measure (over)burden due to informal care for caring relatives: a scoping review protocol. BMJ Open 2023; 13:e067934. [PMID: 37380204 PMCID: PMC10410812 DOI: 10.1136/bmjopen-2022-067934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Family caregivers provide by far the largest share of long-term, unpaid care for their primarily elderly and chronically ill relatives or friends. This is associated with a higher risk of psychological and physical overload for the caregivers due to the persistently high time, financial and emotional burden.Recognising the effects of persistent burden on caring relatives at an early stage significantly contributes to the appropriate coordination of available resources and mediation of individual support to maintain a functional caring relationship without excessive demands. General practitioners are usually responsible for the early detection of burden arising from informal care and the coordination of adequate measures. The objective of this review is to give an overview of instruments to identify and measure (over)burden of caring relatives in German general practice and to describe their characteristics. METHODS AND ANALYSIS We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist in addition to the Joanna Briggs Institute Reviewer's Manual to describe the aims and methods of the planned scoping reviews. This protocol has been registered with Open Science Framework (OSF), https://osf.io/9ce2k. Two reviewers will run the search to identify studies in four databases (PubMed, LIVIVO, the Cochrane Library and CINAHL) in June and July 2023. Abstracts, titles and full-text publications will be screened to extract data from each included study using a data extraction form. Additionally, an overview of all studies including main study characteristics and detailed information on identification instruments will be given to map the different instruments and tools and to clarify statements concerning their use and practicability in general practice. ETHICS AND DISSEMINATION Ethical approval or consent to participate is not required, as data in this study consists of published studies and not individual data from human or animal participants. Dissemination will consist of publications, presentations and other knowledge translation activities.
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Affiliation(s)
- Yvonne Marx
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Alexander Bauer
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Undine Stark
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Medical Faculty, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle Wittenberg, Halle (Saale), Germany
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Weise S, Steybe T, Thiel C, Frese T. Are Nurse-Led Patient Consultations and Nurse-Led Dose Adjustments of Permanent Medication Acceptable for Patients with Diabetes Mellitus and Hypertension in General Practice? - Results of a Focus Group Study. Patient Prefer Adherence 2023; 17:1501-1512. [PMID: 37383032 PMCID: PMC10296604 DOI: 10.2147/ppa.s411902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose Practice nurse (PN)-led patient consultations and PN-led dosage adjustments of permanent medication are uncommon and not well studied in general practice (GP) in Germany. We investigated the perspectives of patients with common chronic diseases in Germany, diabetes mellitus (DM) type 2 and/or arterial hypertension (AT), on PN-led patient consultations and dosage adjustments of permanent medications in GP. Patients and Methods In this exploratory qualitative study, online focus groups were conducted using a semi-structured interview guide. Patients were recruited from collaborating GPs according to a predefined sampling plan. Patients were eligible for this study if they had DM or AT treated by their GP, were on at least one permanent medication and were aged 18 years or older. Focus group transcripts were analyzed using thematic analyses. Results Analyses of two focus groups, involving a total of 17 patients, revealed four main themes: (1) openness to the PN-led care and perceived benefits, eg because of patients' confidence in PNs' skills, or patients' impression that PN-led care would better meet their needs and increase their compliance. Some patients had (2) reservations and perceived risks, especially for PN-led medication changes eg feeling that medication adjustments were a GP's issue. Patients identified (3) reasons for encounters where they were likely to accept PN-led consultation and medication advice, eg management of DM, AT and thyroid disease. Patients also saw several important general requirements for the implementation of PN-led care in German general practice (4). Conclusion There is a potential for openness towards PN-led consultation and PN-led medication adjustment for permanent medication in patients with DM or AT. This study is the first qualitative study to investigate PN-led consultations and medication advice in German general practice. If the implementation of PN-led care is planned, our findings add the patients' perspectives of acceptable reasons for encounter for PN-led care and their general requirements.
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Affiliation(s)
- Solveig Weise
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
| | - Tatjana Steybe
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
| | - Carolin Thiel
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
- SRH University of Applied Health Sciences, Gera, Thuringia, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin Luther-University Halle-Wittenberg, Halle (Saale), ST, Germany
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Brütting C, Herget S, Bauch F, Nafziger M, Klingenberg A, Deutsch T, Frese T. Factors promoting willingness to practice medicine in rural regions and awareness of rural regions in the university's catchment area - cross-sectional survey among medical students in central Germany. GMS J Med Educ 2023; 40:Doc52. [PMID: 37560039 PMCID: PMC10407585 DOI: 10.3205/zma001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/13/2023] [Accepted: 04/06/2023] [Indexed: 08/11/2023]
Abstract
Aim Many universities offer rural medical internships for medical students. The present survey was designed to show how rural medical work is perceived by students, whether these perceptions are associated with origin and previous experience, and how well medical students know rural regions in the vicinity of their university. In addition, students were asked how to support and inspire medical students to later work in a rural region. Methods This cross-sectional study was based on an anonymous online survey of medical students at the Universities of Halle-Wittenberg and Leipzig. The evaluations included descriptive statistics, statistical group comparisons, and qualitative content analysis of free text answers. Results A total of 882 students took part in the survey. Students who had grown up in a rural region or had lived there for a longer time (71.7% of the respondents) rated the work-life balance better (p<0.01) and the patient variety in the countryside slightly higher (p<0.05) than their fellow students from the big city. Students who had worked in a rural practice or hospital before (62.2%) rated patient diversity (p<0.001) and work variety (p<0.001), as well as workload (p<0.01), slightly higher in rural areas than students with no prior experience. On average, the specified rural model regions were still unknown to more than 60% of the students. The suggestions for attracting medical students to later work as rural physicians included financial incentives and, above all, better information about life as a rural physician and the rural regions. Conclusion Thus, the medical faculties of the universities as well as the counties threatened by medical undersupply should further expand the transfer of knowledge and experience regarding rural physician life for the students.
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Affiliation(s)
- Christine Brütting
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Sabine Herget
- University of Leipzig, Faculty of Medicine, Department of General Practice, Leipzig, Germany
| | - Felix Bauch
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Melanie Nafziger
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
| | - Anja Klingenberg
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
| | - Tobias Deutsch
- University of Leipzig, Faculty of Medicine, Department of General Practice, Leipzig, Germany
| | - Thomas Frese
- University of Halle-Wittenberg, Faculty of Medicine, Institute for General Medicine, Halle (Saale), Germany
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Wittmann FG, Zülke A, Pabst A, Luppa M, Thyrian JR, Kästner A, Hoffmann W, Kaduszkiewicz H, Döhring J, Escales C, Gensichen J, Zöllinger I, Kosilek RP, Wiese B, Oey A, König HH, Brettschneider C, Frese T, Riedel-Heller SG. COVID-19 government measures and their impact on mental health: a cross-sectional study of older primary care patients in Germany. Front Public Health 2023; 11:1141433. [PMID: 37283986 PMCID: PMC10239963 DOI: 10.3389/fpubh.2023.1141433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Background With the outbreak of COVID-19, government measures including social distancing and restrictions of social contacts were imposed to slow the spread of the virus. Since older adults are at increased risk of severe disease, they were particularly affected by these restrictions. These may negatively affect mental health by loneliness and social isolation, which constitute risk factors for depressiveness. We aimed to analyse the impact of perceived restriction due to government measures on depressive symptoms and investigated stress as mediator in an at-risk-population in Germany. Methods Data were collected in April 2020 from the population of the AgeWell.de-study, including individuals with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score ≥9, using the depression subscale of the Brief Symptom Inventory (BSI-18) and the Perceived Stress Scale (PSS-4). Feeling restricted due to COVID-19 government measures was surveyed with a standardized questionnaire. Stepwise multivariate regressions using zero-inflated negative binomial models were applied to analyse depressive symptoms, followed by a general structural equation model to assess stress as mediator. Analysis were controlled for sociodemographic factors as well as social support. Results We analysed data from 810 older adults (mean age = 69.9, SD = 5). Feeling restricted due to COVID-19 government measures was linked to increased depressiveness (b = 0.19; p < 0.001). The association was no longer significant when adding stress and covariates (b = 0.04; p = 0.43), while stress was linked to increased depressive symptoms (b = 0.22; p < 0.001). A final model confirms the assumption that the feeling of restriction is mediated by stress (total effect: b = 0.26; p < 0.001). Conclusion We found evidence that feeling restricted due to COVID-19 government measures is associated with higher levels of depressive symptoms in older adults at increased risk for dementia. The association is mediated by perceived stress. Furthermore, social support was significantly associated with less depressive symptoms. Thus, it is of high relevance to consider possible adverse effects of government measures related to COVID-19 on mental health of older people.
