Combining PSMA-PET and PROMISE to re-define disease stage and risk in patients with prostate cancer: a multicentre retrospective study.

BACKGROUND: Prostate-specific membrane antigen (PSMA)-PET was introduced into clinical practice in 2012 and has since transformed the staging of prostate cancer. Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria were proposed to standardise PSMA-PET reporting. We aimed to compare the prognostic value of PSMA-PET by PROMISE (PPP) stage with established clinical nomograms in a large prostate cancer dataset with follow-up data for overall survival. METHODS: In this multicentre retrospective study, we used data from patients of any age with histologically proven prostate cancer who underwent PSMA-PET at the University Hospitals in Essen, Münster, Freiburg, and Dresden, Germany, between Oct 30, 2014, and Dec 27, 2021. We linked a subset of patient hospital records with patient data, including mortality data, from the Cancer Registry North-Rhine Westphalia, Germany. Patients from Essen University Hospital were randomly assigned to the development or internal validation cohorts (2:1). Patients from Münster, Freiburg, and Dresden University Hospitals were included in an external validation cohort. Using the development cohort, we created quantitative and visual PPP nomograms based on Cox regression models, assessing potential PPP predictors for overall survival, with least absolute shrinkage and selection operator penalty for overall survival as the primary endpoint. Performance was measured using Harrell's C-index in the internal and external validation cohorts and compared with established clinical risk scores (International Staging Collaboration for Cancer of the Prostate [STARCAP], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN] risk scores) and a previous nomogram defined by Gafita et al (hereafter referred to as GAFITA) using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) estimates. FINDINGS: We analysed 2414 male patients (1110 included in the development cohort, 502 in the internal cohort, and 802 in the external validation cohort), among whom 901 (37%) had died as of data cutoff (June 30, 2023; median follow-up of 52·9 months [IQR 33·9-79·0]). Predictors in the quantitative PPP nomogram were locoregional lymph node metastases (molecular imaging N2), distant metastases (extrapelvic nodal metastases, bone metastases [disseminated or diffuse marrow involvement], and organ metastases), tumour volume (in L), and tumour mean standardised uptake value. Predictors in the visual PPP nomogram were distant metastases (extrapelvic nodal metastases, bone metastases [disseminated or diffuse marrow involvement], and organ metastases) and total tumour lesion count. In the internal and external validation cohorts, C-indices were 0·80 (95% CI 0·77-0·84) and 0·77 (0·75-0·78) for the quantitative nomogram, respectively, and 0·78 (0·75-0·82) and 0·77 (0·75-0·78) for the visual nomogram, respectively. In the combined development and internal validation cohort, the quantitative PPP nomogram was superior to STARCAP risk score for patients at initial staging (n=139 with available staging data; AUC 0·73 vs 0·54; p=0·018), EAU risk score at biochemical recurrence (n=412; 0·69 vs 0·52; p<0·0001), and NCCN pan-stage risk score (n=1534; 0·81 vs 0·74; p<0·0001) for the prediction of overall survival, but was similar to GAFITA nomogram for metastatic hormone-sensitive prostate cancer (mHSPC; n=122; 0·76 vs 0·72; p=0·49) and metastatic castration-resistant prostate cancer (mCRPC; n=270; 0·67 vs 0·75; p=0·20). The visual PPP nomogram was superior to EAU at biochemical recurrence (n=414; 0·64 vs 0·52; p=0·0004) and NCCN across all stages (n=1544; 0·79 vs 0·73; p<0·0001), but similar to STARCAP for initial staging (n=140; 0·56 vs 0·53; p=0·74) and GAFITA for mHSPC (n=122; 0·74 vs 0·72; p=0·66) and mCRPC (n=270; 0·71 vs 0·75; p=0·23). INTERPRETATION: Our PPP nomograms accurately stratify high-risk and low-risk groups for overall survival in early and late stages of prostate cancer and yield equal or superior prediction accuracy compared with established clinical risk tools. Validation and improvement of the nomograms with long-term follow-up is ongoing (NCT06320223). FUNDING: Cancer Registry North-Rhine Westphalia.

Mortality from prostate cancer in the years 2007-2021 in North Rhine-Westphalia, Germany.

