German Population Research Articles

Age differences in the treatment of lung cancer-a cohort study among 42,000 patients from Germany.

We aimed to describe treatment of lung cancer patients in Germany based on health claims data, focusing particularly on differences by age. Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we identified lung cancer patients diagnosed in 2015-2018 based on a previously developed algorithm and followed them until death, end of continuous insurance or end of 2020. We described initial treatment patterns after diagnosis and survival, stratified among others by age. We included 42,629 incident lung cancer patients (58% male). Surgery within three months after diagnosis was performed in 36%, 31%, 29% and 18% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Among patients without surgery, systemic therapy was administered in 77%, 72%, 54% and 25% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Monoclonal antibodies were administered in 15-30% of patients across age groups, and 4% to 15% received protein kinase inhibitors. Overall, 21% of patients remained untreated. In the age groups < 50, 50-69, 70-79 and ≥ 80, this proportions was 9%, 12%, 22% and 48%, respectively. In conclusion, our study provides a comprehensive overview of the therapy of lung cancer patients in Germany and quantitatively demonstrates the considerable differences between age groups. In terms of clinical cancer registration, the results are useful to estimate the completeness of data for the different types of treatment.

Trends in the use of thyroid diagnostics and treatments between 2008 and 2019 in Germany

Following implementation of a national prevention program against iodine deficiency-related disorders in 1993 in Germany, the prevalence of thyroid disorders declined, but aggregated drug dispensation data suggested a recent increase in thyroid hormone use. We aimed to systematically investigate trends in the use of thyroid diagnostic and treatment measures between 2008 and 2019 in Germany. Using the GePaRD database (claims data from ~ 20% of the German population), we determined the annual age-specific and age-standardized prevalence of the use of thyroid diagnostics (thyroid-stimulating hormone (TSH) measurement, thyroid ultrasound, scintiscan, biopsy) and treatment (medication, surgery, radioiodine therapy) from 2008 to 2019 stratified by sex. Between 2008 and 2019, the age-standardized prevalence of TSH measurement increased by 44% in males (from 165 to 238 per 1,000 persons) and by 31% in females (from 134 to 176 per 1,000). The prevalence of thyroid ultrasound use showed no clear time trend, while there was a decrease in the prevalence of scintiscan use (males/females: decrease by 42/43%) and biopsy (males/females: decrease by 42/34%). The prevalence of levothyroxine use increased by ~ 31% both in males (from 36 to 47 per 1,000) and females (from 134 to 175 per 1,000), while the prevalence of thionamide use, iodine use, thyroidectomy, and radioiodine therapy decreased. Our study suggests a continued decline in the prevalence of clinically significant thyroid disorders between 2008 and 2019. The substantial increase in the prevalence of TSH measurement and levothyroxine use during this time period might indicate overuse of diagnostics and overtreatment, warranting further investigation.

Quality of life of patients with neurofibromatosis 1-Physical disability does not necessarily result in poor mental health.

Neurofibromatosis 1 (NF1) is a chronic neurocutaneous disease known to profoundly affect quality of life (QoL). We have performed an analysis of disease severity, mental and physical QoL and compare the different subclasses among patients with neurofibromatosis 1 (NF1). We conducted a prospective analysis of 89 NF1 patients between January 2016 and March 2018. Data sourced from local records including demographic information, employment status, education level, and marital status. All patients completed 36-Item Short Form Health Survey (SF-36) and additionally the numerical pain rating scale (NPS). Patients were stratified based on severity of NF1, visibility and disease severity. Among 89 patients, severity was classified as grade 4 was identified in 42 (47.2%), moderate in 17 (19.1%), mild in 23 (25.8%) and minimal in 7 (7.9%) cases. According to visibility scale, severe grade 3 was found in 28 (31.5%), moderate grade 2 in 26 (29.2%) and mild grade in 35 (39.3%) cases. SF-36 data, except for pain, showed significantly lower values, if compared to the standard German population (P < 0.001, physical component summary P = 0.045). Sex, marital status and education level did not significantly influence results. Employment was significantly associated with better mental and physical status (P = 0.028 and P = 0.01 respectively) and age >40 was linked to lower physical (P = 0.027) but not mental component scores (P = 0.362). The numerical pain rating scale indicated pain levels of 7-10 in 9 cases (10,1%), 5-6 in 10 patients (11.2%), 1-4 in 26 patients (29.2%) and no pain in 44 cases (49.4%). Physical component scores significantly differed across different NPS grades (P < 0.001) but not in mental component scores (P = 0.06). Finally, no significant differences were found in mental component scores across severity or visibility grades. Severity and visibility grades of patients with NF1 may not necessarily result in poor mental health. Symptomatic treatment should be considered even for severely disabled patients as they may have comparable QoL to less severely affected patients with NF1. Employment was linked to better quality of life outcomes in our findings.

