Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases.

An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.

Impact of the First COVID Lockdown on Accident- and Injury-Related Pediatric Intensive Care Admissions in Germany-A Multicenter Study.

Children's and adolescents' lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017-2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85-1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93-1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57-1.02 and 0.26 (0.05-0.75)), whereas household and leisure accidents increased (1.33 (1.06-1.66) and 1.34 (1.06-1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38-1.16) and 2.09 (1.19-3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42-1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51-3.02)), but decreased in adolescent girls (0.56 (0.32-0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.

Autoantibodies targeting GPCRs and RAS-related molecules associate with COVID-19 severity.

COVID-19 shares the feature of autoantibody production with systemic autoimmune diseases. In order to understand the role of these immune globulins in the pathogenesis of the disease, it is important to explore the autoantibody spectra. Here we show, by a cross-sectional study of 246 individuals, that autoantibodies targeting G protein-coupled receptors (GPCR) and RAS-related molecules associate with the clinical severity of COVID-19. Patients with moderate and severe disease are characterized by higher autoantibody levels than healthy controls and those with mild COVID-19 disease. Among the anti-GPCR autoantibodies, machine learning classification identifies the chemokine receptor CXCR3 and the RAS-related molecule AGTR1 as targets for antibodies with the strongest association to disease severity. Besides antibody levels, autoantibody network signatures are also changing in patients with intermediate or high disease severity. Although our current and previous studies identify anti-GPCR antibodies as natural components of human biology, their production is deregulated in COVID-19 and their level and pattern alterations might predict COVID-19 disease severity.

Development and psychometric properties of a short situational urge to smoke scale (SUS) for smoking adolescents.

As urges are associated with positive-social, negative-affective, and habitual situations, we developed a sound scale to assess urges in these situations. In Northeastern Germany in 2005/2006, a sample of 1,093 smoking adolescents from 7th to 10th grade, aged 12-18 years, was used. Reliability analysis and exploratory and confirmatory factor analyses were applied. A three-factorial structure of the final situational urge to smoke scale (SUS) was found. Internal consistency of the scale was high (α = .89). The SUS is a new internally consistent scale that assesses the urge to smoke in adolescents. Further research needs to examine its predictive validity. The study's limitations are noted.

Does the smoking status of general practitioners affect the efficacy of smoking cessation counselling?

OBJECTIVE: To examine the association between the smoking status of general practitioners (GPs) and abstinence rates among patients receiving GP-delivered brief advice for smoking cessation. METHODS: A quasi-experimental multilevel study with follow-up assessments at 6, 12, 18, and 24 months after baseline was conducted using a random sample of 39 general practices in a defined area (participation rate=87.2%). Patients aged 18-70 were consecutively screened for smoking status (n=11,560) over the course of 3 weeks and were assigned to a control group (week 1), a computer expert system intervention (week 2), or a personal counselling intervention with the GP (week 3). For the current analysis, patients participating in study week 2 were excluded. A total of 1260 patients fulfilled the inclusion criteria and 80.2% took part: 609 patients in study week 1 and 402 patients from study week 3. GPs participated in a training session concerning smoking counselling, which was held between study weeks 2 and 3. Self-reported 4-week and 6-month prolonged abstinence measures at the 6-, 12-, 18-, and 24-month follow-ups were assessed. RESULTS: The smoking status of the GP was neither significantly related to 4-week prolonged abstinence nor 6-month prolonged abstinence among patients in a main effects model. Further modelling revealed that the intervention group modified the effect of the non-smoking status of the GP on the likelihood to quit smoking. A significant interactive effect was found between the non-smoking status of the GP and the intervention group on both abstinence measures. CONCLUSION: The non-smoking status of the GP had a positive effect among counselled patients. PRACTICE IMPLICATIONS: The consideration of lifestyle behavioural variables such as the smoking status of the GP will be essential for further research concerning the efficacy of smoking interventions.

Patterns and predictors of change in a smoking intervention study: latent growth analysis of a multivariate outcome model.