BACKGROUND: The crude mortality rate and the lifetime mortality risk from prostate cancer in Germany are above international average. However age-standardised mortality and years of life lost per capita from prostate cancer are declining. This study analyses the mortality-related measures for the federal state of North Rhine-Westphalia (NRW) in Germany. METHODS: Based on the cause of death statistics and data from the NRW State Cancer Registry on 45,300 deaths in the years 2007-2021, mortality rates, the lifetime mortality risk from prostate cancer, median age at death and years of life lost are presented. Additionally, the 15 most frequent causes of death of 95,013 patients diagnosed with prostate cancer are reported. RESULTS: With a stable lifetime mortality risk from prostate cancer, age-standardised mortality and years of life lost per capita are decreasing while crude mortality and median age at death are increasing in NRW. Less than half of the patients die from their prostate cancer. Cancers of the urinary bladder and other urinary organs also occur more frequently as a cause of death than it would be expected based on the age-specific risk in the total population. CONCLUSIONS: More people in North Rhine-Westphalia are dying of prostate cancer over time due to demographic ageing alone. At the same time, the age-specific mortality risk has not increased and when patients die of prostate cancer, it is at an increasingly older age. However, there is a statistical association with deaths from cancers of the lower urinary tract in patients diagnosed with prostate cancer, which demands further evaluation.

Qualitative evaluation of a brief positive psychological online intervention for nursing staff.

AIM: The aim of this study is to evaluate a brief positive psychological intervention with regard to the mental health of nursing staff in German hospitals. It addresses the question of how positive-psychological online exercises should be designed. BACKGROUND: Nurses in hospitals are known to suffer from mental strain and risk depressive as well as anxiety disorders. The covid-19-pandemic leads to a further aggravation of the situation. Opposed to that, positive psychological interventions can increase resilience by promoting self-management competences and mental strength. RESEARCH METHODS: A 90 min positive-psychological workshop was conducted with six nurses who worked in German hospitals. It consisted of imparting knowledge on positive psychology and learning different positive psychological practices. Afterwards, guideline-based interviews were conducted with six nurses. The outcomes of interest were how the intervention was evaluated, to what extent the intervention led to a reflection and a promotion of self-management competences and whether it allowed the participants to transfer the learnings into everyday life. RESULTS: The intervention led to a reflection of the application competence of positive-psychological techniques by the participating nurses. A promotion of the competences could not be reached. Especially the reflection and promotion of humour competence manifested itself as difficult. CONCLUSION: Despite its short-term nature, the online intervention resulted in a reflection of the nurses' application competence of positive psychology indicating its resource-promoting potential. Follow-up exercises or peer groups should be used for further development, while a training of humour competence might be part of a separate intervention.

Risk factors for digital stress in German public administrations.

OBJECTIVE: As the digitization of the working world progresses, the demands on employees change. Not least, this is true for the setting of public administrations in Germany, which is currently affected by the transformation to E-Government. This study aims to identify and describe a risk cluster of digitally stressed employees in public administrations. METHODS: An online sample of 710 employees from three public administrations in North Rhine-Westphalia were surveyed about digital stress (7 items) and several potential risk factors (19 items) derived from the current research. In the first step, a hierarchical agglomerative cluster analysis is used to detect the risk cluster. This is followed by a comparison to the group of the remaining employees regarding their risk profiles. RESULTS: The analysis states that the digitally stressed cluster accounts for approximately ten percent of the public administration's employees of the total sample. Employees in the risk cluster are less satisfied with on-site work overall, experience less collegial support on-site, experience less collegial support in the home office, resign more often, are more likely to feel overwhelmed, are less educated, are older in age and more often have relatives in need of care. CONCLUSION: This work was able to identify and describe a group of digitally stressed rather than left-behind employees in public administrations to bring awareness to potentially destructive factors in the digital transformation process but eventually to social inequalities. The findings offer the basis for interventions to arise and evoke potential for further research.

Incidence and Relative Survival of Patients with Merkel Cell Carcinoma in North Rhine-Westphalia, Germany, 2008-2021.

BACKGROUND: To date, only a few population-representative studies have been carried out on the rare Merkel cell carcinoma (MCC). We provide incidence and survival estimates of MCC, including the conditional relative survival. METHODS: We analyzed data from the cancer registry of North Rhine-Westphalia, Germany, 2008-2021, covering a population of 18 million. We included all newly diagnosed MCCs and calculated age-standardized (old European Standard population) incidence rates and unconditional and conditional relative survival. RESULTS: Our analysis included 2164 MCC patients. The age-standardized incidence of MCC was 5.2 (men) and 3.8 (women) per million person-years. The 5-year relative survival was 58.8% (men) and 70.7% (women). Survival was lower among men than women in all age-sex groups and was highest for MCC of the upper extremity in both men (68.2%) and women (79.3%). The sex difference in survival is particularly due to the better survival of women with MCC of the head and neck. In terms of survival, the first two years are particularly critical. CONCLUSIONS: Our data validate the worse survival among men and highlights a more favorable prognosis for MCCs located on the limbs. The first two years after diagnosis of MCC are the years with the highest excess mortality.

Mental strain in German public administrations in the course of the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, digital working methods were increasingly implemented within the setting of German public administrations. Beyond the ostensible risk of infection, a high psychological burden arose for the employees. OBJECTIVE: A subsequent progression of mental strain is to be estimated as a residual effect (approximated by controlling other influencing factors) due to the impossibility of a counterfactual control group. METHODS: An online survey was conducted in 2020 and repeated in 2021 among a cohort of n = 706 employees of 38 departments of three public administrations in North Rhine-Westphalia, Germany. Mental strain was assessed by the Wuppertal Screening Instrument. Its temporal variation was operationalized as the intercept of a first-difference multiple regression model. Unit of analysis was the department level. RESULTS: The prevalence of suboptimal and dysfunctional strain increased from 71% to 73%. The multiple regression model showed a significant increase whilst controlling the influence of socio-demographic changes on the department level. Children, age and educational level were significant predictors. R2 indicated that about 40% of the variance in the temporal variation of mental strain could be explained. CONCLUSION: The observed factors explained a significant proportion of the increase in mental strain in German public administrations. Still, far more than half of the increase stemmed from external influences which were largely determined by pandemic conditions and latency effects remain still to be seen.

Impact of digital stress on negative emotions and physical complaints in the home office: a follow up study.

Background: Due to the COVID-19 pandemic many employees perform under increasingly digital conditions. Enabling home office environments became mandatory for companies wherever possible in consideration of the ongoing pandemic. Simultaneously, studies reported on digital stress. The current literature lacks rigorous research into digital stress on psychosomatic outcomes, emotions, and disease. Therefore, we endeavor to understand how digital stress developed over the course of the pandemic and if it predicts differences in negative emotions and physical complaints in the home office setting. Methods: To answer the research question, we conducted an online survey among 441 employees in 2020 and 398 employees in 2022 from three municipal administrations in Germany, who were working from home at least occasionally. We used a cluster analysis to detect digitally stressed employees. Regression analyses were performed on digital stress, negative emotions, and physical complaints. Results: The analysis revealed an increase from 9 to 20% in digital stress, while negative emotions and physical complaints did not show evident differences. In the multivariate model, we observe a change in the proportion of digitally stressed employees between 4 and 17%, while the control variables explain around 9%. Conclusions: Digital stress did not significantly affect either negative emotions or physical complaints. However, digital stress appeared to exert a more substantial predictive influence on negative emotions. The study emphasizes rising digital stress, which contradicts a positive adaption to the digital working conditions within the observed period. The psychosomatic relations are low or lagged. Further research investigating digital stress and countermeasures, especially to understand how to prevent harmful long-term effects such as distress resulting from working from home conditions, is needed.

DigiFuehr 2.0: Novel insights for digital leadership.

OBJECTIVES: Against the background of e-government, it is discussed whether self-organization represents an independent component of digital leadership. Addressing this research question, the instrument "DigiFuehr" is being expanded to include the aspects of self-determination and coordination. The aim is to test the model quality of three adapted scales against the already established support-focusing version. METHODS: Based on an online survey of n = 422 employees at visual display unit workstations in German municipal administrations in April 2022, the original version of DigiFuehr as well as one reduced and two extended versions were validated considering their local and global model fit. RESULTS: All four scales show a good local fit with regard to internal consistency (Cronbach's α), discriminatory power, and dimensionality. Only the scale extended by two items also offers a sufficient global fit and is thus most suitable as a predictor for psychological stress, work satisfaction, and satisfaction with the professional exchange during homeworking. CONCLUSIONS: With "DigiFuehr 2.0", an improved version of the original scale is available. Self-organization is not a component independent of the support dimension, but a further important indicator of a latent digital leadership culture. Neither should come at the expense of the other.

The influence of occasional and frequent work from home on musculoskeletal complaints.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic acts as a recent driver for telework on a global scale. While visual display unit (VDU) workplaces are usually subject to regulatory requirements or occupational health and safety controls, mobile workplaces may increase the risk of developing work-related musculoskeletal complaints (MSCs). OBJECTIVE: This study aimed to explore the influence of work from home (WFH) on musculoskeletal complaints in the context of German municipal administrations. METHODS: This paper is based on an online survey conducted as part of the Health and Digital Change project in cooperation with three municipal administrations in North Rhine-Westphalia, Germany. A multivariate model was constructed to calculate the odds ratio for MSCs including various control variables. RESULTS: While bivariate analysis showed a 0.96-fold risk for employees who work from home, the multivariate model with a split between occasional (OR = 0.79) and frequent (OR = 1.59) WFH revealed a more complex effect. Both odds did not reach the significance level. However, the influence of being female (OR = 3.34) and being overweight (OR = 1.51) was confirmed. Regarding age the OR increases by 1.02 per year of life. Other control variables were the municipal affiliation, university entrance qualification, working hours and feeling overstrained. The regression model improved by 0.07 (McFadden R2) compared to the null model. CONCLUSION: Although WFH is discussed as a rising risk factor for MSCs, the findings in this study indicate, that occasional WFH acts as a rather protective factor against work-related MSCs.

Obesity in the context of migration and socio-economic risk factors - a multivariate epidemiologic analysis.

PURPOSE: While the existence of a healthy migrant effect remains controversial, overweight and obesity are considered a global pandemic. Migrants seem to be affected more often, however most of the few existing studies did not differentiate a first-generation from a second-generation migration background and/or did not control common socio-demographic confounders. This study aims at examining the influence of first- and second-generation migration on body mass index (BMI) and obesity in Germany. SUBJECTS AND METHODS: We conducted a controlled observational study based on a survey of n = 64,089 participants of the German Socio-Economic-Panel. Missing values were multivariate imputed via chained equations (MICE). The influence of migration on BMI and obesity was assessed by comparing first-generation, second-generation and non-migrants to each other. Pairwise statistical testing was done by t tests and Fisher's exact tests. For the multivariate analysis, OLS and logistic regression models and its coefficients (beta, odds ratio) were used. Targeting multiple testing, Holm-correction was utilized. RESULTS: Within the bivariate analysis, all three group-specific mean BMI-values differ significantly from each other (P < .001). The pairwise differences regarding the obesity risk are also significant (P < .001). Within the multivariate analysis, only second-generation migration reveals an influence on BMI compared to first-generation migration (ß = 0.297; 97.5% CI: 0.127-0.467) and non-migrants (ß = 0.366; 98.33% CI: 0.103-0.628). This is equivalent to its influence on obesity versus first-generation (odds ratios = 1.220; 98.33% CI: 1.045-1.423) and non-migrants (odds ratios = 1.134; 97.5% CI: 1.018-1.262). CONCLUSIONS: After controlling socio-demographic confounders, a second-generation migration background but not a first-generation migration background is associated with a higher BMI and obesity.

Does the Selection of the Procedure Impact the Return to Work in Unemployed Patients Undergoing Bariatric Surgery?

PURPOSE: Obesity and its comorbidities are risk factors for absenteeism and unemployment. Bariatric surgery might help to intervene in the vicious circle of unemployment, social disadvantage and increasing obesity. The most common bariatric procedures are sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). This survey analyzes the influence of the bariatric procedure on return to work. METHODS: The data of a German nationwide multicenter registry StuDoQ|MBE from 2015 to 2020 are evaluated. Patients are surveyed who underwent a primary SG or RYGB while being unemployed: 782 patients are included. Primary endpoint is any form of return to work within 1 year after treatment. The surgical procedure acts as the binary main treatment variable. A multivariate binary logistic regression model was performed with age, sex, vocational training and weight loss as third variables so that odds ratios (OR) and adjusted ORs were determined. RESULTS: Of the patients, 41.56% received a RYGB, 58.44% a SG. One year after bariatric surgery, 39.39% of the patients with SG and 33.85% with RYGB reached a return to work. The OR for return to work is 1.27 (p = 0.11) non-significant in favor of SG. The adjusted OR is 1.26 (p = 0.15), indicating that there is no significant influence of the difference between the two surgical procedures on the outcome of return to work. CONCLUSION: There is a positive effect regarding return to work in bariatric patients: More than a third of the previously unemployed patients were employed 1 year after surgery. Procedure-specific influences could not be determined.

Current status of emergency treatment of chemical eye burns in workplaces.

Chemical eye burns present an avoidable, but frequent, occupational injury with potentially detrimental consequences for the quality of life and occupational rehabilitation of the injured. A periodical review of guidelines is required to assure the optimal emergency management. We reviewed the literature with emphasis on current German guidelines, primarily MEDLINE. If the crucial first-line measure, the injury prevention has failed and an eye burn has been sustained, the immediate and copious rinsing of the eye is the pivotal emergency treatment modality. Whereas the immediacy and sufficiency of the emergency rinsing are largely unanimous, there is an ongoing debate about the benefits and risks of specific rinsing solutions, and regular updates on guidelines and recommendations for the emergency treatment are warranted. The easiest and readily available rinsing solution is tap water, which fulfils the crucial criteria conveniently in most industrialized countries: purity, sterility, and neutral pH. Other rinsing solutions are proposing higher osmolality to stabilize the physiological pH, because of their superior buffering capacity. However, there is no compelling evidence for a substantial benefit, and some reports suggest that there could be unwanted side effects. In combination with the substantially increased expenditure and a more complex handling procedure, currently a general recommendation of any other solution than tap water is not warranted.

How to evaluate digital leadership: a cross-sectional study.

BACKGROUND: With the increasing digitalization of the working environment, the demands on managers are changing fundamentally to the point of an emerging field of research in digital leadership. Municipal administrations are particularly affected by the digital transformation processes. Therefore, a score to measure the construct of digital leadership competence in the context of virtual-based workstation was developed and tested. METHODS: Based on an online survey with n = 546 employees at virtual-based workstations in municipal administrations in 2020, the instrument is tested regarding selectivity (coefficients), dimensionality (principal component analysis), homogeneity (inter-product-moment correlations), reliability (Cronbach's α) and construct validity (correlation with general leadership skills). RESULTS: The instrument can be considered selective, one-dimensional, homogeneous, reliable and constructively valid in the sense of the formulated hypotheses. By integrating the employees' perspective, the instrument aims to be one of the first of its kind to initiate a scientific further discourse. Among other things, the categorization of the co-determination component as either traditional or digital leadership can be discussed. CONCLUSIONS: The developed instrument for measuring digital leadership performs well concerning the aspects of discriminatory power, one-dimensionality, homogeneity, reliability as well as construct validity. It aims to induce further research and a scientific discourse on the topic of health-oriented leadership within the world of work 4.0.

Mental Strain of Immigrants in the Working Context.

Inability to work due to reported mental strain and psychiatric disorders is rising in Germany these days. Meanwhile the country's net migration is positive. While there is empirical evidence for a healthy migrant effect regarding the physical health in the beginning (mostly accompanied by a subsequent convergence effect), the mental health of migrants remains partly understudied. In order to evaluate the migrant's share in the rise of reported mental strain in Germany, 4000 employees were surveyed by means of an online access panel. About 16 percent of them revealed a migration background. Their Copenhagen Burnout Inventory (CBI) score is slightly yet significantly above the German autochthonous' one both using bi- and multivariate analysis, indicating that there is a specific vulnerability rather than a healthy migrant effect regarding mental strain at work.

Does the Electronic Health Card for Asylum Seekers Lead to an Excessive Use of the Health System? Results of a Survey in Two Municipalities of the German Ruhr Area.

BACKGROUND: The initial and intermediate-term access of refugees to healthcare in Germany is limited. A previous study showed that the obligation to request healthcare vouchers at the social security offices decreases the asylum seekers' consultation rate of ambulant physicians. The introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers is considered skeptically by some municipalities and federal states, among other reasons due to the fear of an overuse of health care services by asylum seekers. The aim of this study is to further evaluate the data of the authors' initial study with a new focus on inpatient care as well as a differentiation of the ambulant consultation rate into general practitioners and outpatient specialists. METHODS: The now-differentiated consultation rate of the initial study as well as the asylum seekers' use of inpatient care are compared to the values of the sex- and age-corrected autochthonous population as given by the German Health Interview and Examination Survey for Adults (DEGS1). A mean difference test (student's t-test) is used for comparison and significance testing. RESULTS: Asylum seekers who were in possession of the EHIC were significantly less likely to visit their ambulant general practitioners and specialists than the German autochthonous population. Simultaneously, this difference is partly compensated for by their more frequent use of impatient care. CONCLUSIONS: There is no indication that the EHIC leads to an overuse of healthcare services.

Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany.

Objectives: Asylum seekers in Germany represent a highly vulnerable group from a health perspective. Furthermore, their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence regarding its actual impact on the use of medical services. The aim of the study is to examine this impact on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). Study Design: For this purpose, a standardized survey was conducted with 260 asylum seekers in different municipalities, some of which have introduced the EHIC for asylum seekers, while others have not. Methods: The period prevalence was compared between the groups “with EHIC” and “without EHIC” using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results: Asylum seekers in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Conclusions: The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers.