Is loneliness associated with cancellation of medical appointments during the COVID-19 pandemic? Evidence from the Hamburg City Health Study (HCHS).

BACKGROUND: The COVID-19 pandemic engendered numerous societal and economic challenges in addition to health-related concerns. Maintenance of healthcare utilization assumed immense significance during this period. However, few studies have examined the association between loneliness and cancelled medical appointments during the COVID-19 pandemic. This study aimed to examine whether medical appointments are less likely to be cancelled with increased loneliness during a pandemic. We analyzed the association between loneliness and both patient- and provider-initiated appointment cancellations. METHODS: Cross-sectional data from the Hamburg City Health Study (HCHS) were collected during April 2020-November 2021. The analytical sample included 1,840 participants with an average age of 55.1 years (standard deviation: 6.5, range 45-76 years). Medical appointments cancelled by individuals-medical appointments in general, and GP, specialist, and dentist appointments-and appointments cancelled by healthcare providers served as outcome measures. Loneliness was quantified using a single item ranging from 0 to 10. Accordingly, we created empirical loneliness tertiles. Covariates were selected based on the Andersen model. Several penalized maximum likelihood logistic regressions were utilized to examine the association between loneliness and cancellation of medical appointments during the COVID-19 pandemic. RESULTS: The penalized maximum likelihood logistic regressions showed that, compared to individuals in the lowest loneliness tertiles, individuals in the other two tertiles reported a higher chance of medical appointments cancellation by individuals, particularly driven by cancelled GP appointments. Except for age and sex, none of the covariates were comparably associated with the outcomes. When appointments cancelled by healthcare providers served as outcomes, only a higher number of chronic conditions was significantly positively associated with it. CONCLUSIONS: Individuals scoring higher in loneliness had a greater chance of cancelling medical (particularly GP) appointments. This may contribute to a potential cascade of loneliness and skipped medical appointments in the future, resulting in adverse health outcomes over the medium-to-long term. Future research should examine whether lonely people are more likely to lack the social motivation to visit the doctor.

Pro- and anti-inflammatory macrophages express a sub-type specific purinergic receptor profile.

Extracellular nucleotides act as danger signals that orchestrate inflammation by purinergic receptor activation. The expression pattern of different purinergic receptors may correlate with a pro- or anti-inflammatory phenotype. Macrophages function as pro-inflammatory M1 macrophages (M1) or anti-inflammatory M2 macrophages (M2). The present study found that murine bone marrow-derived macrophages express a unique purinergic receptor profile during in vitro polarization. As assessed by real-time polymerase chain reaction (PCR), Gαs-coupled P1 receptors A2A and A2B are upregulated in M1 and M2 compared to M0, but A2A 15 times higher in M1. The ionotropic P2 receptor P2X5 is selectively upregulated in M1- and M2-polarized macrophages. P2X7 is temporarily expressed in M1 macrophages. Metabotropic P2Y receptors showed a distinct expression profile in M1 and M2-polarized macrophages: Gαq coupled P2Y1 and P2Y6 are exclusively upregulated in M2, whereas Gαi P2Y13 and P2Y14 are overexpressed in M1. This consequently leads to functional differences between M1 and M2 in response to adenosine di-phosphate stimulation (ADP): In contrast to M1, M2 showed increased cytoplasmatic calcium after ADP stimulation. In the present study we show that bone marrow-derived macrophages express a unique repertoire of purinergic receptors. We show for the first time that the repertoire of purinergic receptors is highly flexible and quickly adapts upon pro- and anti-inflammatory macrophage differentiation with functional consequences to nucleotide stimulation.

Atopic dermatitis shows significant cutaneous comorbidity: results from large-scale investigations in the working population.

BACKGROUND: Atopic dermatitis (AD) is one of the most common chronic inflammatory diseases of the skin. Rare large-scale data have been published on the prevalence of concomitant dermatoses. OBJECTIVE: To analyse the prevalence and cutaneous comorbidity of AD in Germany. METHODS: A cross-sectional study on voluntary whole-body skin checks by trained dermatologists in over 400 companies throughout Germany reflecting the adult working population was conducted. Prevalence ratios (PR) were calculated to compare dermatological comorbidity in employees with and without current AD. A logistic regression analysis controlling for age, sex and skin type revealed odds ratios (OR) of the occurrence of skin diseases in AD. RESULTS: A total of N = 118 939 people were examined between 2006 and 2017 (43.2% female, mean age 43.2 ± 10.7 years, min. age 16 years, max. age 70 years). AD (point prevalence) was identified in 1.45% (men: 1.50%, women 1.39%) and decreased significantly with age. Self-reported lifetime prevalence of AD was 4.95% (men: 3.72%, women: 6.55%). The following skin diseases were significantly more frequent in people with current AD: Contact dermatitis (PR: 3.38), hand eczema (PR: 4.62), exsiccation dermatosis (PR: 2.19), folliculitis (PR: 1.95) and port-wine stains (PR: 1.49). Among those, folliculitis was the most frequent (prevalence in AD 16.42%). Controlled for age, sex and skin type, AD was significantly associated with - among others - hand eczema (OR: 3.96; 95% CI: 2.95-5.32), contact dermatitis (OR: 2.97; 95% CI: 1.50-5.88) and exsiccation dermatosis (OR: 1.78; 95% CI: 1.30-2.44). Psoriasis was significantly less frequent in people with AD (OR: 0.61; 95% CI: 0.39-0.94). CONCLUSION: In summary, cutaneous comorbidity is frequent and of great importance in people with AD, suggesting the need for comprehensive, dermatologically guided diagnostics in AD.

Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis.

OBJECTIVE: Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS: Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS: Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS: Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.

[Social rights claims for malignant melanoma patients : Providing patient information in German dermatological practices]. / Sozialrechtliche Ansprüche beim malignen Melanom : Aufklärung von Patienten in deutschen dermatologischen Praxen.

BACKGROUND: Treatment of patients with malignant melanoma includes informing the patients about their rights regarding social/disability benefits. In particular, every patient has the right to rehabilitation treatment according to SGB V and IX (SGB: Sozialgesetzbuch; Social Security Code) and to an examination regarding the classification of the disability. OBJECTIVES: The present study examines the extent to which patients with invasive malignant melanoma are informed after initial diagnosis about their social rights to medical rehabilitation measures and the classification of disability. MATERIALS AND METHODS: In the course of a survey in 2014, n = 1800 German dermatological practices were contacted and provided a standardized questionnaire on several care-relevant questions, including the aforementioned ones. RESULTS: Evaluable questionnaires were submitted by n = 424 practices. In all, 52% of dermatologists stated that they regularly provided information on the right to rehabilitation, 15% sometimes, 41% rarely or never. Furthermore, 44% of dermatologists regularly, 17% sometimes and 38% rarely or never informed their patients about the classification of disability. Relevant differences were found in regional comparisons. CONCLUSIONS: Practicing dermatologists seem to transfer the information requirement to the clinics involved in the treatment. It would be beneficial if the information were also provided again by the dermatologists in private practice. In view of the known limited capacity to receive new information from patients with newly diagnosed melanoma, repeated counselling appears to be more patient-friendly.

Strategies to reduce stigma related to visible chronic skin diseases: a systematic review.

Many patients with a visible chronic skin disease experience discrimination and stigmatization. This results in psychosocial impairments in addition to the burden of disease and emphasizes the urgency to implement effective stigma-reduction strategies. To synthesize what is known globally about effective interventions to reduce stigma associated with visible chronic skin diseases, a systematic review was conducted. Four electronic databases were searched until May 2018. Studies evaluating interventions to reduce stigmatization in patients with visible chronic skin diseases and applying at least one stigma-related outcome measure were included. Data were extracted on study design, country, study population, outcome measures and main findings. Results were subsequently synthesized in a narrative review. Critical Appraisal Skills Programme tools were used to assess study quality. Nineteen studies were included in the review. Study design was very heterogeneous and study quality rather poor. Thirteen studies addresses patients with leprosy in low- and middle-income countries, and one study each targeted patients with onychomycosis, leg ulcer, facial disfigurement, atopic dermatitis, vitiligo and alopecia. Evaluated interventions were mainly multi-faceted incorporating more than one type of intervention. While 10 studies focused on the reduction in self-stigma and 4 on the reduction in public stigma, another 5 studies aimed at reducing both. The present review revealed a lack of high-quality studies on effective approaches to reduce stigmatization of patients with visible chronic skin diseases. Development and evaluation of intervention formats to adequately address stigma is essential to promote patients' health and well-being.

[Perception of stigmatization in people with psoriasis-qualitative analysis from the perspective of patients, relatives and healthcare professionals]. / Stigmatisierungserleben bei Psoriasis ­ qualitative Analyse aus Sicht von Betroffenen, Angehörigen und Versorgern.

BACKGROUND: Numerous studies have shown that psoriasis is associated with severe losses in almost all dimensions of health-related quality of life. An important aspect is the stigmatization experience of those affected. OBJECTIVE: The aim of this study was to examine the perception of stigmatization from the perspective of patients, relatives and healthcare professionals using a qualitative approach. MATERIAL AND METHODS: Qualitative surveys in the form or focus groups and interviews with patients, relatives and healthcare providers were conducted. The data were analyzed by qualitative content analysis. RESULTS: The results show that stigmatization is perceived by all groups surveyed. It also became clear that self-stigmatization plays a special role. Affected persons, relatives and medical care providers described self-stigmatization as the greatest burden or restriction of affected persons in various areas of life, such as work, leisure and partnership. There were no crucial differences between sex or age groups. CONCLUSION: Possible knowledge deficits of non-affected persons and wrong assumptions of the affected persons about the attitudes of non-affected persons can be reduced, for example, in the context of encounters between affected persons and non-affected persons as well as between affected persons and medical care providers and thus reduce the public as well as the self-stigma.

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees.

BACKGROUND: Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES: To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS: In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS: In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS: Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

[Primary prevention in the context of skin cancer screening]. / Primärprävention im Rahmen des Hautkrebsscreenings.

BACKGROUND: The skin cancer screening program in Germany is used for early identification of skin tumours with the aim of a lower-risk removal and avoidance of progression. OBJECTIVES: The aim of the study is to investigate the extent to which skin cancer screening (SCS) has an additional effect on dissemination of information on primary prevention. METHODS: This question was examined from the point of view of screening participants and dermatologists. The proportion of appropriately informed persons among persons who have been screened was determined based on a survey of a representative sample of the German standard population of 1004 persons; the provision of information on primary preventive behaviour was based on a survey of dermatological practices (n = 444). Both surveys were evaluated descriptively. RESULTS: Of those who underwent SCS (n = 397), the majority (74%) stated that information on protection against UV radiation was provided during the screening. Among dermatologists offering SCS (n = 424), 70% stated that they personally informed all SCS participants about measures preventing skin cancer, and 46% always or predominantly provided written material after conducting SCS. CONCLUSION: In addition to secondary prevention, SCS also has an important primary preventive function; however there is potential for improvement, since about a quarter of the SCS participants do not receive any information on preventive behaviour from the examining physician. The extent to which this information is actually applied by the SCS participants should be investigated in a longitudinal study.

Modelling first-year cost-of-illness of melanoma attributable to sunbed use in Europe.

BACKGROUND: Melanoma is a life-threatening disease of the skin with an increasing incidence of approximately 87 000 new cases treated per year in the European Union and the European Free Trade Association states resulting in considerable costs for the society. Since the use of sunbeds is known to be a risk factor, which can be easily avoided, costs of malignant melanoma attributable to sunbed use are modelled in the present study. METHODS: Costs-of-illness of melanoma were calculated and compared for all member states of the European Union and the European Free Trade Association states using an established modelling approach. Calculations were based on a systematic literature research. For countries with no available information on cost-of-illness the gross domestic product, health expenditures and gross national income served as a basis for extrapolation of costs. International comparison was enabled by adjusting costs by the national purchasing power parity. RESULTS: After adjusting melanoma treatment costs for the purchasing power parity, direct costs per patient vary between € 1056 in Romania and € 10 215 in Luxembourg. Costs due to morbidity range from € 102 per patient in Sweden and € 5178 in the UK resulting in total costs of € 1751-€ 12 611 per patient. Average weighted total costs per patient amount for € 6861-€ 6967 annually. In total, in 2012 approximately 4450 new cases of melanoma have been induced by sunbed use in the 31 included countries, which corresponds to 5.1% of all incident melanoma cases. National attributable melanoma costs range from € 1570 in Malta to € 11.1 million in Germany and sum up to an amount of € 32.5-€ 33.4 million for all countries. CONCLUSION: This article provides a first estimation on costs of melanoma in Europe. It illustrates the contribution of exposure to artificial ultraviolet light in the economic burden of malignant melanoma.

Cost-of-illness of melanoma in Europe - a modelling approach.

BACKGROUND: Malignant melanoma is accounting for the vast majority of skin cancer death. The treatment and productivity loss due to morbidity or premature mortality are associated with costs for society. There are few cost-of-illness (COI) studies on malignant melanoma in European countries from societal perspective and currently there is no publication analysing the COI in all European countries. OBJECTIVES: The objective of the present study was to comparatively estimate COI of malignant melanoma in the European countries based on an identical approach. METHODS: Cost information was obtained from results of a systematic literature research. For countries with no available cost information, a model for imputation of cost data was developed. Country-specific costs were modelled on the national gross domestic product, health expenditures, gross national income and epidemiological data. The adjustment for purchasing power parity allowed a comparison across countries. RESULTS: Crude national costs of malignant melanoma ranged between € 1.1 million in Iceland and € 543.8 million in Germany and resulted in € 2.7 billion for all EU/EFTA states. Estimated crude costs per patient were lowest in Bulgaria (€ 6422) and highest in Luxembourg (€ 50 734). The share of direct costs varied from 3% to 26% across countries. After adjustment for the purchasing power parity costs per patient ranged between € 14 420 in Bulgaria and € 50 961 in Cyprus. Treatment expenses and morbidity costs were markedly lower for countries that entered the EU since 2004. By contrast, mortality costs were lower in countries with a high gross domestic product per capita. CONCLUSION: In this first estimation, malignant melanoma induces relevant COI in Europe. There was large variation in the costs per patient due to different health care systems and expenses. Beyond decreasing patient burden, early intervention and prevention of melanoma could have a relevant potential to save costs across Europe.

[Real world data sources for health services research on skin cancer]. / Real-world-Datenquellen für die Versorgungsforschung zum Hautkrebs.

Health services research in dermatology with the objective to improve prevention, efficient diagnostics and treatment of skin cancer requires real world data from all sectors. This article provides an overview of currently available relevant real world data sources and the utilization potential. It lists exemplary results of existing studies: secondary data analyses based on billing data from statutory health insurance funds were used among other things to estimate the participation rate in the statutory skin cancer screening. This was approximately 31% in the 2­year period and was higher in the western German federal states than in the eastern ones. Furthermore, participation was higher for women than for men. Regional data in combination with sociostructural and sociodemographic indicators are available for planning of dermatological care and the analysis points to an association with the prevalence of skin cancer. Primary data are available and necessary for recording patient reported endpoints and evaluating the treatment of skin cancer patients by dermatologists. Extensive histopathological databases record not only clinical markers of skin cancer but also sociodemographic characteristics of the patients and indicate a correlation between the time of diagnosis or therapy and the insurance status and place of residence. In addition to the utilization potential, specific limitations of the data sources are listed.

Cost-of-illness of melanoma in Europe - a systematic review of the published literature.

Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost-effective or even cost saving. Cost-of-illness (COI) studies provide information on such potential savings. The purpose of this study is to give an overview on COI studies in European countries and to compare the COI in total and by cost categories. The results can be used to model potential cost savings from prevention. We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their COI, all costs were adjusted for the purchasing power parity. All studies focusing on stage III-IV melanoma include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2972 in Italy and € 17 408 in Sweden after adjusting for purchasing power parity. Most studies on stage I-IV melanoma include costs of hospitalization, outpatient treatment and general practitioner consultation. Direct costs range from € 923 in Sweden to € 9829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3511 in Sweden and € 20 408 in England, morbidity costs between € 103 in Sweden and € 4550 in England. We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost-effective or even cost saving.

Decreasing sunbed use in the German population between 2001 and 2015: survey in 155 679 working persons.

BACKGROUND: UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE: To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS: Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS: Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P < 0.001). There were significantly higher rates of sunbed use in women (12.5%/2.0%) vs. men (7.3%/1.3%; P < 0.001), in younger persons and in participants with darker skin (type II and III) vs. fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; P = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001-2008 and 2.2% in 2009-2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening programme. CONCLUSION: Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening programme may have contributed to this.

[Healthcare research in dermatology 2018 - power of the factual : What healthcare research is and who it serves]. / Versorgungsforschung in der Dermatologie 2018 ­ Kraft des Faktischen : Was Versorgungsforschung ist und wem sie dient.

In the dermatology practiced in Germany, healthcare research is an established and highly differentiated discipline. In many university dermatological institutions and private practices, studies are carried out on the processes of healthcare research for skin diseases. Commissioned by the German Society of Dermatology and the Professional Association of German Dermatologists, a significant number of the studies and projects are conducted by the German Center for Health Services Research in Dermatology (CVderm) as a nationwide reference center. Important projects include the implementation of patient registers and national care studies, research with secondary data and carrying out methodological studies for the further development of scientific questions. Important results are the national healthcare conferences for psoriasis, skin cancer, wounds and atopic dermatitis, the regional care networks as well as projects and cooperation with health insurance companies, local government and public institutions. In the interests of improved patient care, important factors of care are continuously improved. Future health services research in dermatology will be able to contribute even more efficiently for better care planning and management. Patient registers will facilitate the transfer of innovations into care and help to ensure that new treatment approaches can be implemented. Registers also support the optimization of therapy approaches, which can no longer be carried out on the basis of clinical studies alone, for example in the case of psoriasis, due to the large number of drugs available. In the era of digital medicine, healthcare research has an even more important function.

[What motivates patients with atopic diseases to search the internet-a focus group study on expectations and demands]. / Was motiviert Patienten mit atopischen Erkrankungen zur Suche nach Informationen im Internet? Ergebnisse einer Fokusgruppenstudie zu Erwartungen und Anforderungen.

BACKGROUND: People affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen a more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users' behavior. OBJECTIVES: On which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding a web-based service? MATERIALS AND METHODS: Three individual interviews and four focus groups with 37 participants (19-81 years; hay fever, n = 30; asthma, n = 17; eczema, n = 15) were conducted in four German cities. These were recorded and transcribed verbatim. A multiprofessional team developed a system for coding the texts (two independent encoders, MAXQDA analysis software). RESULTS: Those who are affected usually seek information only in case of a concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. A web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills. DISCUSSION: In order to promote self-management skills, a web-based service should focus on allergy symptoms, treatment options and day-to-day help.

Climate deteriorations and Neanderthal demise in interior Iberia.

Time and circumstances for the disappearance of Neanderthals and its relationship with the advent of Modern Humans are not yet sufficiently resolved, especially in case of the Iberian Peninsula. Reconstructing palaeoenvironmental conditions during the last glacial period is crucial to clarifying whether climate deteriorations or competition and contacts with Modern Humans played the pivotal role in driving Neanderthals to extinction. A high-resolution loess record from the Upper Tagus Basin in central Spain demonstrates that the Neanderthal abandonment of inner Iberian territories 42 kyr ago coincided with the evolvement of hostile environmental conditions, while archaeological evidence testifies that this desertion took place regardless of modern humans' activities. According to stratigraphic findings and stable isotope analyses, this period corresponded to the driest environmental conditions of the last glacial apart from an even drier period linked to Heinrich Stadial 3. Our results show that during Marine Isotope Stages (MIS) 4 and 2 climate deteriorations in interior Iberia temporally coincided with northern hemisphere cold periods (Heinrich stadials). Solely during the middle MIS 3, in a period surrounding 42 kyr ago, this relation seems not straightforward, which may demonstrate the complexity of terrestrial climate conditions during glacial periods.

Epidemiology of skin cancer in the German population: impact of socioeconomic and geographic factors.

BACKGROUND: Skin cancer being the most common cancer in Germany has shown increasing incidence in the past decade. Since mostly caused by excessive UV exposure, skin cancer is largely related to behaviour. So far, the impact of regional and sociodemographic factors on the development of skin cancer in Germany is unclear. OBJECTIVES: This study aimed to investigate the association of potential predictive factors with the prevalence of skin cancers in Germany. METHODS: Nationwide ambulatory care claims data from persons insured in statutory health insurances (SHI) with malignant melanoma (MM, ICD-10 C43) and non-melanocytic skin cancer (NMSC, ICD-10 C44) in the years 2009-2015 were analysed. In addition, sociodemographic population data and satellite-based UV and solar radiation data were associated. Descriptive and multivariate (spatial) statistical analyses (e.g. Bayes' smoothing) were conducted on county level. RESULTS: Data from 70.1 million insured persons were analysed. Age-standardized prevalences per 100 000 SHI insured persons for MM and NMSC were 284.7 and 1126.9 in 2009 and 378.5 and 1708.2 in 2015. Marked regional variations were observed with prevalences between 32.9% and 51.6%. Multivariate analysis shows among others statistically significant positive correlations between higher income and education, and MM/NMSC prevalence. CONCLUSION: Prevalence of MM and NMSC in Germany shows spatio-temporal dynamics. Our results demonstrate that regional UV radiation, sunshine hours and sociodemographic factors have significant impact on skin cancer prevalence in Germany. Individual behaviour obviously is a major determinant which should be subject to preventive interventions.

[Prevalence of dermatomycoses in professional football players : A study based on data of German Bundesliga fitness check-ups (2013-2015) compared to data of the general population]. / Prävalenz von Dermatomykosen bei Profifußballspielern : Untersuchung im Rahmen der Bundesligatauglichkeitsuntersuchung (2013­2015) im Vergleich mit Daten der Allgemeinbevölkerung.

BACKGROUND: The prevention, early diagnosis and treatment of onychomycosis is of great importance for professional athletes to avoid physical limitations by complications. So far, there is only little data on the prevalence of dermatomycosis in professional athletes. OBJECTIVES: The aim of the study was to detect the prevalence of dermatomycosis in professional football players compared to the general population. MATERIALS AND METHODS: The prospective, non-interventional, controlled study on the prevalence of dermatomycosis in professional football players was carried out on football players of a German Bundesliga team compared with a previously studied, equivalently aged German working population. A questionnaire survey, a dermatological check-up and a microbiological detection of pathogens in cases of suspicion were performed. RESULTS: Data of 84 football players (n = 45 in 2013; n = 39 in 2015) were compared to data of n = 8186 male employees between 17 and 35 years of age. In the group of athletes, there were findings of 60.7% onychomycosis, 36.9% of tinea pedis and 17.8% of pityriasis versicolor. In the group of the age-equivalent general German working population the findings were: onychomycosis 3.3%, tinea pedis 3.2%, pityriasis versicolor 1.4%. CONCLUSION: Our study shows a clearly higher risk for fungal diseases of the skin especially on the feet of professional football players. The results show a necessity for elucidation within prevention and the establishment of an appropriate therapy of dermatomycosis for professional football players.

Psychiatric comorbidity in alcohol use disorders: results from the German S3 guidelines.

Alcohol use disorders (AUD) have a high comorbidity with mental disorders. Vice versa, alcohol consumption plays an important role in affective disorders, anxiety disorders, ADHD, schizophrenic psychosis, and other mental disorders. In developing the current interdisciplinary, evidence-based treatment guideline on screening, diagnostics, and treatment of AUD, available research on comorbid mental diseases in AUD has been compiled to generate recommendations for treatment. The guideline was prepared under the responsibility of the German Association for Psychiatry, Psychotherapy, and Psychosomatics (DGPPN) and the German Association for Addiction Research and Therapy (DG-Sucht). To meet the methodological criteria for the highest quality guidelines ("S3-criteria") as defined by the Association of Scientific Medical Societies in Germany (AWMF), the following criteria were employed: (1) a systematic search, selection, and appraisal of the international literature; (2) a structured process to reach consensus; and (3) inclusion of all relevant representatives of future guideline users. After assessing and grading the available literature, the expert groups generated several recommendations for the screening, diagnosis, and treatment of comorbid mental disorders. These recommendations were subdivided into psycho-, pharmaco-, and combination therapies. These are the first guidelines ever to make specific treatment recommendations for comorbid mental diseases in AUD. The recommendations extend to different treatment approaches including diagnostics and settings to present available effective and state-of-the-art treatment approaches to clinicians. Hitherto, many clinical constellations have not been addressed in research. Therefore, recommendations for future research are specified.