German Adult Population Research Articles

Pain intensity and comorbid depressive symptoms in the general population: An analysis of the German Health Update Study (GEDA 2019/2020-EHIS).

Pain and depressive symptoms often co-occur, but the influence of pain intensity remains unclear. This study analyses the association between pain intensity and depressive symptoms in the general adult German population. Data was obtained from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Pain intensity in the last 4 weeks was categorized into no pain, mild, moderate, and severe. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire (PHQ-8). The prevalence of depressive symptoms was analysed including a 95% confidence interval (95% CI). A multivariable logistic regression analysed associated factors with depressive symptoms by odds ratio (OR). Of 22,708 participants (51.0% women, 35.1% aged 45-64 years), 41.2% reported no pain, 32.1% mild, 15.3% moderate, and 11.5% severe pain. Depressive symptoms were present in 8.3% overall (women 9.1%, men 7.5%). Participants with no pain, mild, moderate, and severe pain reported depressive symptoms in 2.5%, 6.5%, 14.4%, and 27.1%, respectively. In the multivariable analysis, higher pain intensity was associated with a higher risk of depressive symptoms (mild pain OR 1.8, 95% CI 1.3-2.4; moderate pain OR 2.8, 95% CI 2.0-4.0; severe pain OR 4.0, 95% CI 2.8-5.6). Depressive symptoms were further associated with a Body Mass Index (BMI) under 18.5 kg m-2 (OR 2.4; 95% CI 1.4-4.1), but not with sex (OR 1.1; 95% CI 0.9-1.3). Higher pain intensity increases the risk of depressive symptoms. We suggest regular assessment of pain and further assessment of depressive symptoms in patients with moderate or severe pain. Our study found a clear association between higher pain intensity and depressive symptoms in the general population across all types of pain. Further, being underweight was linked to depressive symptoms overall and the highest prevalence of depressive symptoms was found in underweight persons with severe pain. These findings highlight the importance of assessing depressive symptoms in patients with higher pain intensity, especially in underweight patients.

Digitalization of administrative work at home

Abstract People must perform bureaucratic, administrative work in daily life, such as applying for official documents, concluding contracts, organizing purchases, managing pension plans, etc. This work is time-consuming and unequally distributed in the household. At its best, it is perceived as boring; at its worst, it is mentally and emotionally stressful, leaving people overwhelmed and unable to fulfill their obligations. People can benefit from the digitalization of domestic bureaucracy automating repetitive tasks, reducing mental effort, and saving time for leisure activities. In recent years, there has been a need for more empirical knowledge about the use of technology or the working environment for this purpose. This paper presents insights from an online survey with 617 socio-demographically distributed participants highlighting the devices, tools, special software, and common places people favor for accomplishing these office-like household chores. Our results provide a solid empirical basis that not only quantifies previous qualitative results now using the German adult population but also offers orientation for further in-depth research as well as design.

Interest in anime and manga: relationship with (mental) health, social disconnectedness, social joy and subjective well-being

Abstract Aim Our aim was to examine the association between interest in anime and manga and their relationship with (mental) health (in terms of depressive symptoms, anxiety symptoms, health-related quality of life, symptoms of hikikomori), social disconnectedness (in terms of preference for solitude, loneliness, objective social isolation, and perceived social isolation), subjective well-being (in terms of ikigai, life satisfaction, and happiness) and joy (frequency of laughter, and frequency of hugs). Subjects and methods Data were taken from a large sample of the general German adult population aged 18–74 years (n = 4,738 individuals, average age: 46.4 years). Established tools were used to quantify the outcomes. Multiple linear and ordered logistic regressions were used, as appropriate. Results Regressions showed that a higher interest in anime was associated with several adverse mental health and some social disconnectedness outcomes. Contrarily, a higher interest in anime was associated with favorable subjective well-being outcomes, and favorable joy outcomes. Similarly, regressions showed that a higher interest in manga was associated with several adverse (mental) health and some social disconnectedness outcomes. Contrary, it is associated with lower objective social isolation. Moreover, it is not significantly associated with subjective well-being outcomes, but significantly associated with the joy outcome frequency of hugs. Conclusion A higher interest in manga and anime was associated both with negative and positive outcomes. Particularly a higher interest in anime was associated with more favorable subjective well-being scores, laughing and hugging. In this respect, this topic needs to be approached in a very nuanced way.

Trends in alcohol-attributable morbidity and mortality in Germany from 2000 to 2021: A modelling study.

We aimed to assess: (i) trends in alcohol-specific - that is, fully attributable - morbidity and mortality in the German adult population aged 15-69 between 2000 and 2021; and (ii) changes in alcohol-attributable disease burden - that is, fully and partially alcohol-attributable categories - for 2006, 2012, 2018 and 2021. Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol-attributable fractions were estimated for males and females by age groups (15-29, 30-49, 50-69 years) using the comparative risk assessment methodology. For males and females, the age-standardised rate of alcohol-specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol-specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age-standardised alcohol-attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age-standardised alcohol-attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all-cause morbidity/mortality decreased between 2006 and 2021. The declines in alcohol-attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend.

The implications of policy modeling assumptions for the projected impact of sugar-sweetened beverage taxation on body weight and type 2 diabetes in Germany

BackgroundEvaluating sugar-sweetened beverage (SSB) taxation often relies on simulation models. We assess how assumptions about the response to SSB taxation affect the projected body weight change and subsequent health and economic impacts related to type 2 diabetes mellitus (T2DM) using Germany as an example.MethodsIn the main analysis, we estimated changes in energy intake by age and sex under a 20% value-added tax on SSBs in Germany using marginal price elasticities (PE) and applied an energy equilibrium model to predict body weight changes. We then quantified the impact of several assumption modifications: SSB own-PE adjusted for consumption (M1)/based on alternative meta-analysis (M2); SSB consumption adjusted for underreporting (M3); substitution via marginal (M4a) or adjusted (M4b) cross-PE/as % of calorie change (M4c). We also assessed scenarios with alternative tax rates of 10% (S1) or 30% (S2) and including fruit juice (S3). We calculated overweight and obesity rates per modification and scenario. We simulated the impact on T2DM, associated healthcare costs, and disability-adjusted life years (DALYs) over the lifetime of the 2011 German adult population with a Markov model. Data included official demographics, national surveys, and meta-analyses.ResultsA 20% value-added tax in Germany could reduce the number of men and women with obesity by 210,800 [138,800; 294,100] and 80,800 [45,100; 123,300], respectively. Over the population’s lifetime, this would lead to modest T2DM-related health and economic impacts (76,700 DALYs [42,500; 120,600] averted; €2.37 billion [1.33; 3.71] costs saved). Policy impacts varied highly across modifications (all in DALYs averted): (M1) 94,800 [51,500; 150,700]; (M2) 164,200 [99,500; 243,500]; (M3) 52,600 [22,500; 91,100]; (M4a) -18,100 [-111,500; 68,300]; (M4b) 25,800 [-31,400; 81,500]; (M4c) 46,700 [25,300; 77,200]. The variability in policy impact related to modifications was similar to the variability between alternative policy scenarios (all in DALYs averted): (S1) 26,400 [9,300; 47,600]; (S2) 126,200 [73,600; 194,500]; (S3) 342,200 [234,200; 430,400].ConclusionsPredicted body weight reductions under SSB taxation are sensitive to assumptions by researchers often needed due to data limitations. Because this variability propagates to estimates of health and economic impacts, the resulting structural uncertainty should be considered when using results in decision-making.

General and dermatological population's use and acceptance of digital health in Germany - a representative survey.

Adoption and acceptance of digital health services (DHS) in the German population and in persons with skin diseases is unclear. Both factors were analyzed in this survey. A standardized survey with items on digital competences and attitudes, use and acceptance of DHS was applied to a representative sample of the German adult population. Bivariate and multivariate analyses were conducted. Out of 2,101 participants, 29.9% reported having had skin diseases in the last 12months. Among them, adoption and acceptance were at 43.6% and 52.3%, respectively. Both values are significantly higher compared to participants without skin diseases (29.2%; p<0.01 and 45.5%; p<0.01). 18.9% of participants with a skin disease used digital diagnostic support, but only 9.7% applied it for a skin disease (p<0.01). For all participants, with and without skin disease, the DHS most commonly used were passive health monitoring (14.3%) and diagnostic support (11.5%), telemedicine was least used (4.7% video-consultation, 2.5% store-and-forward). Use and acceptance were associated with young age, education, low data privacy concerns, digital confidence, having a skin disease, and high severity of skin disease. DHS for skin diseases are used rarely but have a high potential.

German adult population norm values of the short Warwick Edinburgh mental well-being scale (SWEMWBS)

PurposeThe Warwick-Edinburgh Mental Well-Being Scale represents an internationally established inventory to assess population mental well-being. Particularly the short form (SWEMWBS) is recommended for use in Mental Health Surveillance. In the present study, we present normative data of the SWEMWBS for the German adult population.MethodsData from the telephone survey German Health Update (GEDA) in 2022 representative of the German adult population (48.9% women, 18–98 years) was processed to estimate SWEMWBS percentile norm values, T-values, z-values and internationally comparable logit-transformed raw scores for the total sample (N = 5,606) as well as stratified by sex, age group and sex with age group combinations.ResultsThe average mental well-being was comparable to that of other European countries at M = 27.3 (SD = 4.0; logit-transformed: M = 24.79, SD = 3.73). To provide a benchmark, the cut off for low well-being was set at the 15th percentile (raw score: 23; logit-transformed: 20.73), for high well-being at the 85th percentile (raw score: 32; logit-transformed: 29.31).ConclusionThe present study provides SWEMWBS norm values for the German adult population. The normative data can be used for national and international comparisons on a population level to initiate, plan and evaluate mental well-being promotion and prevention measures.

Food for future: The impact of menu design on vegetarian food choice and menu satisfaction in a hypothetical hospital setting

Daily food choices do not only affect our health but also the environment in important ways. Food choice architecture can help to nudge people towards more healthy and sustainable food options. The current research explores the influence of menu design strategies on food choices and satisfaction in a hypothetical hospital setting. Specifically, we systematically tested the effect of vegetarian option availability, menu category framing, and health recommendation inclusion on hypothetical food choice and satisfaction, conducting two large online studies representative of the German adult population that consumes meat at least once a week (Study 1: N = 991; Study 2: N = 989). Both studies were based on a menu from a German university hospital. Results revealed that increasing the availability of vegetarian options increased vegetarian food choices. Neutral menu descriptions had no impact, whereas health recommendations that were presented in form of a visual appeal slightly increased vegetarian dish choices. Importantly, the research also considered menu satisfaction, revealing no main effects of availability, framing and health recommendation. Only when a health recommendation was added to a menu with high availability of vegetarian options, satisfaction was decreased. The findings suggest that menu design elements could modestly influence food choices and satisfaction among meat-eaters in healthcare settings, warranting further investigation with hospital patients.

Epidemiology and Treatment of Patients With Primary Open Angle Glaucoma in Germany: A Health Claims Data Analysis.

Based on a large administrative database of German claims data, our study provides current estimates of the prevalence and incidence of primary open angle glaucoma (POAG) in Germany and describes selected outcomes for prevalent patients with POAG. To estimate the prevalence and incidence of POAG in Germany, to describe the patient population in terms of comorbidity burden, routine care, and overall healthcare resource utilization (HCRU) and associated costs, and to describe treatment patterns over time in patients undergoing relevant laser procedures. Based on anonymized German claims data, we carried out a retrospective, noninterventional study covering calendar years 2016-2021. For the adult German population (≥18y), we estimated a POAG 1-year prevalence of 1.70% and a 1-year incidence of 0.17% in 2018; both increased with age, peaking in 80- to 89-year-olds. Prevalence and incidence were lower in 2020 (1.65% and 0.16%, respectively), the first year of the SARS-CoV-2 pandemic. Most patients solely received topical treatment. Most surgically treated patients underwent laser trabeculoplasty, followed by laser iridotomy, trabeculectomy, and filtration operations with implant. In patients undergoing laser trabeculoplasty, the treatment regimen was nearly unchanged in the second year after, compared with 2 years before the procedure. Multimorbidity was commonly observed; 75.5% of patients had arterial hypertension and 50.0% had disorders of lipoprotein metabolism and other lipidemias, compared with 60.1% and 39.2%, respectively, in an age- and sex-matched control sample. Our study provides insights into epidemiology and routine care of POAG in Germany and HCRU in prevalent patients. There was little change in treatment regimens in patients who underwent laser trabeculoplasty, 2 years after the procedure. Most patients were multimorbid highlighting the need for comprehensive care.

Sociodemographic and behavioural differences between frequent and non-frequent users of convenience food in Germany.

Convenience foods are a double-edged sword in that they provide quick and easy nutrition but may promote non-communicable diseases related to excess intakes of sugar, fat, and salt. To inform the German national reduction and innovation strategy for less sugar, fat, and salt in processed foods, the present study sought to analyse the consumption frequency of selected convenience foods and to determine sociodemographic and behavioural factors that characterise frequent users. In a representative computer-assisted telephone interview survey in the adult German population (N = 3,997) conducted in 2018, consumption frequency of 21 convenience foods was assessed. To characterise frequent in contrast to non-frequent users, data on sociodemographics and behavioural aspects were compared. Statistical analyses comprised chi-square tests with Bonferroni correction as well as Spearman's rank correlation. Cramer's V was used to determine the strength of an association. Overall and among frequent users (7.7% of the sample) sweet convenience foods and savoury cooking aids were consumed most frequently. Around 75% of the participants indicated little-to-no consumption of 19 of the 21 convenience foods. Male gender (p < 0.001), younger age (p < 0.001), and not having a high level of education (p = 0.017) were identified as key characteristics of frequent users. Furthermore, frequent users were more likely than non-frequent users to live in a family household (p = 0.003) or without a partner (p < 0.001), and to work in shifts (p = 0.002). Additionally, they showed significantly lower cooking skills (p < 0.001). Public health interventions to limit excess intakes of sugar, fat, and salt from convenience food in Germany should target people of male gender, younger age, and having a lower level of education. On the behavioural side, developing the skills to cook from scratch emerged as major point of focus. Simultaneously, reformulation of the food offer should continue in order to help transition to a more health-promoting food environment.

Translation and Validation of the German Version of the Ikigai-9

Background: The Japanese concept of “ikigai” embodies the feeling of having a meaningful purpose in life. It is associated with several positive outcomes. This study aimed to translate and validate the German version of the Ikigai-9 scale (Ikigai-9-G)—and ikigai scores for certain groups of interest were presented. Methods: Data were taken from a quota sample of the German adult population aged 18 to 74 years (n = 5000; representative in terms of age, sex, and state). Data were collected in August/September 2023. The translation process was conducted in accordance with the existing guidelines. Reliability (Cronbach’s alpha; McDonald’s omega) was assessed. Moreover, we evaluated the structure’s soundness using confirmatory factor analysis for construct validity and examined concurrent validity by exploring pairwise correlations between the Ikigai-9-G with life satisfaction, happiness, health-related quality of life, depressive symptoms, and anxiety symptoms. Additionally, we presented ikigai scores for specific sociodemographic groups of interest. Results: Cronbach’s alpha for the Ikigai-9-G equaled 0.88. The results of confirmatory factor analysis supported the original three-factor model as initially proposed. A higher sense of ikigai was associated with less depressive symptoms (r = −0.43, p &lt; 0.001), less anxiety symptoms (r = −0.39, p &lt; 0.001), higher health-related quality of life (r = 0.42, p &lt; 0.001), higher happiness levels (r = 0.62, p &lt; 0.001), and higher satisfaction with life levels (r = 0.57, p &lt; 0.001). Conclusion: The Ikigai-9 scale is a psychometrically sound tool offering the possibility for assessing ikigai among German speakers. Additional translation and validation studies are required to facilitate comparisons across different countries.

Knowledge about age-related eye diseases in the general population in Germany

BackgroundWith a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions.MethodsKnowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations.ResultsReplies were correct for a median of 9 out of 16 (range 2 – 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011).ConclusionsKnowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.

Toward a representative assessment of competencies for a healthy, physically active lifestyle in the German population: development and validation of a short version of the physical activity-related health competence questionnaire (PAHCO_12)

Representative studies assessing behavior-oriented determinants for physically active lifestyles in the German adult population are lacking due to the absence of validated assessment instruments. Drawing on the physical activity-related health competence (PAHCO) model, the goal of the present study was to develop and evaluate a short version of PAHCO differentiating between the three sub-competencies ’movement competence’, ’control competence’, and ’self-regulation competence’. In the first step, we reduced the number of items from existing PAHCO-related questionnaires, while adjusting them for a telephone survey mode. In the second step, we validated this 12-item version with N = 3986 adults between 18 and 97 years (57.0 ± 18.2 years; 52.0% male) within the representative survey “German health Update” (GEDA 2023). We also gathered information about participants’ age, gender, education, leisure-time physical activity, and self-reported health. The psychometric analyses revealed satisfactory item statistics. Confirmatory factor analyses suggested a model variant in which two items showed theory-conform parallel loadings on a second sub-competence (comparative fit index [CFI] = 0.924, root mean square error of approximation [RMSEA] = 0.073, standardized root mean square residual [SRMR] = 0.044). The latent sub-competencies were significantly related to physical activity (0.20 ≤ β ≤ 0.27) and health (0.50 ≤ β ≤ 0.65), thus indicating criterion validity. The factor structure turned out to be invariant across age, gender, and educational levels. In summary, this study gained initial insights about the reliability and validity of a 12-item version of the PAHCO questionnaire. We recommend the instrument for use within representative surveys, for initial screening, the reporting of descriptive trends, or secondary outcomes of a trial.

Temporal stability of optimism and pessimism (LOT-R) over 6 years in the general population.

The aims of this study were to examine changes in habitual optimism over a six-year period and to analyze the relationship between changes in optimism and changes in other quality of life-related variables. A randomly selected community sample of the German adult general population (N = 4,965) was surveyed twice, with a time interval of 6.04 years. During the course of the 6 years, the mean score of the LOT-R total scale improved (effect size d = 0.11). The temporal stability in terms of the test-retest correlation was r = 0.61 for the total sample. There were only marginal gender differences in this temporal stability, however, the stability in the oldest age group ≥70 years (r = 0.50) was lower than the stability of the other age groups. The cross-sectional correlations showed clear relationships between optimism on the one hand and quality of life, life satisfaction, social support, and low levels of anxiety and physical complaints on the other. The corresponding longitudinal correlations between changes in optimism and changes in the other variables were less pronounced, but in the same direction. The study confirmed the applicability of the LOT-R in longitudinal studies. In samples with participants of 70 years and above, the limited stability in the optimism assessments needs to be considered in clinical practice and epidemiologic research.

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples.

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Associations between body mass index and smoking behaviour: A cross-sectional study of the German adult population

BackgroundBoth smoking and high body weight are risk factors for disease, hence, the association between smoking and body weight is an important health issue. Furthermore, concern about weight gain after quitting smoking is for many smokers a barrier to smoking cessation. The present study aims to explore the association between body mass index (BMI) and current tobacco smoking status in the population of Germany, and smoking and quitting behaviour amongst smokers (and recent ex-smokers =<12 months since quitting). MethodsCross-sectional analysis of two waves of data collected from March through June 2021 through a representative face-to-face household survey in Germany (N = 3 997 respondents aged ≥18). The associations between smoking and quitting behaviours and BMI were analysed through four regression models adjusted for socio-demographic, socio-economic, and smoking characteristics of respondents. ResultsLong-term ex-smokers (>= 12 months since quitting smoking) were more likely to have a higher BMI compared to never smokers (β = 0.64, 95% confidence interval (CI) = 0.10–1.19). There was no statistically significant association between current smoking status or recent ex-smoking status and BMI (β = -0.29,95 %CI = -0.75–0.17 and β = -0.53, 95 %CI = -2.45–1.40). Among current smokers, no statistically significant association was found between BMI and the motivation to stop smoking (OR = 1.01, 95 %CI = 0.99–1.03). Neither number of cigarettes smoked a day nor outcome of most recent quit attempt were related to BMI (β = 0.01, 95 %CI = -0.04–0.05 and OR = 0.41, 95 %CI = 0.05–3.05). ConclusionIn the German population long-term ex-smoking but not current and recent ex-smoking was associated with increased BMI. Future research should further explore the association between smoking behaviour and abdominal obesity, preferably using a more accurate measure for abdominal obesity than BMI.

Nutritional status of flexitarians compared to vegans and omnivores - a cross-sectional pilot study

BackgroundIn the Western world, there has been a notable rise in the popularity of plant-based, meat-reduced flexitarian diets. Nevertheless, there is insufficient data on the nutritional status of individuals following this dietary pattern. The aim of this study was to investigate the intake and endogenous status of various nutrients in a healthy German adult study population consisting of flexitarians (FXs), vegans (Vs) and omnivores (OMNs).MethodsIn this cross-sectional study, dietary intake of 94 non-smoking adults (32 FXs, 33 Vs, 29 OMNs) between 25 and 45 years of age was assessed using 3-day dietary records. In addition, blood samples were collected to determine different endogenous nutrient status markers.Results32%, 82% and 24% of the FXs, Vs, and OMNs respectively reported using dietary supplements. In the FXs, intake of total energy as well as macronutrients and most micronutrients were within the reference range. FXs had higher intakes of fiber, retinol-equ., ascorbic acid, folate-equ., tocopherol-equ., calcium, and magnesium compared to OMNs. However, cobalamin intake in FXs (2.12 µg/d) was below the reference (4 µg/d). Based on 4cB12, 13% of FXs showed a cobalamin undersupply [< -0.5 to -2.5] compared to 10% of OMNs, and 9% of Vs. The median 25(OH)D serum concentrations in FXs, Vs and OMNs were 46.6, 55.6, and 59.6 nmol/L. The prevalence of an insufficient/deficient vitamin-D status [< 49.9 nmol 25(OH)D/L] was highest in FXs (53%), followed by Vs (34%) and OMNs (27%). In FXs and Vs, the supplement takers had better cobalamin and vitamin-D status than non-supplement takers. Anemia and depleted iron stores were found only occasionally in all groups. In women, the prevalence of pre-latent iron deficiency and iron deficiency was highest in FXs (67%) compared to Vs (61%) and OMNs (54%).ConclusionOur findings indicated that all three diets delivered sufficient amounts of most macro- and micronutrients. However, deficiencies in cobalamin, vitamin-D, and iron status were common across all diets. Further studies are needed to investigate the nutrient supply status and health consequences of meat-reduced plant-based diets. The study was registered in the German Clinical Trial Register (number: DRKS 00019887, data: 08.01.2020).

Projected health and economic impacts of sugar-sweetened beverage taxation in Germany: A cross-validation modelling study.

Taxes on sugar-sweetened beverages (SSBs) have been implemented globally to reduce the burden of cardiometabolic diseases by disincentivizing consumption through increased prices (e.g., 1 peso/litre tax in Mexico) or incentivizing industry reformulation to reduce SSB sugar content (e.g., tiered structure of the United Kingdom [UK] Soft Drinks Industry Levy [SDIL]). In Germany, where no tax on SSBs is enacted, the health and economic impact of SSB taxation using the experience from internationally implemented tax designs has not been evaluated. The objective of this study was to estimate the health and economic impact of national SSBs taxation scenarios in Germany. In this modelling study, we evaluated a 20% ad valorem SSB tax with/without taxation of fruit juice (based on implemented SSB taxes and recommendations) and a tiered tax (based on the UK SDIL) in the German adult population aged 30 to 90 years from 2023 to 2043. We developed a microsimulation model (IMPACTNCD Germany) that captures the demographics, risk factor profile and epidemiology of type 2 diabetes, coronary heart disease (CHD) and stroke in the German population using the best available evidence and national data. For each scenario, we estimated changes in sugar consumption and associated weight change. Resulting cases of cardiometabolic disease prevented/postponed and related quality-adjusted life years (QALYs) and economic impacts from healthcare (medical costs) and societal (medical, patient time, and productivity costs) perspectives were estimated using national cost and health utility data. Additionally, we assessed structural uncertainty regarding direct, body mass index (BMI)-independent cardiometabolic effects of SSBs and cross-validated results with an independently developed cohort model (PRIMEtime). We found that SSB taxation could reduce sugar intake in the German adult population by 1 g/day (95%-uncertainty interval [0.05, 1.65]) for a 20% ad valorem tax on SSBs leading to reduced consumption through increased prices (pass-through of 82%) and 2.34 g/day (95%-UI [2.32, 2.36]) for a tiered tax on SSBs leading to 30% reduction in SSB sugar content via reformulation. Through reductions in obesity, type 2 diabetes, and cardiovascular disease (CVD), 106,000 (95%-UI [57,200, 153,200]) QALYs could be gained with a 20% ad valorem tax and 192,300 (95%-UI [130,100, 254,200]) QALYs with a tiered tax. Respectively, €9.6 billion (95%-UI [4.7, 15.3]) and €16.0 billion (95%-UI [8.1, 25.5]) costs could be saved from a societal perspective over 20 years. Impacts of the 20% ad valorem tax were larger when additionally taxing fruit juice (252,400 QALYs gained, 95%-UI [176,700, 325,800]; €11.8 billion costs saved, 95%-UI [€6.7, €17.9]), but impacts of all scenarios were reduced when excluding direct health effects of SSBs. Cross-validation with PRIMEtime showed similar results. Limitations include remaining uncertainties in the economic and epidemiological evidence and a lack of product-level data. In this study, we found that SSB taxation in Germany could help to reduce the national burden of noncommunicable diseases and save a substantial amount of societal costs. A tiered tax designed to incentivize reformulation of SSBs towards less sugar might have a larger population-level health and economic impact than an ad valorem tax that incentivizes consumer behaviour change only through increased prices.

Wisdom capacities in people with and without chronic mental health problems: A representative survey on a general German adult population

Wisdom capacities are important for coping with difficult and ambiguous life situations. People with chronic mental health problems often have problems in coping with life problems. Until now, there are no comparative and representative data on the distribution of wisdom capacities people with and without chronic mental health problems. Identifying strengths and limitations in wisdom capacities in both groups will give a basis for specific focus in wisdom training in clinical settings and public health. This cross-sectional observation study examined a German population with a representative sample of 2505 persons aged 16 &amp;ndash; 95 years in 2019. Sociodemographic data as well as chronic mental illnesses data were collected, and wisdom capacities were assessed by the 12-WD Wisdom Scale. The surveys were carried out using interviews and self-report questionnaires at the respondents&amp;rsquo; homes by an experienced social research company. The wisdom capacities value and problem relativization, as well as emotion acceptance were scored the highest by people with and without chronic mental health problems. Uncertainty tolerance, sustainability and perspective change received the lowest scores. People with chronic mental health problems had slightly lower overall wisdom affinity (M = 7.00, SD = 1.41 on a scale of 0 &amp;ndash; 10) as compared to mentally healthy people (M = 7.7, SD = 1.38). Specifically, persons with chronic mental health problems reported the lowest ratings on wisdom capacities requiring active cognitive reflections (sustainability, perspective change, and uncertainty tolerance). In conclusion, since there are rather small quantitative differences between persons with and without chronic mental health problems, the wisdom concept seems appropriate to be applied to all individuals, regardless of the severity and nature of mental health problems. Wisdom enhancement, for instance, by means of wisdom training, may be focused on wisdom capacities which were rated comparably low, including perspective change, uncertainty tolerance and sustainability.

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population.

The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population. In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values. Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning. The OPD-SQS is a viable measure to assess personality functioning in the general population.