Social relationships and their impact on health-related quality of life in a long-term breast cancer survivor cohort

BACKGROUND

Health-related quality of life (HRQOL) has become increasingly important for breast cancer survivors, but clinically relevant declines often persist for many years after treatment. This study aimed to investigate whether social relationships can mitigate or prevent this decline in HRQOL.

METHODS

Data were used from the German population-based Mamma Carcinoma Risk Factor Investigation (MARIE) cohort of 2022 breast cancer cases with follow-up information for more than 15 years after diagnosis. Correlations between social integration, social support, and global health status (GHS) as an overall measure of HRQOL were analyzed, and linear regression analysis was performed with structural equation modeling.

RESULTS

The majority of participants reported high levels of social integration and social support and moderate levels of GHS. Social integration 5 years after diagnosis was associated with GHS 5 years after diagnosis (β = 1.12; 95% CI, 0.25-1.99), but no longitudinal effects were found. Social support 5 years after diagnosis was associated with better GHS 5 years (β = 0.42; 95% CI, 0.36-0.48) and 10 years after diagnosis (β = 0.12; 95% CI, 0.02-0.22), whereas social support 10 years after diagnosis was associated with GHS 10 years (β = 0.29; 95% CI, 0.20-0.39) and 15 years after diagnosis (β = 0.10; 95% CI, 0.01-0.21).

CONCLUSIONS

These results confirm that social relationships positively influence HRQOL in long-term breast cancer survivors and that their association should receive more attention clinically and beyond routine care.

Trends in stroke severity at hospital admission and rehabilitation discharge before and during the COVID-19 pandemic in Hesse, Germany: a register-based study

BACKGROUND

The COVID-19 pandemic has affected acute stroke care, resulting in a decrease in stroke admissions worldwide. We examined trends in stroke severity at hospital admission, including (1) probable need for rehabilitation (National Institutes of Health Stroke Scale score > 6 points) and (2) probable need for assistance (modified Rankin Scale score > 2 points), and discharge to rehabilitation after acute care among inpatients with acute ischemic stroke and intracerebral hemorrhage.

METHODS

We compared quality assurance data for acute ischemic stroke and intracerebral hemorrhage during the pandemic with the period before the pandemic in Hesse, Germany, using logistic regression analyses.

RESULTS

Fewer inpatients with a probable need for rehabilitation were present at the beginning of the second wave of the COVID-19 pandemic in September 2020 (adjusted OR (aOR) 0.85, 95% CI [0.73, 0.99]), at the end of the second national lockdown in May 2021 (aOR 0.81, 95% CI [0.70, 0.94]), and at the approaching peak of COVID-19 wave 4 in November 2021 (aOR 0.79, 95% CI [0.68, 091]). Rates of probable need for assistance were significantly lower at the beginning of COVID-19 wave 2 in August 2020 (aOR 0.87, 95% CI [0.77, 0.99]) and at the beginning of COVID-19 wave 3 in March 2021 (aOR 0.80, 95% CI [0.71, 0.91]). Rates of discharge to rehabilitation were lower from the beginning in October 2020 to the peak of COVID-19 wave 2 in December 2020 (aOR 0.83, 95% CI [0.77, 0.90]), at the beginning and end of COVID-19 wave 3 in March 2021 and May 2021 (aOR 0.86, 95% CI [0.79, 0.92]), respectively, and at the beginning of COVID-19 wave 4 in October 2021 (aOR 0.86, 95% CI [0.76, 0.98]).

CONCLUSIONS

The results suggest that the COVID-19 pandemic had an impact on stroke management during the pandemic, but the absolute difference in stroke severity at hospital admission and discharge to rehabilitation was small.

Physical activity in adults with and without rheumatoid arthritis: cross-sectional results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

OBJECTIVE

Studies examining habitual physical activity levels and patterns in adults with rheumatoid arthritis (RA) using raw data from modern accelerometers are lacking. We aimed (i) to examine physical activity levels and patterns in adults with RA in their familiar environment, and (ii) to investigate whether physical activity levels differ throughout the day.

METHOD

Data were taken from Wave 8 of the Survey of Health, Ageing and Retirement in Europe, including N = 607 men and women who wore a triaxial accelerometer and had adequate information for RA and accelerometry data summarized as Euclidean norm minus one (ENMO, mg). Growth-curve models and simple contrast analysis were used to examine the effect of RA on daily patterns of physical activity levels, including mean total ENMO in mg, mean minutes of light-intensity physical activity (ENMO values ≥ 25 mg and ≤ 75 mg), and moderate-to-vigorous-intensity physical activity (ENMO values > 75 mg).

RESULTS

Total physical activity averaged throughout the day was 25.0 and 28.6 mg for respondents with and without RA, respectively. Respondents with RA spent more time in light-intensity physical activity throughout the day (p < 0.001), but less time in moderate-to-vigorous-intensity physical activity between 4 am and 11 pm (p < 0.001) than respondents without RA.

CONCLUSION

Adults with RA were less physically active than adults without RA. However, there were no diurnal differences in physical activity.

Outcomes following oropharyngeal squamous cell carcinoma resection and bilateral neck dissection with or without contralateral postoperative radiotherapy of the pathologically node-negative neck

PURPOSE

There are no consensus guidelines regarding the postoperative treatment of the contralateral pathologically node-negative neck in oropharyngeal squamous cell carcinoma. This study aimed to determine if omission of postoperative irradiation of the contralateral pathologically node-negative neck affects oncological outcomes.

METHODS

We retrospectively identified 84 patients with primary surgical treatment including bilateral neck dissection and postoperative (chemo-)radiotherapy (PO(C)RT). Survival was analyzed using the log-rank test and the Kaplan-Meier method.

RESULTS

Patients showed no decrease in tumor-free, cause-specific (CSS), or overall survival (OS) when PO(C)RT of the contralateral pathologically node-negative neck was omitted. Increased OS was found in patients with unilateral PO(C)RT and especially an increased OS and CSS was found in unilateral PO(C)RT and in tumors arising from lymphoepithelial tissue.

CONCLUSIONS

Omitting the contralateral pathologically node-negative neck appears to be safe in terms of survival and our retrospective study advocates further prospective randomized control de-escalation trials.

The impact of regional deprivation on stroke incidence, treatment, and mortality in Germany

BACKGROUND

Regional deprivation has been shown to be an influential factor in stroke incidence risk. However, there is a paucity of knowledge on regional differences in stroke incidence and mortality in Germany.

METHODS

We assessed data from the Diagnosis Related Groups statistics (2016-2019) and the German Federal Registry of Physicians (2019). Negative binomial regression analysis was used to examine the association between the German Index of Multiple Deprivation 2015 covering 401 districts and district-free cities in Germany and stroke incidence, treatment, and mortality.

RESULTS

The adjusted rate ratios of stroke incidence and mortality with the highest deprivation level compared with the least deprived area were 1.161 (95% CI [1.143, 1.179]) and 1.193 (95% CI [1.148, 1.239]), respectively. Moreover, this study revealed that physician density was higher in district-free cities compared to districts.

CONCLUSIONS

Our results indicate that regional deprivation is associated with incident and mortality cases of stroke, necessitating a more targeted approach to stroke prevention in deprived regions.

Frequent Cannabis Use Moderates the Relationship Between Sexual Dysfunction and Depression Among Female German Adults

BACKGROUND

Sexual dysfunction and heavy substance use (alcohol, tobacco, and cannabis) play an important role in the development of depression, while frequent substance use affects sexual dysfunction.

AIM

This study aimed to investigate the association between sexual dysfunction and depression among German adults in a nationally representative sample and the effect of alcohol, tobacco, and cannabis use on this association using moderator analysis.

METHODS

Data come from the German Health and Sexuality Survey (GeSiD) with N = 4,955 men and women aged between 18 and 75 years. We used multiple logistic regression analysis to examine the moderation effect of substance use between sexual dysfunction and depression by including an interaction term.

OUTCOMES

Self-reported diagnosed and treated depression within the last 12 months and the moderation effect of substance use on the association between sexual dysfunction and depression.

RESULTS

Men and women with at least 1 sexual dysfunction were more likely to be affected by depression as compared to those without sexual dysfunction. A moderation effect of frequent cannabis use was found between sexual dysfunction and depression among women.

CLINICAL IMPLICATIONS

Clinicians and therapists addressing addiction, depression, and dysfunction should keep the complex interactions in mind.

STRENGTHS & LIMITATIONS

This study provides new data on the association between sexual dysfunction and depression among German adults in a nationally representative sample and the moderation effect of substance use on this association. Further studies should disentangle the pathways between sexual dysfunction, cannabis use, and depression through moderated mediation analyses.

CONCLUSION

Frequent cannabis use plays a moderating role in the association between sexual dysfunction and depression among German adult women. Belau MH, Wiessner C, Becher H, et al. Frequent Cannabis use Moderates the Relationship between Sexual Dysfunction and Depression Among Female German Adults. J Sex Med 2022;19:940-949.

Randomised controlled trial testing the feasibility of an exercise and nutrition intervention for patients with ovarian cancer during and after first-line chemotherapy (BENITA-study)

OBJECTIVES

Advanced ovarian cancer is a severe disease with major side effects caused by peritoneal carcinomatosis, ascites and gastrointestinal involvement as well as exhaustive treatment like debulking surgery and combination chemotherapy. Two most frequently reported side effects are muscle wasting and malnutrition, leading to frailty, decreased health-related quality of life (HRQoL) and cancer-related fatigue (CRF). As muscle wasting and malnutrition often commence during first-line chemotherapy and develop progressively into a refractory state, an early intervention is warranted. This pilot study aimed to evaluate the safety and acceptance of a combined exercise and nutrition intervention during and after first-line chemotherapy.

DESIGN

The pilot study was conducted as a monocentric 1:1 randomised controlled trial (RCT) with an intervention group (IG) and a control group (CG). Participants were divided by chance into IG or CG. Information on group allocation was conveyed to the study coordinator responsible for making an appointment with the patients for the baseline assessment as well as the physiotherapist and nutritionist responsible for the intervention and outcome assessment in both groups.

PARTICIPANTS

Eligibility criteria included women ≥18 years of age, diagnosed with ovarian cancer, tubal cancer or peritoneal cancer and primary or interval debulking, scheduled but not started adjuvant or neoadjuvant chemotherapy and sufficient German-language skills.

INTERVENTION

The IG received a 12-month exercise and nutrition programme, the CG continued to follow usual care.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were recruitment rate, adherence to intervention, completion rate and adverse events. In addition, in-person assessments (eg, HRQoL, CRF, muscle quality and function and dietary intake and quality) were conducted at baseline (T0, before chemotherapy), week 9 (T1, mid-chemotherapy), week 19 (T2, after completion of chemotherapy) and after 12 months of intervention (T3).

RESULTS

Of 60 eligible patients, 15 patients signed informed consent (recruitment rate=25.0%) and were randomised into IG (n=8) and CG (n=7). Eleven participants completed the study (completion rate, 73.3%), one patient dropped out due to loss of interest, one due to poor health, one was lost to follow-up and one patient died.

CONCLUSION

The BENITA (Bewegungs- und Ernährungsintervention bei Ovarialkrebs) study demonstrated the safety and acceptance of an exercise and nutrition intervention integrated into first-line therapy and follow-up care of ovarian cancer. A large multicentre RCT is planned to investigate the effectiveness of the intervention on HRQoL, CRF and survival and to establish means of implementation into oncology guidelines and clinic routine.

TRIAL REGISTRATION NUMBER

DRKS00013231.

Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany

Background

Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany.

Methods

The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling.

Results

The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]).

Conclusions

Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12303-5.

Body mass index and associated factors among refugees living in North Rhine-Westphalia, Germany: a cross-sectional study

Background

This study aims to determine: (i) information on overweight and obesity, represented by body mass index using measured anthropometric data, among refugees living in North Rhine-Westphalia, Germany, (ii) how body mass index changed throughout the migratory journey to Germany, and (iii) factors influencing body mass index.

Methods

The study utilizes data from the FlueGe health study, a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 in which participants were recruited in several cities in North Rhine-Westphalia (N = 326). We analyzed differences in body mass index before the escape, upon arrival, and since arrival as well as correlations between body mass index since arrival and explanatory variables using linear regression models.

Results

The overall prevalence of overweight and obesity before the escape (t0), upon arrival (t1) and since arrival (t2) were 55.2% (150/272), 45.6% (133/292) and 54.8% (171/312), respectively, with 16.2% (44/272), 12.0% (35/292) and 16.0% (50/312) being obese. There was a significant change between t0 and t1 (p < 0.001), and between t1 and t2 (p < 0.001), but no change over time (between t0 and t2, p = 0.713). Results from multivariate linear regression showed that high education, male sex, higher body mass index before the escape, Iranian or Iraqi nationality, and sobriety were the significant factors for body mass index since arrival. However, when focusing on those who have reported weight gain only, higher body mass index before the escape, male sex, and Iraqi nationality were the significant factors.

Conclusions

Overweight and obesity were common among refugees after settlement in Germany. In particular, sociodemographic factors were associated with a higher body mass index since arrival. Thus, it is important to develop and apply nutrition-related intervention programs for adult refugees that are culturally appropriate and tailored to education level and sex.

Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen älterer Erwachsener mit einer Arthrose, rheumatoiden Arthritis oder Osteoporose

Hintergrund Chronische Muskel-Skelett-Erkrankungen (MSE) verursachen erhebliche Kosten für das deutsche Gesundheitssystem, weshalb sowohl von Seiten der Leistungserbringer als auch von der Politik Informationen über die Nutzung der unterschiedlichen Versorgungsangebote benötigt werden. Wir untersuchen gemäß dem Verhaltensmodell nach Andersen Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen der für chronische MSE relevanten Fachrichtungen Allgemeinmedizin, Orthopädie und Physiotherapie in der von einer Arthrose, rheumatoiden Arthritis oder Osteoporose betroffenen 65–79-jährigen Wohnbevölkerung Deutschlands.

Methoden Auf Grundlage der Daten der ersten Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurden Zusammenhänge zwischen der ambulanten Inanspruchnahme und erklärender Variablen mithilfe von Zähldatenmodellen analysiert.

Ergebnisse Eine erhöhte Inanspruchnahme der Allgemeinmedizin ist mit individuellen Krankheitsfaktoren (erhebliche gesundheitliche Einschränkung: Incidence Rate Ratio (IRR) 1,64 (1,18–2,27); Gelenkschmerzen: IRR 1,38 (1,06–1,79)) assoziiert. Eine erhöhte Inanspruchnahme der Orthopädie geht mit einer vermehrten Inanspruchnahme der Allgemeinmedizin (IRR 1,05 (1,01–1,10)) einher. Die erhöhte Inanspruchnahme der Physiotherapie wird von strukturellen wie individuellen Faktoren bestimmt (Region Ost (inklusive Berlin)): IRR 0,66 (0,47–0,93); erhebliche gesundheitliche Einschränkung: IRR 1,84 (1,09–3,12); vermehrte Inanspruchnahme der Orthopädie: IRR 1,07 (1,01–1,14)).

Schlussfolgerung Erwartungsgemäß nehmen individuelle Krankheitsfaktoren eine bedeutende Rolle in der Erklärung der Nutzung medizinischer Versorgungsangebote ein. Zugleich zeigt sich mit dem Nichtvorhandensein einer Komorbidität ein bislang noch nicht berichteter Prädiktor für die reduzierte Inanspruchnahme der Allgemeinmedizin durch Personen mit einer MSE.