[Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. / Einfluss der COVID-19-Pandemie auf die Diagnostik und Therapie bei Patienten mit Kopf-Hals-Tumoren in Brandenburg und Berlin.

BACKGROUND: The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE: The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS: A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS: No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION: Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.

Changes in Waist Circumference among German Adults over Time - Compiling Results of Seven Prospective Cohort Studies.

AIM: This study aims to quantify longitudinal changes in waist circumference (WC) among adults aged 45-64 years in Germany. METHODS: Data of 15,444 men and 17,207 women from one nationwide and six regional prospective German cohort studies were analyzed. The sex-specific mean change in WC per year of follow-up was assessed for each study separately. Findings from the cohort-by-cohort analysis were combined by applying meta-analytic methods. Progression to central obesity (WC ≥ 102 cm in men and ≥ 88 cm in women) within a standardized period of 10 years was described for each study. RESULTS: The estimated mean change in WC per year of follow-up for all cohorts combined was 0.53 (95% confidence interval 0.29-0.76) cm/year for men and 0.63 (0.48-0.77) cm/year for women, but varied between the included studies. Within 10 years, about 20% of individuals with low WC (<94 cm in men; <80 cm in women) and about 50% of individuals with intermediate WC (94-102 cm in men; 80-88 cm in women) progressed to central obesity. CONCLUSION: The increase in mean WC with aging along with a profound increase of central adiposity is obviously and may have several adverse health effects. Obesity prevention programs should also focus on abdominal obesity.

Depth-dependent changes of obstruction patterns under increasing sedation during drug-induced sedation endoscopy: results of a German monocentric clinical trial.

PURPOSE: Drug-induced sedation endoscopy (DISE) and simulated snoring (SimS) can locate the site of obstruction in patients with sleep-disordered breathing (SDB). There is clinical evidence for a change in collapsibility of the upper airway depending on the depth of sedation. So far, a dose-response relationship between sedation and collapsibility has not been demonstrated. METHODS: DISE and SimS were performed in 60 consecutive patients with SDB under monitoring of depth of sedation by BiSpectral Index® (BIS). Initially, SimS was conducted followed by DISE using bolus application of propofol. Sedation was performed up to a sedation level representing slow wave sleep (BIS = 40). The collapsibility of the upper airway was documented at decreasing sedation levels by an identical pictogram classification. RESULTS: For all levels and patterns of obstruction, a dose-dependent increase in the collapsibility of the upper airway was detected. A maximum collapsibility was achieved at sedation levels representing slow wave sleep. The collapsibility during SimS corresponded to light sleep stages and did not cover slow wave sleep. CONCLUSION: A dose-dependent change of patterns of obstructions can be observed during DISE under BIS monitoring indicating sedation depth. The obtained patterns of obstruction during DISE and SimS should thus be interpreted with regard to the sedation depth.

Socioeconomic status and anthropometric changes-A meta-analytic approach from seven German cohorts.

OBJECTIVE: To study the association between socioeconomic status (SES) and annual relative change in anthropometric markers in the general German adult population. METHODS: Longitudinal data of 56,556 participants aged 18-83 years from seven population-based German cohort studies (CARLA, SHIP, KORA, DEGS, EPIC-Heidelberg, EPIC-Potsdam, PopGen) were analyzed by meta-analysis using a random-effects model. The indicators of SES were education and household income. RESULTS: On average, all participants gained weight and increased their waist circumference over the study's follow-up period. Men and women in the low education group had a 0.1 percentage points greater annual increase in weight (95% CI men: 0.06-0.20; and women: 0.06-0.12) and waist circumference (95% CI men: 0.01-0.45; and women: 0.05-0.22) than participants in the high education group. Women with low income had a 0.1 percentage points higher annual increase in weight (95% CI 0.00-0.15) and waist circumference (95% CI 0.00-0.14) than women with high income. No association was found for men between income and obesity markers. CONCLUSIONS: Participants with lower SES (education and for women also income) gained more weight and waist circumference than those with higher SES. These results underline the necessity to evaluate the risk of weight gain based on SES to develop more effective preventive measures.