OBJECTIVE: This study reports the outcome of a smoking intervention study in a general population setting in Germany. DESIGN: A randomized, controlled trial, with a sample of 719 current daily cigarette smokers. MAIN OUTCOME MEASURE: The authors tested a criterion measurement model that is related to the transtheoretical model and that proposes multivariate outcome measures with positive and negative attitudes about smoking and habit strength. The authors analyzed patterns and predictors of change in self-efficacy and in the pros and cons of nonsmoking using latent growth models. RESULTS AND CONCLUSION: Participation in the intervention groups did not predict average mean levels or growth trajectories in the multivariate outcome model. Accounting for attrition in multisample missing-data procedures and accounting for demographic and smoking behavior variables did not alter this result. Thus, the intervention was ineffective. However, endorsement of self-efficacy and the pros of nonsmoking increased linearly over time in all study groups, which may be attributable to historical or societal changes or to repeated, comprehensive smoking assessments. In addition to reporting the outcome of a smoking intervention trial, the current study also illustrates a modeling approach to the measurement of change.

Does precontemplation represent a homogeneous stage category? A latent class analysis on German smokers.

The authors examined the subtype structure of smokers classified in the precontemplation stage of change within the transtheoretical model. From a general practice-based sample of 1,499 daily smoking patients from Germany (participation rate 80%), they used a subgroup of 929 smokers who were classified in the precontemplation stage and applied latent class analysis, using the pros and cons of nonsmoking and smoking cessation self-efficacy as the defining variables. Cross-sectional validation of the emerging classes was based on smoking behavior and processes of change variables. For longitudinal validation, generalized estimation equation analyses were used on motivational and abstinence criteria from 6-, 12-, 18-, and 24-month follow-ups. A 4-class model best represented the data. Three subtypes (labeled progressive, immotive, and disengaged pessimistic) were similar to clusters identified in U.S. studies. The 4th (disengaged optimistic), by contrast, was reminiscent of a type that had previously only emerged in a Dutch study. Cross-sectional and longitudinal validation results confirmed the distinctiveness and predictive power of the classes. The findings highlight the importance of tailoring interventions for smoking behavior change to the needs of different subgroups of precontemplating smokers.

Real limits in the virtual world: self-limiting behavior of Internet gamblers.

The recent expansion of Internet gambling has stimulated debate, policy, and research on this relatively new phenomenon and its potential consequences. The current study focuses on bettors experiencing problems by sampling Internet gamblers who imposed limits on the amount they were allowed to deposit to a betting site. We analyzed the betting transactions over 18 months of all gamblers who subscribed to an online betting site in February, 2005 (N = 47,134), 567 of whom utilized the site's self-limit feature. Self-limiting gamblers played a wider variety of games and placed more bets than others prior to imposing limits. After imposing limits, self-limiters reduced their activity, but did not reduce the amount they wagered per bet. Time spent gambling, not just money spent, appears to be an important indicator of gambling problems. Self-limit programs appear to be promising options for Internet gamblers at-risk for gambling problems.

Computer-generated tailored feedback letters for smoking cessation: theoretical and empirical variability of tailoring.

PURPOSE: This study examines tailored feedback letters of a smoking cessation intervention that is conceptually based on the transtheoretical model, from a content-based perspective. METHODS: Data of 2 population-based intervention studies, both randomized controlled trials, with total N=1044 were used. The procedure of the intervention, the tailoring principle for the feedback letters, and the content of the intervention materials are described in detail. Theoretical and empirical frequencies of unique feedback letters are presented. RESULTS: The intervention system was able to generate a total of 1040 unique letters with normative feedback only, and almost half a million unique letters with normative and ipsative feedback. Almost every single smoker in contemplation, preparation, action, and maintenance had an empirically unique combination of tailoring variables and received a unique letter. In contrast, many smokers in precontemplation shared a combination of tailoring variables and received identical letters. CONCLUSION: The transtheoretical model provides an enormous theoretical and empirical variability of tailoring. However, tailoring for a major subgroup of smokers, i.e. those who do not intend to quit, needs improvement. Conceptual ideas for additional tailoring variables are discussed.

Reasons for not using smoking cessation aids.

BACKGROUND: Few smokers use effective smoking cessation aids (SCA) when trying to stop smoking. Little is known why available SCA are used insufficiently. We therefore investigated the reasons for not using SCA and examined related demographic, smoking behaviour, and motivational variables. METHODS: Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used SCA and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use. The questionnaire comprised two subscales: "Social and environmental barriers" and "SCA unnecessary." RESULTS: The most endorsed reasons for non-use of SCA were the belief to be able to quit on one's own (55.2%), the belief that help is not necessary (40.1%), and the belief that smoking does not constitute a big problem in one's life (36.5%). One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much. Smokers intending to quit agreed stronger to both subscales and smokers with lower education agreed stronger to the subscale "Social and environmental barriers". CONCLUSION: Main reasons for non-use of SCA are being overly self-confident and the perception that SCA are not helpful. Future interventions to increase the use of SCA should address these reasons in all smokers.

Computer-tailored smoking cessation intervention in a general population setting in Germany: outcome of a randomized controlled trial.

This study reports the outcome of a randomized controlled trial testing a computer-tailored smoking cessation intervention based on the transtheoretical model in a general population setting in Germany. Participants of the smoking intervention study were recruited from an existing general population health examination survey in a university hospital. The sample consisted of 611 current and former smokers at baseline, and of 485 participants in the core group of baseline daily cigarette smokers. Follow-ups were conducted 6, 12, 18, and 24 months after baseline. The intervention was designed for both current and former smokers, involved up to three individualized feedback letters, and was created using expert-system technology. Based on 7-day point-prevalence abstinence and 6-month prolonged abstinence as the outcome measures, the study identified no significant differences between the intervention and control groups. Modeling the full longitudinal data in generalized estimation equation analyses, using different nonresponse procedures, and adjusting for covariates did not alter the results. We conclude that the computer-tailored transtheoretical model-based smoking cessation intervention, as delivered in this study and in this special setting, was ineffective.

Proactive interventions for smoking cessation in general medical practice: a quasi-randomized controlled trial to examine the efficacy of computer-tailored letters and physician-delivered brief advice.

AIMS: To test the efficacy of (i) computer-generated tailored letters and (ii) practitioner-delivered brief advice for smoking cessation against an assessment-only condition; and to compare both interventions directly. DESIGN: Quasi-randomized controlled trial. SETTING: A total of 34 randomly selected general practices from a German region (participation rate 87%). PARTICIPANTS: A total of 1499 consecutive patients aged 18-70 years with daily cigarette smoking (participation rate 80%). INTERVENTIONS: The tailored letters intervention group received up to three individualized personal letters. Brief advice was delivered during routine consultation by the practitioner after an onsite training session. Both interventions were based on the Transtheoretical Model of behaviour change. MEASUREMENTS: Self-reported point prevalence and prolonged abstinence at 6-, 12-, 18- and 24-month follow-ups. FINDINGS: Among participants completing the last follow-up, 6-month prolonged abstinence was 18.3% in the tailored letters intervention group, 14.8% in the brief advice intervention group and 10.5% in the assessment-only control group. Assuming those lost to follow-up to be smokers, the rates were 10.2%, 9.7% and 6.7%, respectively. Analyses including all follow-ups confirmed statistically significant effects of both interventions compared to assessment only. Using complete case analysis, the tailored letters intervention was significantly more effective than brief advice for 24-hour [odds ratio (OR) = 1.4; P = 0.047] but not for 7-day point prevalence abstinence (OR = 1.4; P = 0.068) for prolonged abstinence, or for alternative assumptions about participants lost to follow-up. CONCLUSIONS: The study demonstrated long-term efficacy of low-cost interventions for smoking cessation in general practice. The interventions are suitable to reach entire populations of general practices and smoking patients. Computer-generated letters are a promising option to overcome barriers to provide smoking cessation counselling routinely.

HIV risk reduction in a nurse case-managed TB and HIV intervention among homeless adults.

This study evaluated a six-month nurse case-managed intervention against a standard care control program among 295 sheltered homeless adults from Los Angeles, USA. The primary aim of the intervention was encouraging latent tuberculosis infection treatment completion. The secondary aim was reducing HIV risk, the focus of this report. A longitudinal path model revealed that the intervention impacted cognitive factors of AIDS Knowledge, Perceived AIDS Risk and Self-efficacy for Condom Use, but did not impact substance use and risky sexual behaviors. The dual intervention program for HIV and TB provided promising synergistic effects by targeting risk factors common to both infections.

Variability of tailoring of a smoking cessation intervention based on the transtheoretical model.

OBJECTIVE: This study examines smoking cessation intervention materials that are based on the transtheoretical model from a content-based perspective. METHODS: Data of 2 population-based intervention studies with total N=1044 were used. Analyses compared how many unique intervention materials could be generated theoretically and how many unique intervention materials were needed empirically. RESULTS: The intervention system was able to generate theoretically a total of 1040 unique intervention materials with normative feedback only, and almost half a million unique intervention materials with normative and ipsative feedback. This variability was needed empirically. For smokers in precontemplation, all possible intervention materials were used. For smokers in contemplation, preparation, action, and maintenance, intervention materials were hardly created more than once. CONCLUSION: Using the transtheoretical model to create tailored intervention materials yields an enormous variability of tailoring. However, tailoring for precontemplation needs improvement. Additional tailoring variables for precontemplation could be long-term quitting plans, intention to reduce smoking, experiences with past behavior, or severity of nicotine dependence.

Assessing the playing field: a prospective longitudinal study of internet sports gambling behavior.

Internet gambling is growing rapidly, as is concern about its possible effect on the public's health. This paper reports the results of the first prospective longitudinal study of actual Internet sports gambling behavior during eight study months. Data include recorded fixed-odds bets on the outcome of sporting contests and live-action bets on the outcome of events within contests for 40,499 Internet sports gambling service subscribers who enrolled during February 2005. We tracked the following primary gambling behaviors: daily totals of the number of bets made, money bet, and money won. We transformed these variables into measures of gambling involvement. We analyzed behavior for both fixed-odds and live-action bets. The median betting behavior of the 39,719 fixed-odds bettors was to place 2.5 bets of 4 euro (approximately $5.3 US) every fourth day during the median 4 months from first to last bet. This typical pattern incurred a loss of 29% of the amount wagered. The median betting behavior of the 24,794 live-action bettors was to place 2.8 wagers of 4 euro every fourth day during the median duration of 6 weeks at a loss of 18% of the amount wagered. We also examined the behavior of empirically determined groups of heavily involved bettors whose activity exceeded that of 99% of the sample.

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

OBJECTIVE: To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. DESIGN: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. MAIN OUTCOME MEASURES: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. RESULTS: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). CONCLUSION: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.

[Improvement of medical care by supporting the intention to change health risk behavior]. / Verbesserung der medizinischen Versorgung durch die Förderung der Intention zur Anderung gesundheitsriskanten Verhaltens.

A large proportion of disease and death cases could be prevented, if efficacious programs, particularly concerning tobacco smoking, obesity, and alcohol risk drinking, could be applied. Feasible approaches are based, among others, on the Transtheoretical Model of intentional health behavior change. This model allows to develop practical approaches to reduce risk factors of common diseases at the general population level. Evidence about the promotion of the intention to change health risk behaviors revealed successes, e. g., according to smoking cessation. The effects are growing by time. Intervention that is focused at the promotion of change of health risk behaviors can add to the improvement of health care.

Effects of smoking cessation on health care use: is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity?

BACKGROUND: Although the association between smoking status and health services use is well established, this relation is not well-studied for the comparison of current and former smokers. Some studies showed higher utilization of health services among former smokers compared to continuing smokers. This study investigates the relation between smoking status, time since smoking cessation and hospitalization in a general population sample. We hypothesized that elevated risk of hospitalization among former smokers compared with continuing smokers is related to higher smoking-related morbidity among former smokers. METHODS: Data from a cross-sectional sample of 4310 adults aged 20-79 in Pomerania, Germany was used (response proportion 68.8%). Smoking status, time since smoking cessation (in years), and date of diagnosis of smoking-related diseases were determined from self-reports. We used fractional polynomials to determine the dose-response relation of time since cessation and risk of hospitalization. Confounding was investigated allowing for different sets of confounding variables. RESULTS: We found that the probability of hospitalization was highest among those who quit 1-3 years ago and decreased thereafter. Adjustment for health status and socio-economic variables revealed that this association is attenuated by current diagnosis of smoking-related diseases. CONCLUSION: Short-term excess health care utilization among former smokers might result from smoking-related conditions that may have led to smoking cessation. Findings suggest that smoking cessation has long-term health benefits resulting in lower health care needs.

Alcohol consumption and out-patient services utilization by abstainers and drinkers.

AIMS: Previous studies have found that abstainers utilize out-patient health services more than alcohol consumers. The aim of this study was to investigate this relationship further by including several confounding variables and effect modifiers. It was hypothesized that abstainers utilize more health services because they have less social resources, practice more risky health behaviours, have poorer self-reported health and suffer more from chronic diseases. DESIGN AND PARTICIPANTS: Cross-sectional health survey of a random sample of adults aged 20-64 in Pomerania, Germany. The response rate was 68.8%. Alcohol consumption was assessed using a quantity-frequency measure and categorized into past-year abstainers, low-risk, medium-risk and high-risk drinkers. Confounders and effect modifiers included socio-demographic and health-related variables. FINDINGS: Abstainers had a 43% higher rate (rate ratio = 1.43, 95% CI = 1.24, 1.63) of physician visits compared to low-risk drinkers, adjusting for age and gender. Medium-risk and high-risk drinkers did not differ from low-risk drinkers in terms of out-patient visits. Further regression adjustment for socio-economic covariates, self-reported health status and chronic diseases suggested that abstainers used more out-patient services because they were more ill than drinkers. The effect of mental health status and the number of chronic diseases on out-patient visits was greater for abstainers than drinkers. CONCLUSIONS: The relation between alcohol consumption and out-patient services is explained partly by poorer health among the abstainers. Further research is needed to affirm these results, such as transferring this evidence to the utilization of in-patient health services.

Post-traumatic stress disorder: the role of trauma, pre-existing psychiatric disorders, and gender.

BACKGROUND: The study is aimed at investigating the influence of trauma type, pre-existing psychiatric disorders with an onset before trauma, and gender on post-traumatic stress disorder (PTSD). METHODS: Traumas, PTSD and psychiatric disorders were assessed in a representative sample of 4075 adults aged 18-64 years using the Composite International Diagnostic Interview. Pre-existing DSM-IV diagnoses of anxiety disorders, depressive disorders, somatoform disorders, alcohol abuse and dependence, nicotine dependence, gender, and the type of trauma were analysed with logistic regressions to estimate the influence of these factors on the risk for developing PTSD. RESULTS: The lifetime prevalence of exposure to any trauma did not vary by gender. The conditional probability of PTSD after exposure to trauma was higher in women (11.1% SE = 1.58) than men (2.9% SE = 0.83). Univariate analyses showed that pre-existing anxiety disorders, somatoform disorders and depressive disorders significantly increase the risk of PTSD. Multivariate analyses revealed that specific types of trauma, especially rape and sexual abuse, pre-existing anxiety disorders and somatoform disorders are predictors of an increased risk of PTSD, while gender and depressive disorder were not found to be independent risk factors. CONCLUSION: Women do not have a higher vulnerability for PTSD in general. However, especially sexually motivated violence and pre-existing anxiety disorders are the main reasons for higher prevalences of PTSD in women.