Diabetes-specific quality of life but not health status is independently associated with glycaemic control among patients with type 2 diabetes: a cross-sectional analysis of the ADDITION-Europe trial cohort.

AIMS: To examine the association between health status, diabetes-specific quality of life (QoL) and glycaemic control among individuals with type 2 diabetes. METHODS: 1876 individuals with screen-detected diabetes and a mean age of 66 years underwent assessment of self-reported health status (SF-36), diabetes-specific QoL (the Audit of Diabetes Dependent Quality of Life (ADDQoL19)) and glycated haemoglobin (HbA1c) at five years post-diagnosis in the ADDITION-Europe trial. Multivariable linear regression was used to quantify the cross-sectional association between health status, diabetes-specific QoL and HbA1c, adjusting for age, sex, education, alcohol consumption, physical activity, BMI, intake of any glucose-lowering drugs, and trial arm. RESULTS: The mean (SD) SF-36 physical and mental health summary scores were 46.2 (10.4) and 54.6 (8.6), respectively. The median average weighted impact ADDQoL score was -0.32 (IQR -0.89 to -0.06), indicating an overall negative impact of diabetes on QoL. Individuals who reported a negative impact of diabetes on their QoL had higher HbA1c levels at five years after diagnosis compared with those who reported a positive or no impact of diabetes (b-coefficient [95% CI]: b=0.2 [0.1, 0.3]). Physical and mental health summary SF-36 scores were not significantly associated with HbA1c in multivariable analysis. CONCLUSIONS: Diabetes-specific QoL but not health status was independently associated with HbA1c. Practitioners should take account of the complex relationship between diabetes-specific QoL and glucose, particularly with regard to dietary behaviour. Future research should attempt to elucidate via which pathways this association might act.

Predictors of change in objectively measured and self-reported health behaviours among individuals with recently diagnosed type 2 diabetes: longitudinal results from the ADDITION-Plus trial cohort.

BACKGROUND: There is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes. METHODS: ADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40-69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression. RESULTS: Participants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increases in plasma vitamin C were observed in women (beta-coefficient [95% CI]: beta = -5.52 [-9.81, -1.22]) and in those with screen-detected diabetes (beta = 6.09 [1.74, 10.43]). Younger age predicted a greater reduction in fat (beta = -0.43 [-0.72, -0.13]) and energy intake (beta = -6.62 [-13.2, -0.05]). Patients with screen-detected diabetes (beta = 74.2 [27.92, 120.41]) reported a greater increase in fruit intake. There were no significant predictors of change in self-reported physical activity. Beliefs about behaviour change and diabetes did not predict behaviour change. CONCLUSIONS: Older patients, men and those with a longer duration of diabetes may need more intensive support for dietary change. We recommend that future studies use objective measurement of health behaviours and that researchers add predictors beyond the individual level. Our results support a focus on establishing healthy lifestyle changes early in the diabetes disease trajectory.

Awareness of human papillomavirus infection, genitoanal warts and cancer in a dermatological outpatient clinic setting.

There has been little research into awareness of human papillomavirus (HPV) among dermatological out-patients, despite the fact that management of HPV infection causing genitoanal warts/cancer is part of the routine practice of dermato-venereologists. The aim of this study was to explore awareness of HPV among dermatological outpatients. A self-administered questionnaire was distributed to 360 consecutive attendees of a Munich dermatological outpatient clinic in November 2009. Of the total number of questionnaires, 77.2% were returned, and 69.7% (n=251, 51.8% females) were included in the analysis. 39.4% of the respondents had heard of HPV infection, and 23.9% of vaccination. Of those who had heard of HPV, 81.8% knew that HPV risk is associated with non-use condoms, number of sexual partners (77.8%), smoking (8.1%), and that HPV causes genital warts (65.7%), anal warts (39.4%) and cervical cancer (57.6%). HPV ignorance (never having heard of HPV) was predicted by being male (adjusted odds ratio=2.23, 95% confidence interval=1.32-3.80) and being a parent (adjusted odds ratio=2.11, 95% confidence interval=1.24-3.59). We conclude that dermatological outpatients have insufficient knowledge of HPV, its sequelae and prevention.

Knowledge, attitude and behavioral intention to act regarding HIV infection and prevention in immigrants from the Former Soviet Union in Germany: a comparative study with the native population.

In Germany, immigrants from Former Soviet Union (FSU) countries represent one of the largest immigrant groups. Some FSU countries face the highest HIV prevalence in the region of Eastern Europe and Central Asia. However, the HIV knowledge, attitude and behavioral intent have not been investigated in FSU immigrants compared to the native population yet. A cross-sectional anonymous survey among 1,205 FSU immigrants and 435 native Germans (aged 18-65 years) in Bavaria. Data analysis from the participating 435 (36 %) immigrants and 334 (76.8 %) natives showed that the immigrants were less knowledgeable (p < .001) about HIV transmission (median score 8 vs. 9, ranged from 0 to 10) and HIV prevention (4 vs. 5, ranged from 0 to 6) than the native Germans, especially with regard to HIV transmission during anal (67 vs. 79.1 %; OR = 1.86 [1.32-2.62]) and oral (49.7 vs. 61.8 %; OR = 1.63 [1.21-2.20]) intercourse and showed a high misconception rate. Age and education were associated with knowledge about sexual HIV transmission; male gender, age and education with HIV prevention by single-use of needles/syringes. In case of a suspected HIV contraction, fewer immigrants would request a test; in case of a confirmed HIV diagnosis fewer would use a condom or inform their sexual partner(s). This first comparative study indicates an urgent need for HIV/AIDS education among FSU immigrants.

Regional deprivation in Bavaria, Germany: linking a new deprivation score with registry data for lung and colorectal cancer.

OBJECTIVE: This study aimed to examine the differences in cancer risk by regional deprivation in Bavaria, Germany. METHODS: Multilevel Poisson regression analysis was used to evaluate the association between lung and colorectal cancer risk and community deprivation level based on data from the Cancer Registry of Bavaria (2003­2006). The communities (n=1,408) were classified according to the Bavarian Index of Multiple Deprivation (BIMD), differentiated into quintiles ranging from lowest to highest deprivation. RESULTS: Increased lung cancer risk in men and colorectal cancer risk in both genders were associated with increasing BIMD. Comparing the most deprived with the least deprived communities, the relative risk for lung cancer incidence in men was 1.39 (95% CI 1.29­1.49), for mortality risk 1.54 (95% CI 1.41­1.68). The relative risk for colorectal cancer incidence in men was 1.30 (95% CI 1.22­1.38) and in women 1.19 (95% CI 1.11­1.27); for mortality risk we found 1.57 (95% CI 1.40­1.76) in men and 1.34 (95% CI 1.19­1.51) in women. CONCLUSION: Area-based deprivation is significantly associated with cancer risk in Bavaria.

Associations between regional socioeconomic deprivation and cancer risk: Analysis of population-based Cancer Registry data from Bavaria, Germany.

OBJECTIVE: Previous research from other countries shows a positive association between cancer risk and regional deprivation. This study explores this association for lung and colorectal cancers in Germany. METHOD: Regional deprivation was assessed by the 'Bavarian Index of Multiple Deprivation'. Cancer data were provided by the Cancer Registry of Bavaria (2003-2006). The association between cancer risk and regional deprivation was evaluated by multilevel Poisson regression analysis. RESULTS: Crude incidence and mortality rates (per 1000 people) in the least deprived areas were 1.46 and 0.92 for lung cancer, 2.82 and 0.69 for colorectal cancer. For lung cancer, the age-adjusted relative risk (RR) for incidence in the most deprived districts (compared with the least deprived) in men was 1.41 (95% CI: 1.28-1.54), for mortality 1.59 (95% CI: 1.40-1.80); in women, an elevated RR was seen for mortality (1.24, 95% CI: 1.06-1.46). For colorectal cancer, the RR for incidence (men: 1.31, 95% CI: 1.17-1.46; women: 1.25, 95% CI: 1.12-1.40) and mortality (men: 1.51, 95% CI: 1.28-1.80; women: 1.49, 95% CI: 1.26-1.77) was always highest in the most deprived districts. CONCLUSION: At the district level in Bavaria, the risk for lung and colorectal cancers mostly increases with increasing regional deprivation.

Short risk behaviour knowledge index for HIV average risk population of sexual active age in Munich, Germany.

PURPOSE: A short HIV/AIDS risk behaviour knowledge index based on questions about HIV transmission and prevention of HIV infection during sexual intercourse and intravenous drug use is proposed and implemented for an HIV average risk population in Munich. METHODS: Knowledge levels about HIV/AIDS risk behaviour was assessed in a group of people (n = 210) in sexually active age range of 18-49 years which was at an average risk of contracting HIV. Four questions about HIV transmission by unprotected vaginal, anal, or oral sexual intercourse, and by needle sharing, and two questions about HIV prevention by condom use, and the single use of needles and syringes were chosen from ten others for making a four level risk behaviour knowledge index (HIV/AIDS Transmission through Sex and Intravenous Drug Use, HATSIDU) internally consistent according to Cronbach's alpha. RESULTS: HATSIDU index (mean 3.0, SD +/- 1.18) was not associated (p>0.05) with sex and marital status, but depended (p < 0.05) on age, education and social status. General population of Munich in a sexually active age group of 40-49 years, or those without further education or the unemployed, had a significantly lower knowledge of HIV risk behaviour. CONCLUSION: The HATSIDU is a simple and usable index for the assessment of HIV/AIDS risk behaviour knowledge in a population with an average risk of HIV infection.