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing.

There is currently no standardized ear, nose, and throat (ENT) clinical examination for patients with sleep-disordered breathing (SDB). As a result, there are large inter-individual differences in the examinations due to an inadequate estimation of the relevance of certain anatomic sites. We aimed to identify which examinations/dynamic tests are considered most relevant by German ENT physicians. A questionnaire was designed, evaluating 23 anatomic sites/dynamic tests of the upper aero-digestive tract. The questionnaire was sent to all German ENT departments (n = 153), including universities and other tertiary or secondary referral centers, by postal mail. In addition, almost all private ENT specialists registered with the German professional association (n = 2496) were contacted via e-mail. Participants assessed how often they examined the sites/dynamic tests, subjective importance, and the impact on the therapeutic procedure. A mean score of relevance (mSOR) was generated (minimum score 1; maximum score 75) from these three items. The response rate for hospitals was 58.8 %; while, it was 4.1 % for ENT specialists in private practice. Therefore, the total response rate was 7.3 %. Of the 23 assessed items, some showed a high overall relevance, such as the tonsils (mSOR 64.75), webbing (mSOR 58.14), uvula (mSOR 55.12), or tongue base (mSOR 53.99). Other examinations, such as simulated snoring (mSOR 19.34) or the Mueller maneuver (mSOR 18.98), were estimated as less relevant. Our data reflect the assessment of German otorhinolaryngologists on the clinical examination of SDB patients. The results should be considered as a basis for compiling a standardized procedure.

Health literacy in an urban elderly East-German population - results from the population-based CARLA study.

BACKGROUND: Health literacy (HL) has gained increasing attention in public health research. However, until now research was mainly focused on clinical settings rather than on the general population. Due its relation to social determinants and health outcomes, HL is of special interest in epidemiological studies. The aim of the present study was therefore to describe HL among an elderly general high-risk population, to analyze the potential contributing factors of HL, and to analyze the impact of HL on health-related outcomes. METHODS: We used data from the CARLA Study, which is a prospective population-based cohort study of the elderly general population of the city of Halle (Saale) in Eastern Germany. The short version of the HLS-EU Questionnaire (HLS-EU-Q16) was administered with 1,107 subjects aged between 55 and 91 year old. A HL score ranging from 0 to 50 points was computed and classified according to the recommendation of the HLS-EU project. Socio-economic as well as health-related variables were determined during the standardized interview and clinical examination. We calculated linear as well as logistic regression models in order to analyze the association between HL and health-related outcomes as well as potential influencing factors of HL. RESULTS: Overall, the HL score was 36.9 (SD 6.9). Among all subjects, 4 % showed inadequate HL, 23 % problematic HL, 50 % sufficient HL, and 23 % excellent HL. HL was positively associated with educational level, net household income, and self-perceived social position. Further, we found an increase of HL with age (ß = 0.10; 95 % CL 0.05; 0.15) and a lower HL score among women compared with men (Diff = -1.4; 95 % CL -2.2; -0.6). An inverse association was observed between HL and diabetes among both sexes (OR 0.93; 95 % CL 0.93; 0.98), between HL and myocardial infarction among women, and between HL and stroke among men. CONCLUSIONS: In this elderly general Eastern German population, we found higher HL score values compared with previous studies using the same questionnaire. HL was associated with socio-economic status. Furthermore, this cross-sectional study could show associations between HL and different health-related outcomes even after adjustment for educational level. However, further research is needed in order to evaluate the impact of HL on health-related outcomes using longitudinal data derived from the general population.

Association of Change of Anthropometric Measurements With Incident Type 2 Diabetes Mellitus: A Pooled Analysis of the Prospective Population-Based CARLA and SHIP Cohort Studies.

Our objective was to investigate the association of change of anthropometric measurements and the incidence of type 2 diabetes mellitus (T2DM) within a pooled sample of 2 population-based cohorts.A final sample of 1324 women and 1278 men aged 31 to 83 years from 2 prospective cohorts in Germany, the CARLA (Cardiovascular Disease - Living and Ageing in Halle) and the SHIP study (Study of Health in Pomerania), were pooled. The association of change of body weight and waist circumference (WC) with incidence of T2DM was assessed by calculating sex-specific hazard ratios (HRs). We investigated the absolute change of markers of obesity as well as change relative to the baseline value and estimated crude and adjusted HRs. Furthermore, we conducted the analyses stratified by obesity status and age (<60 vs ≥60 years) at baseline.Associations were found for both change of body weight and WC and incidence of T2DM in the crude and adjusted analyses. In the stratified study sample, those participants with a body mass index of <30 kg/m at baseline showed considerably lower HRs compared with obese women and men for both weight and WC. In the age-stratified analysis, we still found associations between change of weight and WC and incident T2DM with only marginal differences between the age groups.Our study showed associations of change of weight and WC as markers of obesity with incidence of T2DM. Keeping a healthy and primarily stable weight should be the goal for preventing the development of T2DM.

Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway.

Drug-induced sleep endoscopy (DISE) and simulated snoring (SimS) are performed as part of the diagnostic procedure in patients with suspected sleep-disordered breathing (SDB). Despite both techniques frequently performed, they have rarely been evaluated yet in terms of agreement of the obtained results. Both diagnostic procedures were performed consecutively in 40 patients with SDB and documented identically. The obtained data were analysed with respect to the agreement of both procedure at different levels of the oropharynx as well as different patterns of obstruction and vibration. The anterior-posterior collapsibility of the soft palate/uvula revealed a moderate agreement between SimS and DISE (κ = 0.42; 95 % CI 0.22-0.63). The dorsal shift of the tongue base agreed moderate for patients with an AHI below 10 (κ = 0.47) and above 25 (κ = 0.44) between SimS ad DISE. The lateral and circular pharyngeal collapsibility at velum and tongue base level did not agree between SimS and DISE, was higher for DISE and could be partially reversed by mandibular protrusion. Collapse patterns of the soft palate and uvula can be induced by SimS and resemble the patterns induced by DISE. The dorsalization of the tongue base can be simulated to a lower extent by SimS. Lateral and circular patterns of collapse at the upper and lower oropharynx induced by DISE do not seem to be simulated by SimS. SimS seems to be an additional method to screen the collapsibility of the soft palate and uvula prior to DISE.

Evaluation of acoustic characteristics of snoring sounds obtained during drug-induced sleep endoscopy.

INTRODUCTION: Snoring sounds are discussed to contain acoustic information about their geneses. Nocturnal snoring can easily be recorded acoustically but it is difficult to visually verify its genesis. Contrary, snoring patterns induced by drug-induced sleep endoscopy (DISE) can be visually differentiated. The aim of the study was to classify patterns of obstructions and vibration during DISE and to evaluate acoustic characteristics between these different patterns of snoring. METHODS: DISE was performed in 41 male patients with sleep-disordered breathing. The recorded video sequences (n = 108) were classified visually at a mute mode in different patterns of snoring (velar, velar obstructive, tonsillar, post-apnoeic). The sound tracks of these subgroups were analysed and compared with regard to the parameters sound pressure level, loudness, sharpness, roughness, fluctuations strength and centre frequency. RESULTS: Obstructive snoring patterns revealed a higher loudness than non-obstructive patterns (>25 sone). Velar snoring showed more roughness (>150 cAsper) than tonsillar and post-apnoeic snoring and revealed the lowest centre frequency (<3000 Hz) of all patterns. Tonsillar snoring presented the highest sharpness (>1.6 acum) whereas post-apnoeic snoring revealed the largest fluctuation strength (>50 cVacil). CONCLUSION: Different snoring patterns induced by DISE can be classified visually, and an approach to differentiate them acoustically by means of psychoacoustic analyses is demonstrated. On the basis of these results, nocturnal snoring might also be differentiated by psychoacoustic algorithms which could be implemented in acoustic polygraphic screening devices in the future.

Analysis of snoring sound by psychoacoustic parameters.

The analysis of snoring sounds has been in focus for the past two decades. Conventional approaches by fast Fourier transformation face various limitations and demonstrate the necessity for alternative methods of investigation. Psychoacoustic analyses which are common for environmental noise analyses propose a potential approach. The present study investigates the psychoacoustic qualities (loudness, sharpness, roughness) of three different real snoring sounds (primary snoring, PS; Upper airway resistance syndrome, UARS; obstructive sleep apnea syndrome, OSAS) and their alterations under increasing, artificially created sound pressure levels (SPL) from 60-85 dB. PS and UARS were detected to obtain a greater loudness as well as a higher increase under increasing SPL than OSAS. The sharpness was higher in PS and UARS, remaining stable under rising SPL compared to OSAS. The intensities of roughness were at higher levels for PS compared to URAS and OSAS, with an increase of all snoring sounds under rising SPL. By merging the psychoacoustic qualities, an individual acoustic fingerprint can be created to differentiate the three types of snoring. A potential application is proposed for the analysis of snoring sounds during polysomnography as well as for an adequate evaluation of the annoyance by snoring sounds.

The upper airway in sleep-disordered breathing: a clinical prediction model.

OBJECTIVES/HYPOTHESIS: An examination of the upper airway in patients with suspected sleep disordered breathing (SDB) is recommended prior to nighttime polysomnography (PSG) despite a reported low predictive value of those examinations. The aim of this study was to evaluate the data of the clinical examination and to create a clinical prediction model. STUDY DESIGN: Retrospective cohort study. METHODS: A recently introduced method of dynamic examination of the upper airway during simulated snoring (SS) in awake patients is conducted in patients with suspected SDB. Clinical parameters, body mass index (BMI), and the Epworth sleepiness scale (ESS) scores of 622 patients were included in a clinical prediction model and correlated to the apnea-hypopnea index (AHI). RESULTS: A correlation was detected between the AHI and alterations of the upper airway during SS, BMI, and ESS score. A clinical prediction model including clinical data, BMI, and ESS score revealed a high sensitivity but low specificity predicting the nocturnal AHI: calculated AHI = tonsil size x 2.648 + uvula size x 3.776 + dorsal movement during SS x 2.842 + collapse at tongue base level during SS x 4.769 + BMI x 0.609 + ESS score x 1.177 - 27.685. CONCLUSIONS: The dynamic examination of the upper airway during SS in awake patients in combination with clinical data, the BMI, and ESS score is an easy-to-perform screening procedure prior to nighttime PSG and might support the otorhinolaryngologic diagnostic approach in patients with suspected SDB.

The impact of the microphone position on the frequency analysis of snoring sounds.

Frequency analysis of snoring sounds has been reported as a diagnostic tool to differentiate between different sources of snoring. Several studies have been published presenting diverging results of the frequency analyses of snoring sounds. Depending on the position of the used microphones, the results of the frequency analysis of snoring sounds vary. The present study investigated the influence of different microphone positions on the outcome of the frequency analysis of snoring sounds. Nocturnal snoring was recorded simultaneously at six positions (air-coupled: 30 cm middle, 100 cm middle, 30 cm lateral to both sides of the patients' head; body contact: neck and parasternal) in five patients. The used microphones had a flat frequency response and a similar frequency range (10/40 Hz-18 kHz). Frequency analysis was performed by fast Fourier transformation and frequency bands as well as peak intensities (Peaks 1-5) were detected. Air-coupled microphones presented a wider frequency range (60 Hz-10 kHz) compared to contact microphones. The contact microphone at cervical position presented a cut off at frequencies above 300 Hz, whereas the contact microphone at parasternal position revealed a cut off above 100 Hz. On an exemplary base, the study demonstrates that frequencies above 1,000 Hz do appear in complex snoring patterns, and it is emphasised that high frequencies are imported for the interpretation of snoring sounds with respect to the identification of the source of snoring. Contact microphones might be used in screening devices, but for a natural analysis of snoring sounds the use of air-coupled microphones is indispensable.

Pharmaceutical care for migraine and headache patients: a community-based, randomized intervention.

BACKGROUND: Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment. OBJECTIVE: To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints. METHODS: A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life. RESULTS: Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache. CONCLUSIONS: A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required.

Frequency analysis of snoring sounds during simulated and nocturnal snoring.

Despite several ways of investigation, such as clinical examination, drug-induced sleep endoscopy and pressure measurement of the upper airway, it is still difficult to locate the site of snoring exactly. Frequency analysis of snoring sounds is described as a promising diagnostic tool. The aim of the study was to examine simulated snoring under conditions awake, record the produced snoring sounds and compare those sounds with nocturnal snoring. A total of 50 snoring male patients were examined clinically by flexible nasal endoscopy and simulated snoring under conditions awake, and the simulated snoring sounds were recorded. Additionally, nocturnal snoring sounds were recorded during nighttime polysomnography. Snoring events were analyzed by fast-fourier-transformation and the intensity peaks 1-5 were evaluated. Rhythmic and non-rhythmic snoring events were distinguished depending on present obstructive apneas. Clinical and polysomnographical data were correlated with the results of the frequency analysis of the snoring sounds. Simulated snoring sounds revealed a low frequency of 200 Hz in intensity peaks 1 and 2 with an increase up to 3,000 Hz in peaks 3-5. Similar frequency patterns were detected in rhythmic nocturnal snoring. Non-rhythmic snoring events revealed frequency patterns between 2,000 and 3,000 Hz in all five intensity peaks. Simulated snoring resembles rhythmic nocturnal snoring with low-frequency intensity peaks, whereas non-rhythmic snoring revealed high frequencies. The examination during simulated snoring and frequency analysis of snoring sounds might contribute in locating the pathogenesis of snoring.

Analysed snoring sounds correlate to obstructive sleep disordered breathing.

Snoring occurs as a major symptom in patients with sleep disordered breathing (SDB). The aetiology of snoring remains still unclear despite various attempts to localize snoring. The correlation between different snoring sounds and the severity of SDB has not yet been investigated in a larger population. The aim of this study was to record and analyse snoring sounds and to correlate the obtained data with clinical and polysomnographical parameters. Sixty male patients with suspected SDB and reported snoring underwent a clinical examination and night time polysomnography. The parallel digitally recorded snoring sounds were analysed by fast fourier transformation (FFT). Peak intensity was determined from the power spectrum. The periodicity of snoring was classified into rhythmic and non-rhythmic snoring according to the presence of air flow interruptions due to obstructive apneas. Patients with primary snoring revealed peak intensities between 100 and 300 Hz. Patients with an obstructive sleep apnea syndrome (OSAS) revealed peak intensities above 1,000 Hz. Polysomnographical data (AHI, mean and minimum SpO(2)) as well as body mass index (BMI) correlated with peak intensity of the power spectrum. None of the parameters of the clinical examination correlated with peak intensity. Frequency analysis of snoring sounds provides a useful diagnostic tool to distinguish between different patterns of snoring and respective SDB. The topodiagnosis of snoring is not possible by means of frequency analysis or clinical examination alone. Acoustical analysis of snoring sounds seems a promising additional diagnostic tool to verify different types of SDB in snoring patients.