Exploring the Spectrum of Comorbidities Associated with Primary Aldosteronism: Insights from a Large Real-World Case-Control Study

Background: Primary aldosteronism (PA) is a common cause of endocrine hypertension, characterized by excessive aldosterone secretion leading to hypertension, hypokalemia, and metabolic alkalosis. While historically diagnosed based on this classic triad of symptoms, current understanding reveals a more nuanced presentation. This study aimed to investigate the prevalence of PA-associated diseases in a large German population. Methods: Medical records from the IQVIATM Disease Analyzer database were analyzed retrospectively. PA patients (n = 860) were matched with non-PA individuals (n = 4300) by age and sex. Associations between PA and predefined chronic diseases were examined using multivariable logistic regression. Results: PA was significantly associated with hypokalemia (7.8% vs. 1.6%, odds ratio (OR): 3.45; 95% confidence intervals (CIs): 2.41–4.96), hypertension (56.1% vs. 28.5%; OR: 2.37; 95% CIs: 2.00–2.81), hepatic steatosis (11.3% vs. 3.0%; OR: 1.85; 95% CIs: 1.34–2.57), gout (8.3% vs. 2.2%; OR: 1.64; 95% CIs: 1.15–2.35), chronic kidney disease (6.3% vs. 2.2%; OR: 1.59; 95% CIs: 1.10–2.31), diabetes mellitus not otherwise specified (7.9% vs. 2.9%; OR: 1.49; 95% CIs: 1.06–2.09), obesity (13.5% vs. 5.1%; OR: 1.38; 95% CIs: 1.05–1.82), and depression (14.8% vs. 6.2%; OR: 1.37; 95% CIs: 1.07–1.77). Conclusions: While the study design had limitations, including reliance on ICD codes for diagnosis, these findings underscore the critical need for early detection and personalized management strategies for PA to reduce associated risks and improve patient outcomes.

Incidence of type 2 diabetes by occupation – 10-year follow-up of the Gutenberg Health Study

Abstract Background In order to implement targeted type 2 diabetes (T2D) prevention measures for the workplace, it is important to identify high-risk occupations. Most previous studies examine the association between T2D and occupation cross-sectionally, but longitudinal studies are missing. This study aims to investigate the 10-year incidence of T2D in the working population of a German cohort and identify occupations with an increased risk. Methods Data from the population-based Gutenberg Health Study (GHS) were used to examine occupation at baseline (2007-2012) and T2D incidence at the 10-year follow-up. Occupational phases were coded into categories according to the KldB 2010. T2D was defined as either a physician-diagnosed T2D, HbA1c-level ≥6.5% or use of antidiabetic drugs. Age- and sex-standardised incidence and 95% confidence intervals (CI) were calculated for occupational groups based on the age- and sex-distribution of the German population. Standardised incidence ratios (SIR) and 95% CI were calculated using the incidence in the total GHS working population as the reference. Results Of 8130 workers at baseline, 45.2% were female, the mean age was 48.4 years and 4.5% had prevalent T2D. 388 cases occurred between baseline and the 10-year follow-up within the subgroup of persons without prevalent T2D at baseline and with follow-up data (n = 5954). The standardised incidence was 6.9%. “Food production and processing” (20.7%), “cleaners” (16.5%) and “drivers and mobile plant operators” (14.8%) had the highest standardised incidences. Compared to the total working population, we observed a threefold increased SIR for employees in “food production and processing” (3.0, 95% CI 1.8-4.7) and a two times higher SIR for “cleaners” (2.2, 95% CI 1.0-4.7) and “drivers and mobile plant operators” (2.2, 95% CI 1.3-3.3). Conclusions We identified occupations with an increased risk of T2D. Preventive measures and etiological research on work-related risks should focus on these occupations. Key messages • The highest standardised incidence was observed in the occupational groups “food production and processing”, “cleaners” and “drivers and mobile plant operators”. • Targeted prevention measures for type 2 diabetes in the workplace should focus on these occupational groups with increased incidence.

Sex differences in cardiovascular disease in relation to socioeconomic position in the NAKO study

Abstract Background Low socioeconomic position (SEP) is associated with cardiovascular disease (CVD) risk; yet, the underlying pathways are not fully clear and may affect sexes differently. We investigated sex differences in the relationship of SEP with prevalent CVD, cardiovascular risk factors (CRF) and estimated cardiovascular risk in a contemporaneous German population. Methods Data derived from the baseline examination of 204,780 participants in population-based German National Cohort (NAKO). Logistic, multinomial, and linear regression models were used to estimate sex-specific odds ratios (OR) and beta-coefficients with 95% confidence intervals (CI) of CVD, CRF and very high-risk score (SCORE2 ≥7.5% (age 40-49 years) or ≥ 10% (age 50-69 years)) associated with educational attainment and relative income. Women-to-men ratios of ORs (RORs) with 95%-CI were estimated. Results In women compared to men, low vs. high SEP was more strongly associated with obesity, overweight, self-reported myocardial infarction and hypertension, elevated blood pressure values, antihypertensive medication, and alcohol consumption, but less strongly related to smoking. In women with the lowest vs. highest educational level, the OR for a very high 10-year CVD risk was 3.61 (95%-CI 2.88; 4.53), compared to 1.72 (95%-CI 1.51; 1.96) in men. The women-to-men-ROR was 2.33 (95%-CI 1.78; 3.05), attenuated after age-adjustments. For the comparison of low vs. high relative income, the odds of having a very high 10-year CVD risk was 2.55 (95%-CI 2.04; 3.18) in women, and 2.25 (95%-CI 2.08; 2.42) in men (women-to-men ROR, 1.31 (95%-CI 1.05; 1.63). Conclusions In both sexes, there was an inverse graded relationship between SEP and the likelihood of prevalent CVD and CRF, with stronger associations in women than in men. Although women had a lower estimated 10-year CVD risk compared to men, the likelihood of having a very high CVD risk conferred by low SEP vs. a high one was higher in women than in men.

Evaluating Patient Participation in Clinical Trials for CLL and SLE in Germany-A Mixed-Methods Study on Enrollment Potential Based on Claims Data.

Background: In recent years, the pharmaceutical industry in Germany has faced a significant decline in the number of clinical trials conducted. Methods: This study evaluates patient participation in clinical trials for oncology and chronic diseases in Germany, integrating quantitative and qualitative research. Data from the Institute for Applied Health Research Berlin (InGef (Institut für angewandte Gesundheitsforschung, Berlin, Germany)), covering about 88% of the German population, and expert interviews were used. Results: In 2022, 84.6% of 47,305 systemic lupus erythematosus patients (SLE) and 11.9% of 102,300 chronic lymphocytic leukemia patients (CLL) received guideline-based care based on study definitions. Eligibility for clinical trials between 2017 and 2022 was estimated for 8272 SLE and 886 CLL patients, with the actual enrolment of 21 of 2221 SLE patients and 86 of 340 CLL patients reflecting the respective potential. Conclusions: Findings indicate an unexploited potential to enroll patients with chronic diseases compared to the relatively higher enrolment rates observed for oncology diseases, such as CLL. Securing the continuation of clinical trials and utilizing the value of trial participation is of importance for strengthening Germany as an innovation hub and for ensuring that patients have timely access to medical innovations.

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.

Migration Medicine: infectious and non-infectious diseases

Approximately one third of the German population has a migration background.According to the federal office for migration, in 2022 around 2,7 million people have taken refuge or have immigrated to Germany, causing major challenges for our health system. In this article, important infectious diseases, and non-infectious conditions like hemoglobinopathies are presented. To date, especially the latter are not common in Germany and must therefore move more into focus when taking care of migrants. Furthermore, new treatment options for hemoglobinopathies have been approved in the last couple of years, starting with the introduction of Luspatercept a few years ago for Beta-Thalassemias and in 2023 the introduction of Voxelotor for sickle cell disease. In 2024 the gene therapy with Exagamglogen-Autotemcel using the CRISPR/Cas molecular scissor was authorized as a new promising treatment for both conditions.

Exploratory Data Analyses Indicate an Overuse of Dietary Supplements among Male Gym Users in Germany

Background: Dietary supplements (DS) are very popular with the general population, physically active people and professional athletes are often taken without professional advice. Adverse effects on consumer health are increasingly being reported and there are concerns about overdoses of certain nutrients. There are initial indications that some groups of people have a higher affinity to DS than others. It appears that the type of sport and possibly gym membership could have an influence on consumer behaviour. Therefore, this study aimed to identify high consumer groups of DS among the general population in Germany. Methods: The consumption of DS was assessed using an online questionnaire including information about physical activity, gym membership and the consumption and intake doses of DS. Completed questionnaires were returned by 244 participants (m=153, f=91; 30.7±10.4 years SD). The answer options were valued, and subjects were categorized in low, average and high consumers (indicating overdosing). A configural frequency analysis was performed using the independent variables gender, gym membership, consumption. The configurations were tested with an exact binomial test and the p-value was corrected according to Bonferroni (0.05/12=0.0042). Results: Three significant configurations were found (p≤0.0042). The configuration, ‘male-gym member-average consumption’ as well as ‘male-gym member-high consumption’ were significantly overrepresented. Male gym members with low consumption behaviour were significantly underrepresented. Conclusion: This analysis suggests that male gym users in the German population have a higher risk of excessive DS consumption than other subgroups. Awareness campaigns regarding the risk of intake and overconsumption of DS can be targeted to high-risk groups. Due to the small sample size and the different types of fitness gyms, further studies are needed to make clearer statements and identify more precise risk groups.

Epidemiology and Healthcare of Juvenile and Late-Onset Acne: Claims Data Analysis.

Acne is the most frequent chronic inflammatory skin condition in adolescence but occurs also in later age. Our study aimed to characterise the epidemiology, geographical distribution, comorbidity and healthcare of acne juvenilis (AJ) and acne tarda (AT). Statutory health insurance (SHI) data from 2016 to 2020 were analysed. Prevalence rates, including geographical distribution, comorbidities and drug use by specialists group, were measured. In 2020, the prevalence of acne among adults was 1.50% (AT > 25years) and among adolescents was 3.88% (AT ≤ 25years). The highest prevalence (13.02%) was observed at the age of 17 years. Sex differences were higher in AT (73.80% in women) than in AJ (64.55% in women). Compared with non-affected persons, individuals with acne - in particular with AT - showed significantly higher rates of skin-related comorbidities, including folliculitis (rate ratio (RR) 8.89), pyoderma (RR 7.27) and rosacea (RR 5.53), and non-skin-related comorbidities, such as ovarian dysfunction (RR 2.36), rhinitis allergica (RR 1.84) and Crohn's disease (RR 1.79). Preferred systemic therapeutics prescribed were anti-infectives in AT (46.86%) and retinoids in AJ (52.35%). In the majority of cases, dermatologists were involved in the treatment of acne (AT 65.77%; AJ 76.27%). The most commonly prescribed topical agents were adapalene with benzoyl peroxide (AT 87.72%; AJ 85.75%), while systemic isotretinoin (AT 81.20%; AJ 90.06%) was also a frequently used drug. General practitioners were more likely to prescribe anti-infectives, especially topical antibiotics such as chlortetracycline (AT 52.38%; AJ 44.44%) and systemic antibiotics, especially tetracycline (AT 58.33%; AJ 67.50%). Acne affects a relevant proportion of the German population not only in adolescence, and management of this inflammatory skin disease does not naturally follow medical guidelines or specialist recommendations. These findings emphasise the importance of specialised care and comprehensive therapeutic management that should also consider the exploration of comorbidities.

Broadcasting Law and Gospel: Paul Tillich's Wartime Ministry to Nazi Germany

Abstract During World War II, the German theologian Paul Tillich, then a professor at Union Theological Seminary, partnered with the United States’ organization Voice of America to deliver over 100 religious addresses in the German language into his homeland. In these broadcasts, Tillich utilized the Lutheran categories of Law and Gospel to identify and discuss the sins of the Nazis (and Hitler in particular) and to remind the German population that there was still hope in redemption. Remarkably, well before the war's end, Tillich argued for German collective guilt and the need for the atonement and expiation of the German people. He continually warned them of impending judgment and inescapable punishment – both human and divine – as the Allies advanced on the battlefield in a race toward Berlin. Yet Tillich often tempered this focus on judgment with an emphasis on the Gospel, the certain hope Germans have in God's salvation. This prism of Law and Gospel pervades the religious addresses. I will place these broadcasts in the context of the war, the wartime work of Voice in America, and what we know of other religious addresses delivered over the airwaves to Nazi Germany, to reveal how Tillich preached resistance to Nazi Germany.

Data Descriptor for “Understanding and Perception of Automated Text Generation among the Public: Two Surveys with Representative Samples in Germany”

With the release of ChatGPT, text-generating AI became accessible to the general public virtually overnight, and automated text generation (ATG) became the focus of public debate. Previously, however, little attention had been paid to this area of AI, resulting in a gap in the research on people’s attitudes and perceptions of this technology. Therefore, two representative surveys among the German population were conducted before (March 2022) and after (July 2023) the release of ChatGPT to investigate people’s attitudes, concepts, and knowledge on ATG in detail. This data descriptor depicts the structure of the two datasets, the measures collected, and potential analysis approaches beyond the existing research paper. Other researchers are encouraged to take up these data sets and explore them further as suggested or as they deem appropriate.

Assessment of psychological resilience in a large cohort of the general population: Validation and norm values of the RS-5.

Psychological resilience is known as a protective factor against mental health disorders for which valid measures are indispensable. The present work aims to evaluate the Resilience Scale-5 (RS-5) psychometrically, and provide norm values. Data from the Gutenberg Health Study (GHS), encompassing 7,496 participants aged 25 to 86, spanning the years 2017 to 2022, was used. Selectivity, item difficulty, internal consistency, construct and factor validity, as well as factorial invariance were tested. Additionally, correlations and associations with depression, anxiety, and sociodemographic factors were determined. Furthermore, norm values were provided. The RS-5 displayed robust psychometric properties. Participants reported an average resilience score of 28.94 (SD = 5.53, median = 30, IQR = 6, range = 5-35), with those aged ≥75 exhibiting the highest resilience levels (M = 30.21, SD = 5.75, median = 32, IQR = 7). The RS-5 displayed a very good model fit, affirming measurement invariance across sex and age decades. Construct validity found support through anticipated intercorrelations with related psychological constructs. Significant correlations (p < .001) linked higher resilience with female gender, advanced age, higher education, elevated household income, and diminished psychological distress. The RS-5 emerged as a reliable and economic instrument for assessing psychological resilience in individuals aged 25 to 86. The study unraveled distinct sociodemographic characteristics significantly tied to resilience levels within this cohort. In contributing recent norm values tailored to the German population, this research enhances the practical applicability of the RS-5 across diverse contexts and enriches our comprehension of the demographic nuances associated with psychological resilience.

Projections of anxiety disorder prevalence during and beyond the COVID-19 pandemic in Germany using the illness-death model.

Although there is now substantial evidence on the acute impacts of the COVID-19 pandemic on anxiety disorders, the long-term population impact of the pandemic remains largely unexplored. To quantify a possible longitudinal population-level impact of the pandemic by projecting the prevalence of anxiety disorders through 2030 among men and women aged up to 95 years in Germany under scenarios with varying impacts of the pandemic on the incidence of anxiety disorders. We used a three-state illness-death model and data from the Global Burden of Disease Study to model historical trends of the prevalence and incidence of anxiety disorders. The German population projections determined the initial values for projections. The COVID-19 incidence rate data informed an additional incidence model, which was parameterised with a wash-in period, delay, wash-out period, incidence increase level and decay constant. When no additional increase in the incidence during the pandemic waves during 2020-2022 was assumed, it was estimated that 3.86 million women (9.96%) and 2.13 million men (5.40%) would have anxiety disorders in 2030. When increases in incidence following pandemic waves were assumed, the most extreme scenario projected 5.67 million (14.02%) women and 3.30 million (8.14%) men with the mental disorder in 2030. Any increased incidence during the pandemic resulted in elevated prevalence over the projection period. Projection of anxiety disorder prevalence based on the illness-death model enables simulations with varying assumptions and provides insight for public health planning. These findings should be refined as trend data accumulate and become available.

Environment-related health risks, knowledge and awareness among people in precarious milieus: secondary data analysis from the German "Environmental Awareness Study".

Precarious milieus more frequently suffer from environmental risks and show lower environmental awareness and behavior than other milieus in the German population. This study investigates the factors that influence environmental awareness in precarious milieus and the roles of environmental knowledge and the perception of environment-related health burdens. A quantitative secondary data analysis of the German Environmental Awareness Study 2018 (N = 2017) was used to analyze the perception of environmental health burdens, environmental knowledge, and environmental awareness between precarious milieus (n = 190) and seven other milieus. One-way analysis of variance (ANOVA) and Bonferroni post hoc tests were used for this purpose. More in-depth analyses of the precarious milieus were carried out using multiple regression analyses. There were significant differences in the perceptions of environmental health burdens affected by rail-traffic noise and neighborhood noise. Furthermore, environmental knowledge in precarious milieus was significantly lower than in five out of the seven other milieus (all p < 0.001) and was significantly associated with environmental cognition and gender. Precarious milieus had higher environmental affect than established milieus but less than that of critical-creative milieus and young idealists (all p < 0.001). Environmental cognition and environmental behavior were significantly associated with environmental affect. Environmental cognition was significantly higher in precarious milieus than in established milieus and among young pragmatists but was lower than in critical-creative milieus and among young idealists (all p < 0.001). Environmental affect, environmental knowledge, and gender were significantly associated with environmental cognition. In precarious milieus, environmental behavior was significantly lower than in traditional milieus and critical-creative milieus and among young idealists (all p < 0.001) and was significantly associated with environmental affect. The differences in the perception of environmental health burdens, environmental knowledge, and environmental awareness among precarious milieus indicate that there is a need for specific education and support structures for these population groups. Further research is needed to determine what other factors within the precarious milieus influence environmental knowledge and awareness, as well as the skills needed to understand environmental information, which are included in the framework of environmental (health) literacy.

Estimating the Effective Size of European Wolf Populations.

Molecular methods are routinely used to estimate the effective size of populations (N e). However, underlying model assumptions are frequently violated to an unknown extent. Although simulations can detect sources of bias and help to adjust sampling strategies and analyses methods, additional information from empirical data can also be used to calibrate methods and improve molecular N e estimation methods. Here, we take advantage of long-term genetic and ecological monitoring data of the grey wolf (Canis lupus) in Germany, and detailed population genetic studies in Poland, Spain and Portugal to improve N e estimation strategies in this species, and species with similar life history traits. We first calculated N e from average lifetime reproductive success and detailed census data from the German population, which served as a baseline to compare to molecular estimates based on linkage disequilibrium and sibship frequency. This yielded a robust N e/N c estimation that we used to calibrate molecular estimates of German, Polish and Iberian wolf populations. The linkage disequilibrium method was strongly influenced by spatial genetic structure, much more than the sibship frequency method. When N e was estimated in local neighbourhoods, both methods yielded comparable results. Estimates of the metapopulation effective size seemed to correspond generally well with the sum of the estimates of local neighbourhoods. Overall, we found that the number of packs is a good proxy of the effective population size. Using this as a rule of thumb, we evaluated for all European wolf populations the N e 500 indicator and concluded that half of the European wolf populations do not yet fulfil this criterion.

The loneliness barometer 2024: methodology and selected results

Loneliness is arelatively new topic in the field of health and social policy. Apivotal requirement for the formulation of effective policies addressing loneliness in Germany lies in the access to comprehensive, longitudinal data.In 2024, the first "Loneliness Barometer" was conducted by the Loneliness Network Germany (KNE) at the Institute for Social Work and Social Pedagogy e. V. (ISS e. V.) on behalf of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ). It is areport on the long-term development of loneliness within the German population (18years and older), for which representative data from the German Socio-Economic Panel (SOEP, 1992-2021) were analysed. The loneliness barometer is also intended to provide evidence-based statements on the long-term development of loneliness burdens in Germany in the future.This article provides an insight into the decisions made in the development of the Loneliness Barometer methodology and presents selected key findings from the first Loneliness Barometer. Leveraging data from the German Socio-Economic Panel (SOEP), the Loneliness Barometer underscores the multifaceted disparities faced by individuals grappling with heightened loneliness levels. These disparities manifest across various domains: diminished health outcomes, constrained social and financial resources encompassing education and employment, reduced economic participation, curtailed political engagement and heightened scepticism towards democratic institutions. The article concludes with considerations of the limitations and future development possibilities of the Loneliness Barometer.

Out of pocket health-care services in Germany during pregnancy under consideration of migration and acculturation.

More than a quarter of the German population has a migration background (MB). As various studies in the healthcare sector have already shown, ethnic background and migration status can have an influence on individual patient care. The aim of our study was to evaluate whether there are differences in utilization of out of pocket health-care services and the consultation situation in the context of prenatal care, taking into account migration status, acculturation and socio-demographic aspects. In the period from 01.03.21-01.03.22, a total of 511 women in childbed at the University Women's Hospital Ulm were interviewed in a retrospective survey using a standardized questionnaire translated into 9 languages and asked about their prenatal care. Due to the COVID pandemic, the study had to be terminated after one year. Women with MB-particularly 1st generation migrant women-used significantly fewer out of pocket prenatal care services (p < 0.001) and felt less informed and counselled regarding costs and benefits of possible prenatal care examinations (p < 0.001) compared to women without MB. Consistent with these results, there were associations between the assimilation index (AI) of patients with MB and both utilization and perception of individual healthcare services. Our study indicates that even today there are still differences in the treatment and perception of various health services in the context of prenatal care between women with and those without MB.

Use of fixed-dose combinations for cardiovascular indications from 2018 to 2023: a nationwide population-based study.

Clinical guidelines support the use of fixed-dose combinations (FDC) for prevention of cardiovascular disease. Implementation of FDC into clinical care remains challenging, and current population-based data are scarce. Claims data on dispensed drugs in an outpatient care setting of approximately 87% of the German population were analysed regarding the use of FDC according to time, age of the insured persons, and active ingredients. The overarching trend for all FDC revealed a decrease from 77.3 defined daily doses per 1000 statutory health-insured (SHI) persons per day (DID) in the second half-year of 2018 (2018HY02) to 60.8 DID in the first half-year of 2023 (2023HY01) (Spearman ρ = -0.988; P < 0.001). The total DID for all antihypertensives (AHT) increased from 590.6 in 2018HY02 to 624.8 in 2023HY01 (ρ = 0.855; P = 0.002), but the DID for fixed-dose AHT (AHT-FDC) declined from 74.1 in 2018HY02 to 55.0 in 2023HY01 (ρ = -0.988; P < 0.001). Conversely, the use of all lipid-lowering agents (LLA) and LLA-FDC continuously increased: The total DID of all LLA rose from 92.5 in 2018HY02 to 134.4 in 2023HY01 (ρ = 1.000; P = 0.000), and for LLA-FDC from 3.1 in 2018HY02 to 5.5 DID in 2023HY01 (ρ = 0.915; P < 0.001). AHT-FDC and LLA-FDC were less frequently dispensed to patients at least 80 years than to patients less than 80 years. Dispensing of multiple purpose FDC increased from 2018HY02 to 2023HY01 from 0.11 DID to 0.26 DID (ρ = 1.000; P = 0.000) but remained negligible. Use of AHT-FDC in Germany is declining. In contrast, FDC containing LLA are increasingly prescribed. Dispensing of multiple purpose FDC is very low. Strategies are needed to facilitate the use of FDC as recommended by current guidelines.