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Affiliation(s)
- Felix G. Wittmann
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
- Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Anika Kästner
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | | | - Juliane Döhring
- Institute of General Practice, University of Kiel, Kiel, Germany
| | | | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Isabel Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Robert Philipp Kosilek
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Birgitt Wiese
- Hannover Medical School, Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover, Germany
| | - Anke Oey
- Hannover Medical School, Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Service Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Moser K, Mikolajczyk R, Bauer A, Tiller D, Christoph J, Purschke O, Lückmann SL, Frese T. [BeoNet-Halle-development of a multifunctional database for the automated extraction of healthcare data from general practitioner and specialist practices]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:569-577. [PMID: 37079066 PMCID: PMC10163113 DOI: 10.1007/s00103-023-03691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
The Beobachtungspraxennetzwerk Halle (BeoNet-Halle) is an innovative database of outpatient care that has been collecting patient data from participating primary care and specialty practices throughout Germany since 2020 and making it available for research and care. The database is set up and maintained by the Institute of Medical Epidemiology, Biometrics and Informatics and the Institute of General Practice and Family Medicine of the Martin Luther University Halle-Wittenberg. Furthermore, the Data Integration Center of the University Medical Center Halle is involved in the project. In principle, anonymized and pseudonymized patient data from all commercially available practice management systems should flow into the databases.In this article, we describe the structure and methods of the multi-purpose database BeoNet and quantify the current data stock. The workflow of collection, transfer, and storage of broad consents is described and advantages and limitations of the database are discussed.BeoNet-Halle currently contains anonymized data of approximately 73,043 patients from five physician practices. Furthermore, it includes data from more than 2,653,437 ICD-10 diagnoses, 1,403,726 prescriptions, and 1,894,074 laboratory results. Pseudonymized data were successfully exported from 481 patients.BeoNet-Halle enables an almost seamless representation of the care provided in the participating practices. In the future, the database will map patient treatment pathways across practices and provide high-quality care data to contribute to health policy decision-making and optimization of care processes.
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Affiliation(s)
- Konstantin Moser
- Institut für Allgemeinmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland.
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle (Saale), Deutschland.
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle (Saale), Deutschland
| | - Alexander Bauer
- Institut für Allgemeinmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
| | - Daniel Tiller
- Universitätsklinikum Halle, Datenintegrationszentrum SMITH Konsortium, 06120, Halle (Saale), Deutschland
| | - Jan Christoph
- AG (Bio‑)Medical Data Science, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle (Saale), Deutschland
- Universitätsklinikum Halle, Datenintegrationszentrum SMITH Konsortium, 06120, Halle (Saale), Deutschland
| | - Oliver Purschke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle (Saale), Deutschland
| | - Sara Lena Lückmann
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06112, Halle (Saale), Deutschland
| | - Thomas Frese
- Institut für Allgemeinmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Deutschland
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23
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Gottschick C, Diexer S, Massag J, Klee B, Broda A, Purschke O, Binder M, Sedding D, Frese T, Girndt M, Hoell JI, Michl P, Gekle M, Mikolajczyk R. Mental health in Germany in the first weeks of the Russo-Ukrainian war. BJPsych Open 2023; 9:e66. [PMID: 37057843 PMCID: PMC10134205 DOI: 10.1192/bjo.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND In the connected world, although societies are not directly involved in a military conflict, they are exposed to media reports of violence. AIMS We assessed the effects of such exposures on mental health in Germany during the military conflict in Ukraine. METHOD We used the German population-based cohort for digital health research, DigiHero, launching a survey on the eighth day of the Russo-Ukrainian war. Of the 27 509 cohort participants from the general population, 19 444 (70.7%) responded within 17 days. We measured mental health and fear of the impact of war compared with other fears (natural disasters or health-related). RESULTS In a subsample of 4441 participants assessed twice, anxiety in the population (measured by the Generalised Anxiety Disorder-7 screener) was higher in the first weeks of war than during the strongest COVID-19 restrictions. Anxiety was elevated across the whole age spectrum, and the mean was above the cut-off for mild anxiety. Over 95% of participants expressed various degrees of fear of the impact of war, whereas the percentage for other investigated fears was 0.47-0.82. A one-point difference in the fear of the impact of war was associated with a 2.5 point (95% CI 2.42-2.58) increase in anxiety (11.9% of the maximum anxiety score). For emotional distress, the increase was 0.67 points (0.66-0.68) (16.75% of the maximum score). CONCLUSIONS The population in Germany reacted to the Russo-Ukrainian war with substantial distress, exceeding reactions during the strongest restrictions in the COVID-19 pandemic. Fear of the impact of war was associated with worse mental health.
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Affiliation(s)
- Cornelia Gottschick
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Janka Massag
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Anja Broda
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Oliver Purschke
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Mascha Binder
- Department of Internal Medicine IV - Oncology/Haematology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Daniel Sedding
- Mid-German Heart Centre, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin-Luther-University Halle-Wittenberg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Germany
| | - Jessica I Hoell
- Paediatric Haematology and Oncology, Martin-Luther-University Halle-Wittenberg, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Germany
| | - Michael Gekle
- Julius Bernstein-Institute of Physiology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Germany
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24
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Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, Graziani F, Hobbs FDR, Huck O, Hummers E, Jepsen S, Kravtchenko O, Madianos P, Molina A, Ungan M, Vilaseca J, Windak A, Vinker S. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). J Clin Periodontol 2023; 50:819-841. [PMID: 36935200 DOI: 10.1111/jcpe.13807] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
AIM To explore the implications for dentists and family doctors of the association between periodontal and systemic diseases and the role of dentists and family doctors in managing non-communicable diseases (NCDs) and promoting healthy lifestyles. MATERIALS AND METHODS The consensus reports of the previous Focused Workshops on the associations between periodontitis and diabetes (2017) and periodontitis and cardiovascular diseases (2019) formed the technical reviews to underpin discussions on both topics. For the association with respiratory diseases, a systematic review was specifically commissioned for the Workshop discussions. Working groups prepared proposals independently, and then the proposals were discussed and approved at plenary meetings. RESULTS Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea and COVID-19 complications. Dentists and family doctors should collaborate in managing NCDs, implementing strategies for early detection of periodontitis in primary care centres and of cardiovascular diseases or diabetes in dental settings. Family doctors should be informed about periodontal diseases and their consequences, and oral health professionals (OHPs) should be informed about the relevance of NCDs and the associated risk factors. CONCLUSIONS Closer collaboration between OHPs and family doctors is important in the early detection and management of NCDs and in promoting healthy lifestyles. Pathways for early case detection of periodontitis in family medicine practices and of NCDs in dental practices should be developed and evaluated.
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Affiliation(s)
- David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah and the Hebrew University Medical Center, Jerusalem, Israel
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Thomas Frese
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Allgemeinmedizin, Halle (Saale), Germany
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy
| | - F D Richard Hobbs
- Oxford Primary Care, Radcliffe Primary Care Building, ROQ, University of Oxford, Oxford, UK
| | - Olivier Huck
- Dental Faculty, University of Strasbourg, Strasbourg, France
| | - Eva Hummers
- Department of General Practice and Family Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | | | - Phoebus Madianos
- Department of Periodontology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Josep Vilaseca
- Department of Medicine, University of Vic - Central Catalonia University. Vic, Barcelona, Spain
- Primary Health Care Service, Althaia Foundation - Healthcare and University Network, Manresa, Spain
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Lühnen J, Frese T, Mau W, Meyer G, Mikolajczyk R, Richter M, Schildmann J, Braunisch MC, Fichtner F, Holzmann-Littig C, Kranke P, Popp M, Schaaf C, Schmaderer C, Seeber C, Werner A, Wijnen-Meijer M, Meerpohl JJ, Steckelberg A. Public information needs and preferences on COVID-19: a cross-sectional study. BMC Public Health 2023; 23:394. [PMID: 36849938 PMCID: PMC9969022 DOI: 10.1186/s12889-023-15131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Right from the beginning of the SARS-CoV-2 pandemic the general public faced the challenge to find reliable and understandable information in the overwhelming flood of information. To enhance informed decision-making, evidence-based information should be provided. Aim was to explore the general public's information needs and preferences on COVID-19 as well as the barriers to accessing evidence-based information. METHODS We performed a cross-sectional study. Nine hundred twenty-seven panel members were invited to an online survey (12/2020-02/2021). The HeReCa-online-panel is installed at the Martin Luther University Halle-Wittenberg to assess regularly the general public's view on health issues in five regions in Germany. The survey was set up in LimeSurvey, with nine items, multiple-choice and open-ended questions that allowed to gather qualitative data. Quantitative data were analysed descriptively and a content analysis was carried out to categorise the qualitative data. RESULTS Six hundred thirty-six panel members provided data; mean age 52 years, 56.2% female, and 64.9% with higher education qualifications. Asked about relevant topics related to COVID-19, most participants selected vaccination (63.8%), infection control (52%), and long-term effects (47.8%). The following 11 categories were derived from the qualitative analysis representing the topics of interest: vaccination, infection control, long-term effects, therapies, test methods, mental health, symptoms, structures for pandemic control, infrastructure in health care, research. Participants preferred traditional media (TV 70.6%; radio 58.5%; newspaper 32.7%) to social media, but also used the internet as sources of information, becoming aware of new information on websites (28.5%) or via email/newsletter (20.1%). The knowledge question (Which European country is most affected by the SARS-CoV-2 pandemic?) was correctly answered by 7.5% of participants. The Robert Koch Institute (93.7%) and the World Health Organization (78%) were well known, while other organisations providing health information were rarely known (< 10%). Barriers to accessing trustworthy information were lack of time (30.7%), little experience (23.1%), uncertainty about how to get access (22.2%), complexity and difficulties in understanding (23.9%), and a lack of target group orientation (15,3%). CONCLUSIONS There are extensive information needs regarding various aspects on COVID-19 among the general population. In addition, target-specific dissemination strategies are still needed to reach different groups.
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Affiliation(s)
- Julia Lühnen
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences, Institute of Health and Nursing Science, Magdeburgerstraße 8, 06112, Halle (Saale), Germany. .,Martin Luther University Halle-Wittenberg, Clinic for Internal Medicine I, Halle (Saale), Germany.
| | - Thomas Frese
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Wilfried Mau
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences, Institute of Rehabilitation Medicine, Halle (Saale), Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences, Institute of Health and Nursing Science, Magdeburgerstraße 8, 06112, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences; Institute of Medical Epidemiology, Biometrics and Informatics, Halle (Saale), Germany
| | - Matthias Richter
- Martin Luther University Halle-Wittenberg; Interdisciplinary Center for Health Sciences; Institute of Medical Sociology, Halle (Saale), Germany
| | - Jan Schildmann
- Martin Luther University Halle-Wittenberg; Interdisciplinary Center for Health Sciences, Institute for History and Ethics of Medicine, Halle (Saale), Germany
| | - Matthias C Braunisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Munich, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Center, Leipzig, Germany
| | - Christopher Holzmann-Littig
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Munich, Germany.,Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Faculty of Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Faculty of Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Christian Schaaf
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Munich, Germany
| | - Christoph Schmaderer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nephrology, Munich, Germany
| | - Christian Seeber
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Center, Leipzig, Germany
| | - Anne Werner
- Department of Medical Psychology and Medical Sociology, University of Leipzig, University Medical Center Leipzig, Leipzig, Germany
| | - Marjo Wijnen-Meijer
- Technical University of Munich, School of Medicine, TUM Medical Education Center, Munich, Germany
| | - Joerg J Meerpohl
- Cochrane Germany Foundation, Cochrane Germany, Freiburg, Germany.,Medical Center & Faculty of Medicine, Institute for Evidence in Medicine, University of Freiburg, Freiburg, Germany
| | - Anke Steckelberg
- Martin Luther University Halle-Wittenberg, Interdisciplinary Center for Health Sciences, Institute of Health and Nursing Science, Magdeburgerstraße 8, 06112, Halle (Saale), Germany
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26
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Schwenker R, Deutsch T, Unverzagt S, Frese T. Identifying patients with psychosocial problems in general practice: A scoping review. Front Med (Lausanne) 2023; 9:1010001. [PMID: 36844957 PMCID: PMC9945547 DOI: 10.3389/fmed.2022.1010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Objective We conducted a scoping review with the aim of comprehensively investigating what tools or methods have been examined in general practice research that capture a wide range of psychosocial problems (PSPs) and serve to identify patients and highlight their characteristics. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search was conducted in four electronic databases (Medline [Ovid], Web of Science Core Collection, PsycInfo, Cochrane Library) for quantitative and qualitative studies in English, Spanish, French, and German with no time limit. The protocol was registered with Open Science Framework and published in BMJ Open. Results Of the 839 articles identified, 66 met the criteria for study eligibility, from which 61 instruments were identified. The publications were from 18 different countries, with most studies employing an observational design and including mostly adult patients. Among all instruments, 22 were reported as validated, which we present in this paper. Overall, quality criteria were reported differently, with studies generally providing little detail. Most of the instruments were used as paper and pencil questionnaires. We found considerable heterogeneity in the theoretical conceptualisation, definition, and measurement of PSPs, ranging from psychiatric case findings to specific social problems. Discussion and conclusion This review presents a number of tools and methods that have been studied and used in general practice research. Adapted and tailored to local circumstances, practice populations, and needs, they could be useful for identifying patients with PSPs in daily GP practice; however, this requires further research. Given the heterogeneity of studies and instruments, future research efforts should include both a more structured evaluation of instruments and the incorporation of consensus methods to move forward from instrument research to actual use in daily practice.
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Affiliation(s)
- Rosemarie Schwenker
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, University of Leipzig, Leipzig, Germany
| | - Susanne Unverzagt
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Center for Health Sciences, Institute of General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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27
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Gerhards SK, Luppa M, Röhr S, Pabst A, Bauer A, Frankhänel T, Döhring J, Escales C, Zöllinger IR, Oey A, Brettschneider C, Wiese B, Hoffmann W, Gensichen J, König HH, Frese T, Thyrian JR, Kaduszkiewicz H, Riedel-Heller SG. Depression and Anxiety in Old Age during the COVID-19 Pandemic: A Comparative Study of Individuals at Cardiovascular Risk and the General Population. Int J Environ Res Public Health 2023; 20:2975. [PMID: 36833671 PMCID: PMC9957242 DOI: 10.3390/ijerph20042975] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 05/22/2023]
Abstract
Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64-81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.
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Affiliation(s)
- Sina K. Gerhards
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
- Health and Ageing Research Team (HART), School of Psychology, Massey University, Palmerston North 4474, New Zealand
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Thomas Frankhänel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Isabel Renate Zöllinger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Anke Oey
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, 30625 Hannover, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | | | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, 04103 Leipzig, Germany
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28
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Hirpa S, Fogarty AW, Addissie A, Bauld L, Frese T, Unverzagt S, Kantelhardt EJ, Getachew S, Deressa W. Prevalence and risk factors for tobacco, khat, and alcohol consumption among high school students in Ethiopia. BMC Public Health 2023; 23:226. [PMID: 36732737 PMCID: PMC9893175 DOI: 10.1186/s12889-023-15088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tobacco, khat, alcohol, and marijuana are the main risk factors for non-communicable diseases. There are limited studies on substance use in Ethiopia, especially among secondary school students. This study aims to determine the epidemiology of substance use among secondary school students in Ethiopia. METHODS This cross-sectional study was conducted in March 2020 in four large regions of Ethiopia and the capital Addis Ababa. We collected data from 3,355 grade 9 and grade 10 students in 36 randomly selected high schools. Data were collected on tobacco, khat, alcohol and other substances. Mixed effect logistic regression models were fitted to determine the predictors of cigarette smoking. RESULTS 157 (4.7%) of the participants ever smoked cigarettes and 81 (2.4%) were current smokers. 106 (3.2%) ever used smokeless tobacco, 1,342 (41.8%) had ever drunk alcohol, 290 (8.7%) ever used khat, 137 (4.8%) chewed khat regularly and 76 (2.3%) ever used marijuana. There was a significant regional variation in substance use patterns; cigarette and khat use was the highest in southern regions, whereas alcohol use was highest in the northern areas. Availability of cigarette and khat shops within a 100-meter radius of the school compound was reported by 1,229 (37.5%) and 816 (25%) students, respectively. Three hundred fifty-four (10.9%) students had ever seen someone smoking a cigarette in the school compound. Ever use of smokeless tobacco (Adjusted Odds Ratio (AOR) = 9.4, 95%CI: 4.9-17.9), ever use of shisha (AOR = 8, 95% CI: 3.9-16.3), ever use of khat (AOR = 4.1, 95%CI: 2.5-6.8), ever use of alcohol (AOR = 2.3, 95%CI: 1.4-3.7), having a friend who smoked a cigarette (AOR = 2, 95%CI: 1.2-3.5), and ever seen someone smoking a cigarette in the school compound (AOR = 1.9, 95%CI: 1.1-3.4) were associated with ever use of cigarettes. CONCLUSION Substance use prevalence in Ethiopia has regional variations and prevention strategies should be tailored to the needs of the regions. Although this study reported a lower prevalence of cigarette smoking, students could access cigarettes and khat in nearby school areas. The existing tobacco control laws that prohibit selling tobacco products to children and adolescents under 21 years of age and ban establishing tobacco shops close to school compounds should be enforced.
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Affiliation(s)
- Selamawit Hirpa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
- General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Institute for Medical Epidemiology, Biostatics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Linda Bauld
- Usher institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Thomas Frese
- General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Susanne Unverzagt
- General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva J Kantelhardt
- Institute for Medical Epidemiology, Biostatics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Institute for Medical Epidemiology, Biostatics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Aubertin P, Frese T, Kasper J, Mau W, Meyer G, Mikolajczyk R, Richter M, Schildmann J, Steckelberg A. Efficacy of Three Numerical Presentation Formats on Lay People's Comprehension and Risk Perception of Fact Boxes-A Randomized Controlled Pilot Study. Int J Environ Res Public Health 2023; 20:2165. [PMID: 36767532 PMCID: PMC9915941 DOI: 10.3390/ijerph20032165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Fact boxes present the benefits and harms of medical interventions in the form of tables. Some studies suggest that people with a lower level of education could profit more from graphic presentations. The objective of the study was to compare three different formats in fact boxes with regard to verbatim and gist knowledge in general and according to the educational background. (2) Methods: In May 2020, recruitment started for this randomized controlled trial. Participants were given one out of three presentation formats: natural frequencies, percentages, and graphic. We used Limesurvey® to assess comprehension/risk perception as the primary outcome. The Kruskal-Wallis test and the Mann-Whitney U test were used in addition to descriptive analyses. (3) Results: A total of 227 people took part in the study. Results of the groups were nearly identical in relation to the primary outcome verbatim knowledge, likewise in gist knowledge. However, participants with lower educational qualifications differed from participants with higher educational qualifications in terms of verbatim knowledge in the group percentages. (4) Conclusions: The results indicate that all three forms of presentation are suitable for conveying the content. Further research should take the individual preferences regarding the format into account.
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Affiliation(s)
- Pascal Aubertin
- Institute of Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0176 Oslo, Norway
| | - Wilfried Mau
- Institute of Rehabilitation Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Matthias Richter
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Anke Steckelberg
- Institute of Health and Nursing Science, Interdisciplinary Center for Health Sciences, Martin Luther University, Halle-Wittenberg, 06112 Halle (Saale), Germany
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Schultheiß C, Willscher E, Paschold L, Gottschick C, Klee B, Bosurgi L, Dutzmann J, Sedding D, Frese T, Girndt M, Höll JI, Gekle M, Mikolajczyk R, Binder M. Liquid biomarkers of macrophage dysregulation and circulating spike protein illustrate the biological heterogeneity in patients with post-acute sequelae of COVID-19. J Med Virol 2023; 95:e28364. [PMID: 36458566 PMCID: PMC9878213 DOI: 10.1002/jmv.28364] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
Post-acute sequelae of COVID-19 (PASC) are long-term consequences of SARS-CoV-2 infection that can substantially impair the quality of life. Underlying mechanisms ranging from persistent viruses to innate and adaptive immune dysregulation have been discussed. Here, we profiled the plasma of 181 individuals from the cohort study for digital health research in Germany (DigiHero), including individuals after mild to moderate COVID-19 with or without PASC and uninfected controls. We focused on soluble factors related to monocyte/macrophage biology and on circulating SARS-CoV-2 spike (S1) protein as a potential biomarker for persistent viral reservoirs. At a median time of 8 months after infection, we found pronounced dysregulation in almost all tested soluble factors, including both pro-inflammatory and pro-fibrotic cytokines. These immunological perturbations were remarkably independent of ongoing PASC symptoms per se, but further correlation and regression analyses suggested PASC-specific patterns involving CCL2/MCP-1 and IL-8 that either correlated with sCD162, sCD206/MMR, IFN-α2, IL-17A and IL-33, or IL-18 and IL-23. None of the analyzed factors correlated with the detectability or levels of circulating S1, indicating that this represents an independent subset of patients with PASC. These data confirm prior evidence of immune dysregulation and persistence of viral protein in PASC and illustrate its biological heterogeneity that still awaits correlation with clinically defined PASC subtypes.
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Affiliation(s)
- Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/HematologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/HematologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/HematologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health SciencesMedical School of the Martin‐Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health SciencesMedical School of the Martin‐Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Lidia Bosurgi
- I. Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Protozoa Immunology, Bernhard Nocht Institute for Tropical MedicineHamburgGermany
| | - Jochen Dutzmann
- Department of Cardiology and Intensive Care Medicine, Mid‐German Heart Center, University HospitalMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Daniel Sedding
- Department of Cardiology and Intensive Care Medicine, Mid‐German Heart Center, University HospitalMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Thomas Frese
- Institute of General Practice and Family MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Matthias Girndt
- Department of Internal Medicine IIMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Jessica I. Höll
- Pediatric Hematology and OncologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Michael Gekle
- Julius Bernstein‐Institute of Physiology, Faculty of MedicineMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health SciencesMedical School of the Martin‐Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/HematologyMartin‐Luther‐University Halle‐WittenbergHalle (Saale)Germany
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Bruns F, König C, Frese T, Schildmann J. General practice in the German Democratic Republic (1949-1990) : A discipline between threat and professionalization. Wien Klin Wochenschr 2023; 135:45-51. [PMID: 36289091 PMCID: PMC9849158 DOI: 10.1007/s00508-022-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the 1950s the socialist health policy in East Germany did not follow a clear-cut course with regard to outpatient medical care. Whilst state-run policlinics gradually took the place of doctors in private practice, the required qualifications of physicians working in outpatient care remained unclear. After preparatory lobbying by committed physicians from the outpatient sector, the 1960 Weimar Health Conference finally paved the way for the preservation and professionalization of general practice in East Germany. AIM The article analyzes the formation of general practice as a specialty in East Germany between 1945 and 1990. We scrutinize the status of general practitioners and their field in the socialist health system as well as the foundation of their medical society. Our paper aims to contribute to a broader history of general practice in Germany. METHODS We draw on literature from that time, unpublished archival material, and interviews with contemporary witnesses. RESULTS After the establishment of standards for specialist training in the early 1960s, general practice was introduced as a field of specialty in 1967. By this, East Germany had a compulsory specialist training in general practice much earlier than West Germany. In 1971, a specialist society for general practice was founded in East Germany. However, institutionalization at the medical faculties was still lacking. Meanwhile, the nationalization of outpatient care continued. In the years that followed, primary medical care was increasingly provided in policlinics. In 1989, of 40,000 physicians in the GDR, only about 340 were still practicing in their own offices. CONCLUSION Within the nationalized GDR health system a committed group of physicians, under difficult political circumstances, pushed for professionalization of general practice and its recognition as a field of specialty. When general medicine was recognized as a specialty in 1967, this happened earlier than in other countries and constituted an important milestone.
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Affiliation(s)
- Florian Bruns
- Institut für Geschichte der Medizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Christian König
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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32
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Massag J, Diexer S, Klee B, Costa D, Gottschick C, Broda A, Purschke O, Opel N, Binder M, Sedding D, Frese T, Girndt M, Hoell J, Moor I, Rosendahl J, Gekle M, Mikolajczyk R. Anxiety, depressive symptoms, and distress over the course of the war in Ukraine in three federal states in Germany. Front Psychiatry 2023; 14:1167615. [PMID: 37181901 PMCID: PMC10172594 DOI: 10.3389/fpsyt.2023.1167615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The Russian invasion of Ukraine and the resulting consequences are in the center of political discussions, media, and likely individual thinking of the population in Germany. Yet, the impact of this prolonged exposure on mental health is not known hitherto. Methods Using the population based cohort study DigiHero from three federal states (Saxony-Anhalt, Saxony, and Bavaria), we assessed anxiety levels (GAD-7), depressive symptoms (PHQ-9), and distress (modified PDI) in the first weeks of war and 6 months later. Results Of those 19,432, who responded in the first weeks of war, 13,934 (71.1%) responded also 6 months later. While anxiety and emotional distress decreased during the 6 months, their average scores were still elevated, and a substantial fraction of respondents displayed clinically relevant sequelae. Persons from low-income households were especially affected, specifically by fears related to the personal financial situation. Those who reacted with a particularly strong fear in the beginning of war were more likely to have persistent clinically relevant symptoms of depression and anxiety also 6 months later. Discussion The Russian invasion of Ukraine is accompanied by continuing impairment of mental health in the German population. Fears surrounding the personal financial situation are a strong determinant.
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Affiliation(s)
- Janka Massag
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniela Costa
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Broda
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Oliver Purschke
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nils Opel
- Department for Psychiatry and Psychotherapy, University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Jena, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Haematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Sedding
- Department of Cardiology and Intensive Care Medicine, Mid-German Heart Centre, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jessica Hoell
- Paediatric Haematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute for Medical Sociology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Gekle
- Julius-Bernstein-Institute of Physiology, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Jena, Germany
- *Correspondence: Rafael Mikolajczyk,
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Nafziger M, Geier AK, Bauch FJ, Deutsch T, Frese T. When and why do medical students drop out of extracurricular longitudinal general practice tracks? A cross-sectional study from two German medical faculties. BMJ Open 2022; 12:e064481. [PMID: 36521907 PMCID: PMC9756222 DOI: 10.1136/bmjopen-2022-064481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To explore when and why undergraduate medical students drop out of longitudinal extracurricular general practice (GP) tracks and to describe their future career plans. DESIGN Cross-sectional online survey and descriptive analysis of routine data. SETTING GP tracks at two German medical faculties, data collection took place between September 2020 and April 2021. PARTICIPANTS Of 111 students who had taken part in one of the two GP tracks and dropped out prematurely, 101 were contactable via email. Overall, the response rate was 72.3% with 73 completed questionnaires and 75.3% of the participants were female. PRIMARY AND SECONDARY OUTCOME MEASURES Reasons for leaving the GP track (closed and free-text answers), attitudes towards a career in GP and future career plans. RESULTS Students left the tracks predominantly during the first 2 years of study. Students most frequently stated that structural reasons such as the distance to the GP teaching practice (74.2%), interest in another medical discipline (66.1%), private reasons (58.1%) and the GP mentor (53.1%) influenced their decision to drop out. However, 87.1% of the students indicated that their exit could not have been prevented by the project administration. CONCLUSIONS Reasons for dropping out differ between GP tracks and not all reasons are within reach of programme design and staff. Addressable issues include student selection with regard to career plans, support and strengthening of student-mentor relationships, the location of GP practices, and/or travel and accommodation support.
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Affiliation(s)
- Melanie Nafziger
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Felix Johannes Bauch
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Fehl M, Gehres V, Geier AK, Mundt T, Klinge K, Frese T, Bleckwenn M, Deutsch T. Medical students' adoption and evaluation of a completely digital general practice clerkship - cross-sectional survey and cohort comparison with face-to-face teaching. Med Educ Online 2022; 27:2028334. [PMID: 35107417 PMCID: PMC8812779 DOI: 10.1080/10872981.2022.2028334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, the University of Leipzig completely switched to online teaching. Thus, we developed a practice-oriented digital substitute for a two-week mandatory general practice (GP) clerkship. Main components were processing of clinical cases and additional GP topics, visual diagnoses, information and examination videos, and regular remote exchanges with associated GP teachers. We took the chance to comprehensively evaluate the new teaching formats (acceptance, use, working enjoyment, learning gain, practical relevance, insights into general practice) and to compare evaluations with two previous semesters to gain insights for future blended learning concepts. METHODS Cross-sectional post-hoc online evaluation among fourth year (of six) medical students participating in the digital mandatory 2-week GP clerkship during summer semester 2020; additional cohort comparison with two previous semesters (face-to-face clerkship). RESULTS Out of 192 participants in the digital clerkship, 99 completed our questionnaire (response rate = 51.6%). Results were compared with 277 previous evaluations (face-to-face semesters). Most participants reported having enjoyed the online-based clerkship (87.9%), having learned a lot (89.9%), having gained insights into general practice (76.8%), and perceived high practical relevance (90.9%). Implementing the new teaching formats into future face-to-face clerkships was welcomed by 65.6%. Clinical cases, visual diagnoses, examination videos and communication with GP teachers were rated best regarding working enjoyment, learning gain, practical relevance and insights into a GP's work. Cohort comparison revealed somewhat better evaluations regarding knowledge transfer for the digital clerkship while imparting of skills and attitudes was reportedly worse. CONCLUSIONS Students welcomed the digital content and perceived relevant learning gain. Our results may help to develop future blended learning concepts. Clinical cases, examination videos and visual diagnoses appear to be particularly suitable as useful online complements which could enrich face-to-face teaching. As students especially valued the exclusive time for exchanges with their preceptor, this should be facilitated in face-to-face clerkships.
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Affiliation(s)
- Marina Fehl
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
- CONTACT Marina Fehl University of Leipzig, Philipp-Rosenthal-Straße 55, Leipzig04103
| | - Vera Gehres
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Anne-Kathrin Geier
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Mundt
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Kay Klinge
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
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Oehme R, Sandholzer-Yilmaz AS, Heise M, Frese T, Fankhaenel T. Utilization of point-of-care tests among general practitioners, a cross-sectional study. BMC Prim Care 2022; 23:41. [PMID: 35264103 PMCID: PMC8906527 DOI: 10.1186/s12875-022-01643-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
Background Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs). Methods A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany. Results A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful. Discussion/conclusion The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results. Trial registration In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01643-9.
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Healy KV, Weise S, Fink A, Frese T, Richter M, Knöchelmann A. Learning Approaches as a Means to Understand Difficulties and Opportunities in Type 2 Diabetes Self-Management Training: A Qualitative Content Analysis of Two German Educational Curricula. American Journal of Health Education 2022. [DOI: 10.1080/19325037.2022.2120580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Astrid Fink
- Martin Luther University Halle-Wittenberg
- District Administration Groß-Gerau
| | | | - Matthias Richter
- Martin Luther University Halle-Wittenberg
- Technical University of Munich
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Wendel F, Bauer A, Blotenberg I, Brettschneider C, Buchholz M, Czock D, Döhring J, Escales C, Frese T, Hoffmann W, Kaduszkiewicz H, König HH, Löbner M, Luppa M, Schwenker R, Thyrian JR, Weißenborn M, Wiese B, Zöllinger I, Riedel-Heller SG, Gensichen J. Social Network and Participation in Elderly Primary Care Patients in Germany and Associations with Depressive Symptoms-A Cross-Sectional Analysis from the AgeWell.de Study. J Clin Med 2022; 11:jcm11195940. [PMID: 36233810 PMCID: PMC9572848 DOI: 10.3390/jcm11195940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60−77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients.
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Affiliation(s)
- Flora Wendel
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
- Correspondence:
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Iris Blotenberg
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Juliane Döhring
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Catharina Escales
- Institute of General Practice, University of Kiel, 24105 Kiel, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17487 Greifswald, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Rosemarie Schwenker
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, 17489 Greifswald, Germany
| | - Marina Weißenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Birgitt Wiese
- MHH Information Technology, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Isabel Zöllinger
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, 80336 Munich, Germany
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Shushman I, Kolesnyk A, Kolesnyk P, Kuodza G, Mykyta I, Bayen S, Frese T. Validation of a modified questionnaire to assess Ukrainian Family Physicians’ readiness to implement the evidence-based screening recommendations into their clinical practice, using a mixed method study. BMC Prim Care 2022; 23:225. [PMID: 36071373 PMCID: PMC9449945 DOI: 10.1186/s12875-022-01818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Abstract
Background Ukrainian Family Doctors' knowledge and readiness for the implementation of new guidelines recommendations into practice has to be evaluated and taken into consideration, meanwhile they often use the old protocols of annual checkups. This study aimed to perform a linguistic and cultural validation of Ukrainian adopted questionnaire designed on the German prototype “Readiness of general practitioners to recommend and implement evidence-based screening recommendations questionnaire”. Methods This was a mixed method study. The English version of the original German prototype questionnaire was translated into Ukrainian with forward–backward method. Additionally Ukrainian version was modified by including an extra questions about evidence based screening of cardiovascular risks, infectious diseases, type 2 diabetes mellitus, depression, and some old-fashioned annual checkups which are still commonly used in routine family doctors’ practice. During the face validation process, 10 practicing general practitioners assessed all the items in the questionnaire as adequately structured, grammatically correct, and understandable. During qualitative part of content validation process 11 experts found and corrected some grammatical errors, indicated that items of the questionnaire were comprehensible and related to Ukrainian culture. During the quantitative part of content validation process experts accessed 5 of 6 items as essential, relevant, and clear. Internal consistency of the items, assessed by using Cronbach’s alpha method was acceptable. To access how stable can be results provided by the questionnaire, test–retest reliability was performed, where 19 general practitioners filled in the same questionnaire twice over a period of two weeks. Results In our study CVR > 0.79 and CVI > 0.59 were acceptable. The internal consistency was evaluated by using Cronbach’s alpha method and had to be above 0.7. According to the test–retest reliability results of weighted kappa and Cohen's kappa coefficients, test–retest agreement of the questionnaire was moderate for 29%, substantial for 38%, and almost perfect for 5% of the items (p ≤ 0.05). Kappa coefficients were not computed for 10% of items as there was no variability in the assessments. Conclusions The Ukrainian version of the questionnaire can be used for the assessment Ukrainian Family Doctor’s readiness to implement the evidence-based screening recommendations into their clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01818-4.
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Unverzagt S, Bolm-Audorff U, Frese T, Hechtl J, Liebers F, Moser K, Seidler A, Weyer J, Bergmann A. Influence of physically demanding occupations on the development of osteoarthritis of the hip: a systematic review. J Occup Med Toxicol 2022; 17:18. [PMID: 36002875 PMCID: PMC9400208 DOI: 10.1186/s12995-022-00358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Hip osteoarthritis (HOA) is a disabling disease affecting around 33 million people worldwide. People of working age and the elderly are at increased risk of developing HOA and the disease is associated with high costs at individual and societal levels due to sick leaves, job loss, total hip replacements and disability pension. This systematic review evaluated the influence of physically demanding occupations on the development of HOA in men. Methods Cohort studies, case–control studies and cross-sectional studies with publications in English or German, which assessed the association between exposure to physically demanding occupations and development of HOA, were searched in electronic databases (Medline, Embase, HSE-Line, Cochrane Library) and conference abstracts from 1990 until May 2020. We assessed the methodological quality of selected studies, interpreted all relative effect estimators as relative risks (RRs) and meta-analytically reviewed the effects of occupations with high physical workloads. All steps are based on a study protocol published in PROSPERO (CRD42015016894). Results Seven cohort studies and six case–control studies were included. An elevated risk to develop HOA was shown for six physically demanding occupational groups. Working in agriculture including fishery and forestry and food production doubles the risk of HOA. Construction, metal working and sales as well as exposure to whole body vibration while driving vehicles increases the risk by roughly 50 to 60%. Unskilled or basic level workers, who were frequently exposed to repetitive heavy manual work, had nearly a doubled risk (RR 1.89 95%CI: 1.29 to 2.77) compared to workers with lower exposure. Conclusions Existing studies state an association between various occupations with high physical workload and an increased risk of developing HOA. High Physical workloads include including lifting and carrying heavy loads, demanding postures, repetitive activities, long standing and running, as well as exposure to body vibrations. Occupational prevention and early detection as well as individual health promotion strategies should place their focus on reducing the impact of high physical strain at work sites. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-022-00358-y.
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Affiliation(s)
- Susanne Unverzagt
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Ulrich Bolm-Audorff
- Department for Occupational Safety and the Environment, Regional Authority Darmstadt, Wilhelminenstraße 1 - 3, 64283, Darmstadt, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Julia Hechtl
- Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 20, 06112, Halle (Saale), Germany
| | - Falk Liebers
- Division 3 Work and Health, Unit 3.1 Prevention of Work-related Diseases, Federal Institute for Occupational Safety and Health (BAuA), Friedrich-Henkel-Weg 1-25, 44149, Dortmund, Germany
| | - Konstantin Moser
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Andreas Seidler
- Institute and Polyclinic for Occupational and Social Medicine, Technical University of Dresden, Faculty of Medicine, Löscherstraße 18, 01309, Dresden, Germany
| | - Johannes Weyer
- Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 20, 06112, Halle (Saale), Germany
| | - Annekatrin Bergmann
- Department of Occupational Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 20, 06112, Halle (Saale), Germany
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Wittmann F, Czock D, Frese T, Gensichen J, Haefeli W, Hoffmann W, Kaduszkiewicz H, König HH, Thyrian JR, Wiese B, Luppa M, Riedel-Heller SG. COVID-19 measures and their impact on mental health of older people
and the effect of perceived stress and resilience. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- F Wittmann
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
| | - D Czock
- Universitätsklinikum Heidelberg, Department of Clinical
Pharmacology and Pharmacoepidemiology, Heidelberg, Deutschland
| | - T Frese
- Martin-Luther Universität Halle-Wittenberg, Institute of
General Practice and Family Medicine, Halle, Deutschland
| | - J Gensichen
- Universität München, Institute of General Practice and
Family Medicine, München, Deutschland
| | - W Haefeli
- Martin-Luther Universität Halle-Wittenberg, Institute of
General Practice and Family Medicine, Halle, Deutschland
| | - W Hoffmann
- Universität Rostock, Deutsches Zentrum für
Neurodegenerative Erkrankungen, Greifswald, Deutschland
- Universität Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
| | - H Kaduszkiewicz
- Universität Kiel, Institute of General Practice, Kiel,
Deutschland
| | - H-H König
- Universität Hamburg, Department of Health Economics and Health
Service Research, Hamburg, Deutschland
| | - JR Thyrian
- Universität Rostock, Deutsches Zentrum für
Neurodegenerative Erkrankungen, Greifswald, Deutschland
| | - B Wiese
- Medizinische Hochschule Hannover, Institute for General Practice,
Hannover, Deutschland
| | - M Luppa
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Institut für Sozialmedizin,
Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
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41
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Claus M, Luppa M, Czock D, Frese T, Gensichen J, Haefeli W, Hoffmann W, Kaduszkiewicz H, König HH, Wiese B, Thyrian JR, Riedel-Heller SG. Association of modifiable lifestyle factors with cognitive function
in the AgeWell.de-trial. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Claus
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
| | - M Luppa
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
| | - D Czock
- University Hospital Heidelberg, Department of Clinical Pharmacology and
Pharmacoepidemiology, Heidelberg, Deutschland
| | - T Frese
- Martin-Luther-University Halle-Wittenberg, Institute of General
Practice and Family Medicine, Halle (Saale), Deutschland
| | - J Gensichen
- University of LMU Munich, Institute of General Practice and Family
Medicine, Munich, Deutschland
| | - W Haefeli
- University Hospital Heidelberg, Department of Clinical Pharmacology and
Pharmacoepidemiology, Heidelberg, Deutschland
| | - W Hoffmann
- University Medicine Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
- German Center for Neurodegenerative Diseases (DZNE), Site
Rostock/Greifswald, Greifswald, Deutschland
| | - H Kaduszkiewicz
- University of Kiel, Institute of General Practice, Kiel,
Deutschland
| | - H-H König
- University Medical Center Hamburg-Eppendorf, Department of Health
Economics and Health Services Research, Hamburg, Deutschland
| | - B Wiese
- Hannover Medical School, Institute for General Practice, Work Group
Medical Statistics and IT-Infrastructure, Hannover, Deutschland
| | - JR Thyrian
- University Medicine Greifswald, Institute for Community Medicine,
Greifswald, Deutschland
- German Center for Neurodegenerative Diseases (DZNE), Site
Rostock/Greifswald, Greifswald, Deutschland
| | - SG Riedel-Heller
- Medical Faculty, University of Leipzig, Institute of Social Medicine,
Occupational Health and Public Health (ISAP), Leipzig, Deutschland
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42
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Healy K, Weise S, Fink A, Frese T, Knöchelmann A. Lerntypen unter Menschen mit Typ 2 Diabetes: Eine Aufteilung nach
sozioökonomischem Status. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- K Healy
- Medizinische Fakultät der Martin-Luther-Universität
Halle-Wittenberg, Institut für Medizinische Soziologie, Halle (Saale),
Deutschland
| | - S Weise
- Medizinische Fakultät der Martin-Luther-Universität
Halle-Wittenberg, Institut für Allgemeinmedizin, Halle (Saale),
Deutschland
| | - A Fink
- Medizinische Fakultät der Martin-Luther-Universität
Halle-Wittenberg, Institut für Medizinische Soziologie, Halle (Saale),
Deutschland
| | - T Frese
- Medizinische Fakultät der Martin-Luther-Universität
Halle-Wittenberg, Institut für Allgemeinmedizin, Halle (Saale),
Deutschland
| | - A Knöchelmann
- Medizinische Fakultät der Martin-Luther-Universität
Halle-Wittenberg, Institut für Medizinische Soziologie, Halle (Saale),
Deutschland
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Wakob I, Schmid GL, Nöhring I, Elze R, Sultzer R, Frese T, Schiek S, Bertsche T. Developing a Mobile Health Application to Communicate Adverse Drug Reactions - Preconditions, Assessment of Possible Functionalities and Barriers for Patients and Their General Practitioners. J Multidiscip Healthc 2022; 15:1445-1455. [PMID: 35837350 PMCID: PMC9275429 DOI: 10.2147/jmdh.s369625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Mobile health (mHealth) applications offer structured and timely communication between patients and general practitioners (GPs) about adverse drug reactions (ADR). Preconditions, functionalities and barriers should be studied to ensure safe implementation. Methods We performed a cross-sectional questionnaire survey addressing (i) preconditions, (ii) users’ assessment of functionalities and (iii) barriers to mHealth managing ADR communication. Results A total of 480 patients and 31 GPs completed the survey. (i) A total of 269 (56%) patients and 13 (42%) GPs were willing to use mHealth for ADR communication. Willingness was negatively correlated with age for both patients (r = −0.231; p < 0.001) and GPs (r = −0.558; p = 0.002). (ii) Most useful functionalities mentioned by patients (>60%) included “Rapid feedback on urgency of face-to-face consultations.” GPs valued information on “Patient’s difficulties in medication administration.” (iii) In free-text answers, the barrier reported most frequently by patients was “preferred personal GP contact” (6%), whereas GPs claimed, “uncomplicated use with low expenditure of time and personnel” (19%). Conclusion Older patients and GPs mainly show reservations about mHealth for ADR communication but recognize possible benefits. mHealth implementation should avoid a negative effect on GPs’ time budgets; the primary goal should not be to reduce the number of GP-patient contacts but to optimize them.
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Affiliation(s)
- Ines Wakob
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Ingo Nöhring
- Department of General Practice, Medical Faculty of the University of Leipzig, Leipzig, Germany
| | - Romy Elze
- University Computer Center, Department of Research and Development, Leipzig University, Leipzig, Germany
| | | | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University, Halle (Saale), Germany
| | - Susanne Schiek
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany.,Drug Safety Center, Faculty of Medicine, University Hospital of Leipzig and Leipzig University, Leipzig, Germany
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Schultheiß C, Willscher E, Paschold L, Gottschick C, Klee B, Henkes SS, Bosurgi L, Dutzmann J, Sedding D, Frese T, Girndt M, Höll JI, Gekle M, Mikolajczyk R, Binder M. The IL-1β, IL-6, and TNF cytokine triad is associated with post-acute sequelae of COVID-19. Cell Rep Med 2022; 3:100663. [PMID: 35732153 PMCID: PMC9214726 DOI: 10.1016/j.xcrm.2022.100663] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 02/07/2023]
Abstract
Post-acute sequelae of COVID-19 (PASC) is emerging as global problem with unknown molecular drivers. Using a digital epidemiology approach, we recruited 8,077 individuals to the cohort study for digital health research in Germany (DigiHero) to respond to a basic questionnaire followed by a PASC-focused survey and blood sampling. We report the first 318 participants, the majority thereof after mild infections. Of those, 67.8% report PASC, predominantly consisting of fatigue, dyspnea, and concentration deficit, which persists in 60% over the mean 8-month follow-up period and resolves independently of post-infection vaccination. PASC is not associated with autoantibodies, but with elevated IL-1β, IL-6, and TNF plasma levels, which we confirm in a validation cohort with 333 additional participants and a longer time from infection of 10 months. Blood profiling and single-cell data from early infection suggest the induction of these cytokines in COVID-19 lung pro-inflammatory macrophages creating a self-sustaining feedback loop. We report a post-COVID-19 digital epidemiology study with biomarker analysis (n = 651) PASC persists in 60% of participants up to 24 months after mild COVID-19 PASC is associated with high IL-1β, IL-6, and TNF levels but not autoantibodies Overactivated monocytes/macrophages are likely the source of cytokine production
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Affiliation(s)
- Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06097 Halle (Saale), Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06097 Halle (Saale), Germany
| | - Svenja-Sibylla Henkes
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Lidia Bosurgi
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; Protozoa Immunology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Strasse 74, 20359 Hamburg, Germany
| | - Jochen Dutzmann
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Jessica I Höll
- Pediatric Hematology and Oncology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Michael Gekle
- Julius Bernstein-Institute of Physiology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 6, 06110 Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06097 Halle (Saale), Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
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Abstract
OBJECTIVES To investigate general practitioners' (GPs') willingness to participate in long-term medical research and in research networks (RNs). DESIGN AND SETTING Cross-sectional survey among German GPs around Halle-Wittenberg and Leipzig in 2020. SUBJECTS Random sample of 905 GPs. MAIN OUTCOME MEASURES AND RESULTS Response rate 37%, 69% female. Overall, 57% were interested in participating in medical research, 34% in an active role in a RN. Interest in RN participation was positively associated with male sex, younger age, previous experiences in medical research, being involved in teaching undergraduates, and having qualification in a further specialty. Main motivators were improving patient care, giving a more realistic picture of GP care, and carrying out research on topics within their own interest areas and a reliable contact person at the leading institution. Most GPs were not afraid of reduced earnings; however, time investment was the main barrier for participation. GPs were willing to dedicate twice as much time to research when remuneration was offered. High rated topics were polypharmacy, chronic diseases, drug safety and adverse drug reactions. CONCLUSION GPs are interested to participate in practice-based research. The study results providing useful and generalizable insights in barriers and motivators should be considered when building and running GP-RNs.KEY POINTSThere is a difference between general practitioners' (GPs') overall interest in clinical research and their job and socio-demographic related readiness to participate in research networks (RNs).GPs are interested in RNs when it is a resource of and leading to enhanced patient-oriented care.GPs are willing to dedicate twice as much time to research when remunerated.GPs need a reliable counterpart within the leading institution.
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Affiliation(s)
- Larissa Virnau
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Annett Braesigk
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Bauer
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- CONTACT Thomas Frese Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, Halle/Saale06112, Germany
| | - Heidrun Lingner
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
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Heise M, Heidemann C, Baumert J, Du Y, Frese T, Avetisyan M, Weise S. Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study. Prim Care Diabetes 2022; 16:387-394. [PMID: 35400607 DOI: 10.1016/j.pcd.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. METHODS We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. RESULTS DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress. CONCLUSION DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.
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Affiliation(s)
- M Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - C Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - J Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - Y Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - T Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - M Avetisyan
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - S Weise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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Sandholzer-Yilmaz AS, Kroeber ES, Ayele W, Frese T, Kantelhardt EJ, Unverzagt S. Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review. BMJ Open 2022; 12:e050021. [PMID: 35545395 PMCID: PMC9096485 DOI: 10.1136/bmjopen-2021-050021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The epidemiological transition from infectious to chronic diseases leads to novel challenges in African health systems. The prevalence of diabetes mellitus (DM) is increasing dramatically. Undiagnosed and undertreated DM leads to numerous complications including end-organ damage and death. Our objectives were to collect the best locally generated evidence on DM interventions, identify knowledge gaps and determine underexplored research areas. DESIGN A systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS AND SETTING African patients in primary, secondary and tertiary prevention, diagnosis and treatment DM type 1 (DM1), type 2 (DM2) and gestational DM (GDM). OUTCOME All-cause mortality, glycaemic control, complications, quality of life, hospital admission, treatment adherence and costs. DATA SOURCES Articles published in MEDLINE Ovid, CENTRAL, CINAHL, African Journals Online and African Index Medicus and the International Clinical Trials Registry Platform in English language without time restrictions. The systematic search was last updated in October 2020. RESULTS Out of 3736 identified publications, we included 60 eligible studies conducted in 15 countries, 75% were conducted in urban healthcare settings, including 10 112 participants. We included 8 studies on DM1, 6 on GDM, 2 on pre-DM, 37 on mainly DM2 including 7 on DM-related complications. The design of the studied intervention was heterogeneous with a focus on educational strategies. The other studies investigated the efficacy of nutritional strategies including food supplementations, pharmacological strategies and strategies to enhance physical activity. Seven studies included interventions on DM-related complications. CONCLUSIONS Research activities increased in recent years, but available evidence is still not representative for all African countries. There is a big lack of evidence in primary healthcare and rural settings, implementation research, pharmacological interventions, especially in poorer countries. Nevertheless, the identified studies offer a variety of effective interventions that can inform medical care and future research. PROSPERO REGISTRATION NUMBER CRD42019122785.
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Affiliation(s)
- Angelika Sabine Sandholzer-Yilmaz
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
- Department of Haematology and Oncology, University of Göttingen, Gottingen, Germany
| | - Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
| | - Wondimu Ayele
- Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - T Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-University Halle-Wittenberg Medical Faculty, Halle, Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg Faculty of Medicine, Halle, Germany
- University Leipzig, Department of General Practice, Leipzig, Germany
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Hirpa S, Dobbie F, Fogarty A, Addissie A, Kaba M, Frese T, Unverzagt S, Kantelhardt EJ, Siddiqi K, Bauld L, Deressa W. "If I don't smoke shisha, I won't be able to sleep": lived experiences of high school students in Ethiopia. J Glob Health Rep 2022; 6:001c.33806. [PMID: 35518649 PMCID: PMC7612691 DOI: 10.29392/001c.33806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Shisha smoking predisposes the users to cardiovascular diseases, cancer, and infections, such as tuberculosis, hepatitis, and herpes. In Ethiopia, there is little data on the adolescents' shisha smoking experience. This study aimed to explore the lived experience of high school students and inform ongoing and future prevention and control interventions. Methods This study was conducted in Addis Ababa and Adama cities in Ethiopia. Twenty-five secondary school students aged 15-22 years who had shisha smoking experience participated in this study. A topic guide was used to facilitate the in-depth interviews (IDIs) and a digital audio recorder recorded the interviews. Interviews varied between 40-90 minutes and were conducted in private open-air spaces where only the interviewee and researcher were present. Each transcript was coded using Atlas.ti version 8 software. The analytical approach was iterative, with interview transcripts analyzed at the time of coding and re-analyzed after a preliminary result was drafted to search for additional themes. Results Students described two key factors that influenced their decision to initiate shisha smoking: peer influence and perceiving it as a means to release stress. After initiating shisha use students maintained the behaviour because of: peer influence, khat chewing, enjoyment of shisha smoking, having prolonged leisure time, and accessibility to shisha. Students regretted the impact shisha use had on their lives, such as conflict with their families, poor academic performance, and spending money on shisha smoking. Female students were also concerned about reproductive health risks related to shisha use. Conclusions Peer influence played a major role both in initiating and maintaining shisha use. However, students admitted concern over the impact of shisha smoking on academic performance and their relationship with their families. Since shisha use is associated with khat chewing; shisha smoking control programs cannot be successful without controlling khat. Especially young girls had worries about their reproductive health risks associated with shisha use. This suggests that targeted awareness raising programs highlighting the dangers of shisha use for both health and safety; especially for young women is required.
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Affiliation(s)
- Selamawit Hirpa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute of General Practice and Family Medicine, Centre of Health Sciences, Martin-Luther-University Halle-Wittenberg, Germany
| | - Fiona Dobbie
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute for Medical Epidemiology, Biostatistics and Informatics, Centre of Health Sciences, Martin-Luther-University Halle-Wittenberg, Germany
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Centre of Health Sciences, Martin-Luther-University Halle-Wittenberg, Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Centre of Health Sciences, Martin-Luther-University Halle-Wittenberg, Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Centre of Health Sciences, Martin-Luther-University Halle-Wittenberg, Germany
| | - Kamran Siddiqi
- The University of York and Hull York Medical School, Health Sciences, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, UK
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Carmienke S, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Heise M. Participation in structured diabetes self-management education programs and its associations with self-management behaviour - a nationwide population-based study. Patient Educ Couns 2022; 105:843-850. [PMID: 34272129 DOI: 10.1016/j.pec.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the relationship between participation in structured diabetes self-management education programs (DSME) and self-management behaviour (SMB) in routine care. METHODS The study included 864 ever- and 515 never-DSME participants from the population-based survey German Health Update (GEDA) 2014/2015. SMB and clinical care variables were: Following a diet plan, keeping a diabetes diary, holding a diabetes pass, self-monitoring of blood glucose (SMBG), foot self-examination (FSE), retinopathy screening, haemoglobin A1c (HbA1c) measurement and examination of the feet by clinicians (FEC). We conducted logistic regression analyses for association of DSME-participation with SMB, adjusting for various variables. RESULTS DSME-participation was significantly associated with SMB including following a diet plan (OR 1.88 [95% CI 1.21-2.92]), keeping a diabetes journal (OR 3.83 [2.74-5.36]), holding a diabetes health passport (OR 6.11 [4.40-8.48]), SMBG (OR 2.96 [2.20-3.98]) and FSE (OR 2.64 [2.01-3.47]) as well as retinopathy screening (OR 3.30 [2.31-4.70]), HbA1c measurement (OR 2.58 [1.88-3.52]), and FEC (OR 3.68 [2.76-4.89]) after adjusting for confounders. CONCLUSION DSME-participation is associated with higher frequencies of various SMB and clinical care variables in routine care. Never-DSME attenders are more likely not to receive retinopathy screening, FEC and HbA1c measurements as recommended. PRACTICE IMPLICATIONS Clinicians should refer diabetes patients to a DSME and ensure a regular follow up for never-DSME attenders.
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Affiliation(s)
- Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Jens Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Yong Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
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Dudo K, Ehring E, Fuchs S, Herget S, Watzke S, Unverzagt S, Frese T. The association of sleep patterns and depressive symptoms in medical students: a cross-sectional study. BMC Res Notes 2022; 15:109. [PMID: 35317836 PMCID: PMC8939186 DOI: 10.1186/s13104-022-05975-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Mental health is a fundamental aspect in ensuring the stable and successful professional life of future physicians. Depressive symptoms can negatively affect the work-life-balance and efficiency at work of medical students. To date, there have been very few studies involving medical students that examine the association between single sleep characteristics and the outcome of the Beck Depression Inventory-II score. Therefore, the aim of the present study is to investigate this possible association. A classroom survey using socio-demographic characteristics, the Beck Depression Inventory-II, and the Pittsburgh Sleep Quality Index was conducted amongst students at a German medical school from December 2017 to September 2018. Data analysis was performed with descriptive statistics and binary logistic regression. Results Of the students surveyed, 19% showed depressive symptoms with a Beck Depression Inventory-II score over 13 and 42% of these cases were moderate or severe. The occurrence of relevant depressive symptoms was associated with lower sleep quality, higher sleep latency, and the consumption of sleeping pills. In general, female students and students from abroad had a higher risk of depressive symptoms. Addressing these relevant findings in medical school can increase awareness of mental health.
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Affiliation(s)
- Katrin Dudo
- Institute of General Practice & Family Medicine, Faculty of Medicine, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Emilia Ehring
- Institute of General Practice & Family Medicine, Faculty of Medicine, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Stephan Fuchs
- Institute of General Practice & Family Medicine, Faculty of Medicine, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Sabine Herget
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Stefan Watzke
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital Halle (Saale), Julius-Kühn-Straße 7, 06112, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice & Family Medicine, Faculty of Medicine, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice & Family Medicine, Faculty of Medicine, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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