Suicidality and risk of suicidality in psoriasis: a critical appraisal of two systematic reviews and meta-analyses.

AIM: Chi et al.1 and Singh et al.2 each conducted a systematic review and meta-analysis of observational studies examining the relationship between suicidality and psoriasis. SETTING AND DESIGN: Chi et al. included only cohort studies while Singh et al. included cohort, cross-sectional and case-control studies. PRIMARY EXPOSURE AND OUTCOME: The primary outcome, suicidality, was assessed in people with psoriasis (exposure) and people without psoriasis. Analyses were separated for suicidal ideation and behaviour. RESULTS: Chi et al. included five population-based cohort studies that were considered to be of high quality according to the Newcastle-Ottawa Scale (NOS). They found no significant increase in the risk of suicide [risk ratio (RR) 1·13, 95% confidence interval (CI) 0·87-1·46], suicide attempt (RR 1·25, 95% CI 0·89-1·75) or suicidality (RR 1·26, 95% CI 0·97-1·64) among people with psoriasis. Singh et al. included 18 studies that were rated to be of medium quality to high quality according to the NOS. They found a pooled odds ratio (OR) of 2·05 (95% CI 1·54-2·74) for suicidal ideation among patients with psoriasis. For suicidal behaviours (combined attempted and completed suicides) a pooled OR of 1·26 (95% CI 1·13-1·40) was obtained, suggesting a higher risk of these behaviours in people with psoriasis. Subgroup analysis showed that patients with psoriasis were more likely to attempt suicide (OR 1·32, 95% CI 1·14-1·54) and complete suicide (OR 1·20, 95% CI 1·04-1·39) than those without psoriasis. CONCLUSIONS: Singh et al. concluded that patients with psoriasis have a significantly higher risk of suicidal ideation, suicide attempts and completed suicides, while Chi et al. concluded that the available, limited, very low-quality evidence does not support the notion of an association between psoriasis on the one hand, and suicide, suicidal ideation and suicide attempts on the other.

[Development of a German language questionnaire for assessing chronic pruritus (AGP-questionnaire): background and first results]. / Entwicklung eines deutschsprachigen Fragebogens zur Erfassung von chronischem Pruritus (AGP-Fragebogen) : Hintergrund und erste Ergebnisse.

Chronic pruritus may manifest itself clinically in terms of different duration, intensity and quality. There is no questionnaire assessing these parameters systematically. The study presents a pruritus questionnaire for the German speaking region (AGP-Questionnaire) developed by 4 experts in the field. It comprises questions on course, intensity and quality of pruritus, general health status, sociodemographic data, quality of life (QoL) and pruritus cognition. Standardised questionnaires such as the SF-12 Health Survey (recall period 4 weeks), the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) were also used to assess the instrument's convergent validity. Feedback of the participants was obtained by a one-page evaluation sheet. 100 patients suffering from chronic pruritus of the university hospitals of Giessen, Heidelberg, Munich and Muenster participated in the study. This questionnaire is useful in providing a comprehensive and structured approach to assessing individual patients' chronic pruritus. The validity and sensitivity of this new pruritus questionnaire will require examination in further studies.

Differential effects of a tertiary individual prevention programme for patients with occupational skin disease depending on diagnosis.

BACKGROUND: Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (TIP) aim at helping individuals with refractory OSD to remain active in the workforce. Evidence exists that these interventions improve skin protection behaviour related cognitions. However, it is not clear whether these effects generalize to all types of OSD. OBJECTIVE: To evaluate whether effects on socio-cognitive determinants of skin protection behaviour vary between patients with work related atopic dermatitis (AD) and other work related skin diseases. METHODS: A total of 14 inpatients with work related AD and 87 inpatients with other work related skin diseases completed measures on socio-cognitive determinants of skin protection behaviour before and after a 3-week inpatient TIP. Mixed model analyses, using maximum-likelihood estimation tested whether there were differential effects of the intervention on socio-cognitive determinants of skin protection behaviour. RESULTS: Although patients with AD reported more favourable cognitions towards skin protection behaviour than patients with other skin diseases at admission, these cognitions deteriorated or remained on the same level. Patients with other forms of OSD on the other hand developed more favourable cognitions during the intervention. CONCLUSION: Professionals working in the field of OSD should not cease to assist AD patients in achieving optimal skin protection behaviour. Tertiary individual prevention measures may need to pay more attention to the needs of individuals with an occupationally relevant AD. This may contribute to their being able to remain active in the workforce. The alternative would entail regular sick leave, poorer quality of life and economic hardship for the AD patient.

Colonoscopy use in a country with a long-standing colorectal cancer screening programme: evidence from a large German survey.

BACKGROUND: Given the potential colonoscopy has in prevention and early detection of colorectal cancer (CRC), its overall use within a population is a meaningful parameter to estimate the future CRC burden. We aimed to examine overall prevalence and correlates of colonoscopy use in Germany, a country with a long-standing, opportunistic CRC screening programme. METHODS: The data were collected in 2004 through the Health Care Access Panel, a nationally generalisable survey of German households. The sample comprised 15,810 men and women aged 50 to 70 years without a personal history of cancer. RESULTS: Overall, 36 % of respondents reported to have had at least one colonoscopy in the past (25 % once and 11 % more than once). Prevalence of colonoscopy use strongly increased by age (from 25 % to 43 % in age groups 50 - 54 and 65 - 70, respectively), but hardly differed by sex. Previous faecal occult blood testing (FOBT) was the most important correlate of colonoscopy use in either sex. CONCLUSIONS: Our survey from 2004, when FOBT was still the most important screening tool in Germany, suggests that more than one third of the German population underwent colonoscopy at least once up to age 70. While introduction of screening colonoscopy is expected to impact on overall colonoscopy use in the long run, these data can serve as point of reference to assess the extent and the patterns of such changes.

Increased expression of ALCAM/CD166 in pancreatic cancer is an independent prognostic marker for poor survival and early tumour relapse.

BACKGROUND: ALCAM (activated leucocyte cell adhesion molecule, synonym CD166) is a cell adhesion molecule, which belongs to the Ig superfamily. Disruption of the ALCAM-mediated adhesiveness by proteolytic sheddases such as ADAM17 has been suggested to have a relevant impact on tumour invasion. Although the expression of ALCAM is a valuable prognostic and predictive marker in several types of epithelial tumours, its role as a prognostic marker in pancreatic cancer has not yet been reported. METHODS: In this study, paraffin-embedded samples of 97 patients with pancreatic cancer undergoing potentially curative resection were immunostained against ALCAM, ADAM17 and CK19. Expression of ALCAM and ADAM17 was semiquantitatively evaluated and correlated to clinical and histopathological parameters. RESULTS: We could show that in normal pancreatic tissue, ALCAM is predominantly expressed at the cellular membrane, whereas in pancreatic tumour cells, it is mainly localised in the cytoplasm. In addition, univariate and multivariate analyses show that increased expression of ALCAM is an adverse prognostic factor for recurrence-free and overall survival. Overexpression of ADAM17 in pancreatic cancer, however, failed to be a significant prognostic marker and was not coexpressed with ALCAM. CONCLUSIONS: Our findings support the hypothesis that the disruption of ALCAM-mediated adhesiveness is a relevant step in pancreatic cancer progression. Moreover, ALCAM overexpression is a relevant independent prognostic marker for poor survival and early tumour relapse in pancreatic cancer.

Knowledge and attitude regarding human immunodeficiency virus/acquired immunodeficiency syndrome in dermatological outpatients.

BACKGROUND: Dermatologists are often the first-line specialists who recognize and diagnose human immunodeficiency virus (HIV) infection because of pathognomic skin signs. It is therefore important to investigate attitudes and knowledge regarding HIV/acquired immunodeficiency syndrome (AIDS) amongst dermatological patients in order to provide information for dermatologists and to draw their attention to the issues. OBJECTIVES: Awareness of HIV/AIDS, its prevention, and hypothetical behaviour were surveyed in dermatological outpatients. PATIENTS/METHOD: The anonymous cross-sectional survey was conducted with consecutive German-speaking outpatients aged 18-65 years, who registered at the dermatological outpatient's clinic (excluding venereology, genitourinary or HIV medicine) of the University of Munich (Germany). RESULTS: Three hundred forty-seven (77.5%) questionnaires were accepted for analysis. Most of the patients knew about HIV incurability (89.4%), HIV transmissibility during needle sharing (95.3%), or vaginal (87.4%) and anal intercourse (79.5%), as well as about HIV prevention by condom use (97.8%), and use of single needles (76.2%). However, knowledge gaps and misconceptions were detected regarding the risk of HIV transmission during oral sex, and the efficacy of sexual fidelity and avoidance of blood transfusions in HIV prevention. The lowest knowledge level (< 50% correct answers) was detected in patients aged 50-59 years, in unemployed, divorced/widowed, and in those without or with incomplete school education. CONCLUSIONS: Patient education about HIV/AIDS in dermatological ambulant settings should be performed differentially with regard to socio-demographic factors, and focused on the topic of oral sexual HIV transmission and on some other specific misconceptions.

[Early detection of prostate cancer in Germany. A study of a representative random sample of the population]. / Prostatakarzinomfrüherkennung in Deutschland. Untersuchung einer repräsentativen Bevölkerungsstichprobe.

The goals of our study were to assess the prevalence of prostate cancer screening (PCS) among German men in terms of regularity of use and to analyze predictors of PCS use. A representative sample of 10,659 men aged 45-70 (mean=55.2) were surveyed to self-assess regularity of DRE and PSA tests; sociodemographic variables (age, income, education, marital status and health insurance status), family history of cancer, physician recommendation and medical checkups were assessed as well.Two thirds of the sample report ever undergoing a DRE; 48% had ever had a PSA test. In contrast, the rates of men who undergo PCS regularly are lower (44% DRE, 33% PSA). PCS increases with age; socioeconomic variables (such as education or income), however, are less important predictors. Family history of cancer is associated with PCS use, but not with regularity of use. The most important predictors are having medical checkups and physician recommendation.

Gender differences in FOBT use: evidence from a large German survey.

We examined prevalence and correlates of fecal occult blood testing (FOBT) uptake in a sample of men and women aged 50 to 70 years without a personal history of cancer (n=15,810). The data was collected in 2004 through the Health Care Access Panel (HCAP), a nationally generalizable survey of German households. A pronounced gender difference in FOBT use emerged. Women reported regular use more often, while men reported irregular use with a higher frequency. Nearly every third men (29.6%), compared to 17.5% of the women had never made use of FOBT. The influence of socioeconomic factors on FOBT uptake was negligible. Family history of cancer was significantly associated with FOBT but the effect was very small. Use of medical checkups and physician recommendation were the most important predictors of FOBT use in men and women. Gender differences in use of medical checkups and physician recommendation to undergo an examination for the early detection of cancer partly mediated the gender differences in FOBT use.