General Population In Germany Research Articles

When Utilitarian Claims Backfire: Advertising Content and the Uptake of Insects as Food.

A key challenge for climate change mitigation on the consumer side is to break habits that excessively lead to carbon emission. One of the culturally most robust human routines is the heavy reliance of the Western societies on conventional meat sources such as beef, pork, and poultry, which were recently accused of causing particularly high climate costs. In this light, the UN (FAO) has suggested the increasing use of insects as an alternative source of animal protein intended for human diets. Yet, insects have not reached the mainstream of Western cuisine. Currently, a frequent promotion strategy of insects is to highlight the Utilitarian benefits associated with their consumption (e.g., with respect to the environment or one's health). The present research addresses the efficacy of such claims in a consumer research study involving 180 participants recruited from the general population in Germany. Arguing based on social-cognitive research in the area of moral and environmental psychology, we hypothesized and found that a focus on beneficial, but temporally distant motives (e.g., health)—counterintuitively—decreases consumption in comparison to immediate, hedonic advertisements (e.g., tasty). Furthermore, our study provides process evidence suggesting pretrial expectations induced by a particular claim mediate the relationship between claims and consumption. Thus, the present research not only refutes a state-of-the-art approach in the promotion of insects as food, but also provides an alternative approach and process evidence by integrating psychological factors.

Cancer Incidence and Mortality Among Ethnic German Migrants From the Former Soviet Union.

Germany is a country known for immigration. In 2015, 21% of the general population in Germany consisted of individuals with a migration background. This article focuses on cancer-specific incidence and mortality among one of the biggest migrant groups in Germany: the resettlers. Resettlers are ethnic Germans who mainly immigrated from the Russian federation and other countries of the former Soviet Union after its collapse in 1989. We investigated differences between resettlers and the general German population, regarding (i) incidence and mortality of malignant neoplasms, (ii) time trends of the corresponding incidence and mortality, and (iii) cancer stage at diagnosis. We provide data from two resettler cohorts covering an observation time of 20 years: one cohort on cancer incidence (N = 32,972), and another cohort on mortality (N = 59,390). Cancer-specific standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for all malignant neoplasms combined and the most common cancer-sites were calculated between resettlers and the general German population. Time trend analyses using Poisson regression were performed to investigate the developments of SIRs and SMRs. To investigate differences in stage at diagnosis, logistic regression was performed, calculating Odds Ratios for condensed cancer stages. We observed higher incidence and mortality of stomach cancer [SIR (men) 1.62, 95%CI 1.17–2.19; SMR (men) 1.62, 95%CI 1.31–2.01; SIR (women) 1.32, 95%CI 0.86–1.94; SMR (women) 1.52, 95%CI 1.19–1.93] and higher mortality of lung cancer [SMR (men) 1.34, 95%CI 1.20–1.50] among resettlers compared to the general German population, but lower incidence and mortality of colorectal (both sexes), lung (women), prostate and female breast cancer. However, time trend analyses showed converging incidence risks of cause-specific incidence over time, whereas differences of mortality did not show changes over time. Results from logistic regression suggest that resettler men were more often diagnosed with advanced cancer stages compared to the Münster population. Our findings suggest that risk factor patterns of the most common cancer-sites among resettlers are similar to those observed within the Russian population. Such increases in prostate, colorectal and breast cancer incidence may be the consequence of improved detection measures, and/or the adaptation of resettlers to the German lifestyle.

Oral Symptoms and Oral Health-Related Quality of Life in People with Rare Diseases in Germany: A Cross-Sectional Study.

Background: The aim of this study was to collect information on oral health-related quality of life (OHRQoL) in people with rare diseases. Methods: A questionnaire comprising free text questions and the German version of the standardized Oral Health Impact Profile-14 (OHIP-14) questionnaire on OHRQoL was developed. All participants who indicated oral symptoms in the questionnaire were included in a cluster analysis. Different cluster analyses were performed (Ward’s, k-Means) to find symptom profile groups in the data. Results: A total of 484 questionnaires with 96 rare diseases were included in the study. The most reported symptoms were anomalies of the tooth formation, dysgnathia, changes in number of the teeth, and malocclusions. The OHIP mean values of the five resulting symptom clusters ranged from 15.1 to 19.9, which is very high compared to the general population in Germany, which has a mean value of 4.09. Discussion: All investigated symptoms show a negative association with OHRQoL, but the strongest were for symptoms of the oral mucosa and periodontal diseases. All the symptoms described in this cluster analysis can lead to considerably higher mean values of the OHIP total score among people with rare disease and thus to worse OHRQoL than reported in the general population.

Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents.

The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.

Quality of life, problems, and needs of disease-free breast cancer survivors 5years after diagnosis.

After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support. Disease-free breast cancer survivors (n = 190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5years post-diagnosis. QoL-related functions and symptoms (EORTC QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany. QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%). While QoL in disease-free breast cancer survivors 5years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.

Epidemic Vitamin D Deficiency in Prisoners Compared to the German Population: An Analysis Based on Laboratory Results

Effects of long-term imprisonment on the vitamin D (vitD) status of prison inmates in Germany have not been systematically assessed so far. Special circumstances in prisons - little sunlight exposure combined with restricted outdoor activities - may lead to vitD deficiency among prisoners. The aim of this study was to assess the vitD status of prisoners and the general population in order to quantify the extent of vitD deficiency in both groups. VitD status (25(OH)D in blood serum samples) was assessed in female inmates of a prison in southern Germany between May 2012-June 2013. Suboptimal vitD status was defined as levels of 10-<20 µg/l, severe deficiency as<10 µg/l. A systematic literature search in PubMed was conducted in order to compare study results with vitD levels in the general population. Blood sera of 84 inmates (median age: 43 years; range: 19-75) were analyzed. Thirty women (36%) showed severe vitD deficiency, 47 (56%) suboptimal vitD levels. The literature search identified 10 studies which reported considerable vitD deficiency in the general population in Germany. VitD deficiency is very common in both prison inmates and the general population. Unlike prison inmates, the population is able to decide whether, when and how long they want to exposure to sunlight. Moreover, they can counteract deficiency via a nutrition rich in vitD. This is not possible for inmates. To prevent long-term effects of vitD deficiency, intake of vitD supplements during duration of imprisonment seems reasonable.

The use of E-Cigarettes in the German Population: Results of the Epidemiological Survey of Substance Abuse 2015

Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented. The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis. E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking. E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

Comorbid Mental Disorders in Gastroenterology and Hepatology: Prevalence and Psychosocial Needs in Tertiary Care

In the field of gastroenterology and hepatology, associations and interactions with comorbid mental disorders are often described, but there is currently a lack of methodologically high-quality studies on prevalence and the need for care. The aim of the study was to take account of this shortcoming. Prospective, monocentric, cross-sectional study of a representative sample of inpatients at a university hospital. A total of 308 participants were examined for the presence of 8 frequent psychological syndromes with a validated questionnaire (PHQ-D). In addition, 63 participants were examined for the presence of mental disorders according to ICD-10 with a diagnostic interview (SKID-I) that covers a wider range of diagnoses. The need for psychosocial care was raised from the perspective of internal medicine practitioners and psychosomatic experts. The prevalence for at least 1 mental syndrome in the questionnaire sample (PHQ-D excl. PHQ-15) was 39.6%, in 23.8% of whom more than one syndrome was present. The most frequent were depressive and anxiety syndromes. There were significant differences in the various subgroups (sex, type and severity of the somatic disease). The 4-week prevalence for any mental disorder in the interview sample (SKID-I) was 52.4%. Affective and somatoform disorders as well as adaptation disorders were dominant. The need for psychosocial care was reported in 23.1% by the practitioners and in 30.2% by the experts. Patients with gastroenterological-hepatological tertiary care have a high prevalence of treatment-related psychological syndromes or disorders. In comparison with the reference data of the Robert Koch Institute on the 12-month prevalence of mental disorders among the general population in Germany, the proportion of current mental disorders is almost twice as high (52.7 vs. 27.1%, p<0.001). To cover the need for care, the provision of psychosomatic liaison services and the strengthening of psychosomatic basic care in gastroenterology/hepatology should be established.

Predicted 10-year risk of cardiovascular mortality in the 40 to 69 year old general population without cardiovascular diseases in Germany.

AimsTo estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology.Methods and resultsIn 3,498 participants (40–69 years) from the German Health Examination Survey for Adults 2008–2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE <1%), moderate (SCORE 1-<5%) and high 10-year CVD mortality risk (SCORE ≥5% or diabetes, renal insufficiency, SBP/DPB ≥180/110 mmHg or cholesterol >8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to <20.000 inhabitants (5.4% vs.10.9%). There were no significant associations between predicted CVD mortality risk and SES or community size in men and regions in men and women. Among the high risk group, 58.2% of men and 9.8% of women had SCORE ≥5%, leaving the majority of women (60.1%) classified as high risks due to diabetes and SCORE <5%.ConclusionOur results suggest the persistence of socioeconomic disparities in predicted cardiovascular mortality in women and support the need of large-scale prevention efforts beyond individual lifestyle modification or treatment. Furthermore, the importance of additional comorbidities for the high risk group classification is highlighted.

Which Infectious Blood Donors Could Be Identified by the Donor History Questionnaire - Comparison of Blood Donors Infected with HIV or HCV with Notified Cases from General Population in Germany

Background: Potential risks for transfusion-transmissible infections are identified by donor history questionnaires (DHQs), and donors with higher risks are deferred from donation. We assessed to which extent the currently used DHQs support the identification of infections among blood donors. Methods: Between 2006 and 2013, we analyzed data from notified HIV and HCV cases in the general population and positive blood donors in Germany. Logistic regressions were used to identify relevant infection risks. We estimated the possible effect of improved capture of risk factors for donor selection by calculation of population attributable fractions (PAF). Results: Risky sexual contacts - MSM as well as heterosexual contacts - were the most prominent infection risks among HIV-infected donors. Whereas MSM contacts were significantly less reported by donors than by cases from the general population, 58% of donors disclosed heterosexual risks compared to 26% of notified cases. The complete identification of heterosexual risk contacts might prevent acceptance of 53% of HIV-infected donors. HCV-infected donors were more likely to report heterosexual exposure, imprisonment, and piercing/tattoo than notified HCV cases. Improved recording of piercing/tattoo could prevent acceptance of 16% of HCV-infected donors. Conclusion: Donor selection should be improved with special attention to the identification of (hetero)sexual risk factors, invasive procedures (piercing/tattoo and imprisonment) applying well-designed DHQs, effective donor education, and confidential environment in all steps of the selection process.

A large proportion of people who inject drugs are susceptible to hepatitis B: Results from a bio-behavioural study in eight German cities

BackgroundPeople who inject drugs (PWID) are at high risk of hepatitis B virus (HBV) infection by sharing needles and drug use paraphernalia. In Germany, no routine surveillance of HBV prevalence and vaccination coverage among PWID exists. MethodsSocio-demographic and behavioural data were collected between 2011 and 2014 through face-to-face interviews, during a bio-behavioural survey of PWID recruited in eight German cities. Dried blood spots (DBS) prepared with capillary blood were tested for HBV markers. Factors associated with past/current HBV infection and vaccination status were analysed by univariable and multivariable analysis using logistic regression. The validity of self-reported HBV infection and vaccination status was analysed by comparison to the laboratory results. ResultsAmong 2077 participants, the prevalence of current HBV infection was 1.1%, of past HBV infection was 24%, and of vaccine-induced HBV antibodies was 32%. No detectable HBV antibodies were found in 43%. HBV infection status was significantly associated with study city, age, years of injecting, use of stimulants, migration status, and homelessness; HBV vaccination status was significantly associated with study city, age, and level of education. Correct infection status was reported by 71% and correct vaccination status by 45%. ConclusionsHBV seroprevalence among PWID was about five times higher than in the general population in Germany, confirming PWID as an important risk group. Targeted information campaigns on HBV and HBV prevention for PWID and professionals in contact with PWID need to be intensified. Routinely offered HBV vaccination during imprisonment and opioid substitution therapy would likely improve vaccination rates among PWID.

Gesundheitszustand und medizinische Versorgung von Asylsuchenden – Konzeption und Pilotierung eines Fragebogens

BackgroundScientific evidence on the health status of asylum seekers in Germany and their access to health care is fragmentary. There is a lack of appropriate questionnaires collecting indicators of health status and health care, which enable a meaningful comparison with a reference population. This article presents experiences in designing a questionnaire and findings available from a pilot testing to pave the way to improve design and methods in future studies. Materials and methodsThe questionnaire comprises 28 mainly closed questions on self-reported health status, access to medical care and sociodemographic indicators. In order to guarantee comparability with the general population in Germany, most questions are derived from national health surveys. The questionnaire was translated into seven languages. Pilot testing was conducted between October 2014 and February 2015 in the course of the monthly welfare payments to asylum seekers in three districts of the German federal state of Baden-Wuerttemberg. ResultsA total of 156 out of 614 contacted asylum seekers participated in the pilot study (response rate: 25.4 %). The completion rate for items concerning health status and health care was satisfactory (> 75 %). Several items regarding sociodemographic data and linguistically complex questions showed the lowest item response rates (< 50 %). We recommend streamlining the questionnaire and using precise, closed and culturally adapted items. ConclusionsThe questionnaire proved to be expedient and practicable to assess relevant indicators of health status and health care provision. It appears that there is scope for improvement regarding the shortening and cultural adaptation of the questionnaire and the range of available translations. After addressing the mentioned limitations and further development, our approach could contribute to measuring regional disparities, differences between asylum seekers and the general population and temporal changes. In order to obtain representative data, the sampling strategy should be optimised.

Refractive, corneal and ocular residual astigmatism: distribution in a German population and age-dependency - the Gutenberg health study.

Worldwide, the most frequent cause of visual impairment is uncorrected refractive error. This analysis focused on the distribution and associations of refractive, corneal and ocular residual astigmatism. As part of the Gutenberg Health study, a population-based cross-sectional study was conducted in the general population of Germany. A comprehensive ophthalmological examination including refraction, tonometry, and Scheimpflug imaging of the anterior cornea (Pachycam) was performed. In addition to the magnitude and type (with-the-rule, against-the-rule, oblique) of the refractive or corneal astigmatism, we calculated the vector components (J0, J45) of both astigmatisms and calculated the ocular residual astigmatism. We performed multiple quantile regression analysis to evaluate the factors associated with refractive, corneal and ocular residual astigmatisms. A total of 13,558 subjects (49% female) with a mean age of 54.0years (range 35-74years) were included in this study. The prevalence of refractive astigmatism (>1.0D) was 13.0% in right eyes and 12.0% in left eyes, and 85% of these subjects wore spectacles. The distribution of refractive astigmatism showed a two-peak distribution with high astigmatism for with-the-rule and against-the-rule astigmatism. The associated factors were corneal curvature, age and sex for the different astigmatisms (p<0.001). We analyzed the prevalence of different astigmatisms within a European population. We confirmed a shift with aging from with-the-rule to against-the-rule astigmatism to refractive and corneal astigmatism. Astigmatism has a large impact on visual perception; more than 85% of people with astigmatism over one diopter wore glasses for distance vision.

Epidemiology of refractive errors

Refractive errors are very common and can lead to severe pathological changes in the eye. This article analyzes the epidemiology of refractive errors in the general population in Germany and worldwide and describes common definitions for refractive errors and clinical characteristics for pathologicaal changes. Refractive errors differ between age groups due to refractive changes during the life time and also due to generation-specific factors. Current research about the etiology of refractive errors has strengthened the influence of environmental factors, which led to new strategies for the prevention of refractive pathologies.

Diagnosed Depression and Utilization of Health Care Services and Preventive Measures in the General Adult Population in Germany - Results from a Nationwide Cross-Sectional Telephone Survey

To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany. Cross-sectional analysis of data from a representative telephone survey (men N = 18,675, women N = 24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed. Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health check-ups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men. Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.

High Prevalence of Vitamin D Deficiency in Patients With Bone Marrow Edema Syndrome of the Foot and Ankle.

Bone marrow edema syndrome (BMOS) is a phenomenon primarily affecting the lower extremity. It is characterized by a sudden onset of pain and an ill-defined osseous hyperintense signal in magnetic resonance imaging. The main cause of BMOS is still largely unknown. Its pathophysiology is presumably multifactorial and it has recently been demonstrated that it usually involves an increase in bone turnover and alterations within the bone microenvironment. Vitamin D plays a pivotal role in maintaining a healthy and well-balanced bone microenvironment. However, to date only limited information has been reported on vitamin D status in patients with BMOS. Moreover, it is still uncertain whether hypovitaminosis D is associated with the etiology and course of the disease. For this reason, the aim of this study was to determine serum vitamin D levels (25(OH)D) of patients diagnosed with BMOS of the foot and ankle. Patients were identified and laboratory results collected by retrospective review of the medical records between year 2011 and 2015. Diagnosis was based on clinical examination, the existence of prolonged foot pain, the presence of abnormal bone marrow signal intensity in T1- and T2-weighted magnetic resonance imaging, and the patient's medical history. All patients who demonstrated other concomitant diagnoses were excluded from the study. Overall, 31 patients were affected by BMOS with a mean age of 44.4 (range, 18-76) years. Notably, 84% of patients (26/31) had low vitamin D levels with a mean 25(OH)D level of 19.03 ng/mL. Specifically, 61% of patients (19/31) were vitamin D deficient, 23% (7/31) vitamin D insufficient, and only 5 patients (16%) had sufficient vitamin D levels. Statistical analysis showed no significant difference comparing vitamin D levels with patient age, sex, and time of diagnosis. Moreover, there was no correlation between vitamin D status and the number of bony foci or location of BMOS. We found a widespread rate of vitamin D deficiency in patients presenting with BMOS of the foot and ankle. Comparing these data to the vitamin D status of the general population in Germany and to patients living in comparable latitudes, this raises the possibility that BMOS might be associated with low vitamin D status. Level IV, retrospective case series.

Establishing an Open Probability-Based Mixed-Mode Panel of the General Population in Germany

Various open probability-based panel infrastructures have been established in recent years, allowing researchers to collect high-quality survey data. In this report, we describe the processes and deliverables of setting up the GESIS Panel, the first probability-based mixed-mode panel infrastructure in Germany open for data collection to the academic research community. The reference population for the GESIS Panel is the German-speaking population aged between 18 and 70 years permanently residing in Germany. In 2013, approximately 5,000 panelists had been recruited from a random sample drawn from municipal population registers. We describe the outcomes of the sampling strategy and the multistep recruitment process, involving computer-aided personal interviews conducted at respondents’ homes. Next, we describe the outcomes of the two self-administered survey modes (online and paper-and-pencil) of the GESIS Panel used for the initial profile survey and all subsequent bimonthly data collection waves. Across all stages of setting up the GESIS Panel, we report sample composition discrepancies for key demographic variables between the GESIS Panel and established benchmark surveys. Overall, the findings highlight the usefulness of pursuing a mixed-mode strategy when building a probability-based panel infrastructure in Germany.

Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15)

BackgroundThe PHQ-15 is widely used as an open access screening instrument for somatic symptoms in different health care settings. The objectives of the study were to contribute to the construct validity and to generate normative data for the PHQ-15. MethodsThe survey was conducted in the general population in Germany from August 2011 to November 2014 (n=9250). All participants underwent an extensive core assessment including a set of questionnaires. ResultsMen reported significantly less (p<0.001) physical symptoms than women (4.6 [SD=3.6] vs. 6.3 [SD=4.1]). The PHQ-15 total score was strongly correlated with the physical component of quality of life (r=−0.58), fatigue (r=0.56), anxiety (r=0.54) and sleep problems (r=0.54). While high socioeconomic status was associated with low prevalences of all complaints, obesity was associated with some of the complaints, especially shortness of breath and pain in arms, legs, and joints. Normative data for the PHQ-15 were generated for men and women. ConclusionsThis investigation confirms the burden caused by somatic symptoms in terms of impaired physical quality of life. In association with psychosocial consequences such as anxiety as well as sleep problems, future studies should also focus on the disease burden of somatic symptoms. In addition, the normative data provide a framework for the interpretation and comparison with other populations.

Identifying ischemic stroke associated with cancer: a multiple model derived from a case-control analysis.

Ischemic stroke in patients with cancer is thought to be associated with a worse prognosis and might be the initial symptom of an unknown malignancy. However, diagnostic algorithms to reliably identify cancer-associated stroke have not been developed. In this retrospective single-centre analysis, 68 patients with ischemic stroke and an active solid malignancy were identified. Neurological assessment and outcome, cardiovascular risk factors, neuroimaging studies as well as laboratory findings were compared to 68 age- and sex-matched control subjects with ischemic stroke without diagnosis of cancer. Lung, pancreatic and renal cancer showed increased prevalences compared to those of the general population in Germany. Diagnosis of cancer was most often made within the 12months preceding (32.4%) or during the diagnostic work-up for stroke (17.7%). Cancer-associated stroke was characterized by a more severe clinical deficit, frequent clinical deterioration (13.2 vs. 1.5%) or death (25 vs. 4.4%). Ischemic lesions often involved multiple territories (51.6 vs. 12.7%), more often with co-existing subacute and acute infarctions in imaging studies (54.8 vs. 11.1%). Patients with cancer had significantly higher levels of C-reactive protein, relative granulocytosis and serum lactate dehydrogenase activity. Using receiver operating characteristics-based multiple analysis, we developed a model using these parameters which detected cancer-associated stroke with a sensitivity of 75% and specificity of 95%. Our analysis suggests that a multiple algorithm combining the number of territories involved and laboratory signs of inflammation and cell turnover might identify patients with stroke suffering from previously unknown malignancy.

Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany.

BackgroundDespite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care.ObjectiveThis pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress.MethodsTo assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman’s rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress.ResultsDescriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled “usefulness or helpfulness,” “relative advantage or comparability,” and “accessibility or access to health care.” Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems.ConclusionsThis pilot study showed deficient “e-awareness” and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the “black box” of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs.