[Time trend in programme sensitivity within the German mammography screening programme in North Rhine-Westphalia and Lower Saxony]. / Zeitliche Entwicklung der Programmsensitivität des deutschen Mammographie-Screening-Programms in Nordrhein-Westfalen und Niedersachsen.

BACKGROUND: The programme sensitivity is a performance indicator for evaluating the quality of the mammography screening programme (MSP). OBJECTIVES: We analysed the development of the programme sensitivity over time in two federal states of Germany, North Rhine-Westphalia (NRW) and Lower Saxony (NDS). MATERIALS AND METHODS: Data from 2,717,801 (NRW) and 1,197,660 (NDS) screening examinations between 2006 and 2011 were linked with data of the State Cancer Registry NRW and the Epidemiological Cancer Registry NDS, respectively. Breast cancers (invasive and in situ) were either detected at screening or diagnosed within the 24-month interval after an inconspicuous screening result outside the programme. The crude and age-standardized programme sensitivity was calculated per calendar year. The German mammography screening office provided aggregated recall rates. RESULTS: The age-standardized programme sensitivity increased markedly for initial screening examinations from 2006 to 2011 from 75.0% (95% CI: 72.1-77.9) to 80.5% (95% CI: 78.5-82.5) in NRW, and from 74.9% (95% CI: 71.4-78.5) to 84.7% (95% CI: 81.1-88.3) in NDS. Concurrently, recall rates increased as well. For subsequent screening examinations, the programme sensitivity increased from 2008 to 2011 from 68.1% (95% CI: 63.1-73.1) to 71.9% (95% CI: 70.2-73.6) in NRW, and from 69.8% (95% CI: 64.2-75.4) to 74.9% (95% CI: 72.3-77.5) in NDS, whereas the recall rates remained relatively constant. CONCLUSIONS: In both federal states, the programme sensitivity increased over time. This increase, possibly indicating an improved quality of diagnosis within the MSP as a learning system, is discussed under consideration of the age distribution of screening participants and the recall rates.

[Patients' need for consultation after a geriatric assessment in family practice : Survey]. / Patientenseitiger Gesprächsbedarf nach einem geriatrischen Assessment in Hausarztpraxen : Survey.

BACKGROUND: During a doctor-patient consultation patients usually seek information by disclosing their reasons for requesting the encounter. Geriatric assessment allows a proactive examination of patients' overall health and function and provides an opportunity to broach issues beyond the initial purposes of the consultation. OBJECTIVES: The study aimed at investigating older patients' information seeking behavior following a geriatric assessment and the kind of topics they wished to discuss, taking a variety of patient and health-related factors into account. MATERIAL AND METHODS: A total of 317 patients (≥ 70 years) underwent a geriatric assessment in 40 general practices. Subsequently they obtained a list of the problems uncovered and rated the relevance and information needs for each problem. Analyses consisted of determining the prevalence of information need for each health topic and identifying predictors in a mixed model (multilevel regression analysis). RESULTS: The 317 patients presented with a median of 11 health problems (interquartile range, IQR 8-14) and 80 % of the patients had information needs concerning only a few of the problems. High information needs were present for physical complaints and for vaccination issues. Little information seeking behavior was evident for unhealthy lifestyles, falls, limitations in daily activities and psychosocial problems. In the mixed model the personal relevance and the type of health problem both had a significant and independent effect on information seeking behavior. CONCLUSION: A geriatric assessment generates a moderate need for information. It provides physicians with an opportunity to focus on those health problems that are important to older patients but not usually addressed in normal consultations. This particularly applies to limitations in daily activities and psychosocial problems.

Prevalence and incidence of anemia in the German Heinz Nixdorf Recall Study.

This study aims to determine prevalence and incidence of anemia in the general population in Germany and evaluate a potential role of serum-free light chains (FLC) as biomarker in anemia. The population-based Heinz Nixdorf Recall Study comprises 4,814 men and women aged 45-75 years. Hemoglobin <13 g/dl in men and <12 g/dl in women defined anemia. Laboratory data was used to classify cases into renal, iron deficiency (IDA), vitamin B12/folic acid deficiency, anemia of chronic disease (ACD), and unexplained anemia (UA). Follow-up data was available from annual questionnaires, death certificates, and 5-year follow-up visit (5-year FU). Anemia cases (152) were identified (prevalence 3.2 %, 95 % CI 2.7-3.7). In participants aged 65 or older, prevalence was 4.3 % (95 % CI 2.9-6.0) in both men and women. Main anemia subtypes were: IDA 19 %, ACD 25 %, and UA 44 %. Incidence increased with age and was 12.8/1,000 person-years and 10.9/1,000 person-years in men and women aged 65 or older, respectively. UA was characterized by elevated FLC. Participants with elevated FLC and high-sensitivity C-reactive protein (hsCRP) had an increased risk of anemia at 5-year FU. FLC-alone or in combination with hsCRP-may serve as biomarker indicating an increased risk of developing anemia.

Prevalence and progression of monoclonal gammopathy of undetermined significance and light-chain MGUS in Germany.

We determined the prevalence and progression rate of monoclonal gammopathy of undetermined significance (MGUS) and light-chain MGUS (LCMGUS) in Germany utilizing the biobank of the population-based Heinz Nixdorf Recall Study. The Heinz Nixdorf Recall Study comprises 4,814 men and women aged 45-75 years. To detect monoclonal proteins, standard serum electrophoresis was combined with parallel screening immunofixation using pentavalent antisera. Additionally, free light chains (FLC) were measured in all samples. Definition of MGUS included M-protein concentration, laboratory results, and disease history. LCMGUS was defined as abnormal FLC ratio, increase in FLC causing the abnormal ratio, and lack of intact immunoglobulin. One hundred sixty-five MGUS cases were identified among 4,702 screened samples (prevalence 3.5%, 95% confidence interval (CI) 3.0-4.1; median age 63 years, range 47-75 years; 103 (62%) male; IgG 59%, IgA 17%, IgM 17%, biclonal 4.8%, kappa 56%, and lambda 44%). Five cases progressed (0.6%/year, 95% CI 0.2-1.4). An abnormal FLC ratio was detected in 220 samples. Thirty-nine of these showed intact immunoglobulin. Thirty-four of the remaining met LCMGUS criteria (prevalence 0.7%, 95% CI 0.5-1.0). None of the LCMGUS cases progressed. We demonstrate a MGUS prevalence of 3.5% and a LCMGUS prevalence of 0.7% in the general population aged 45-75 years in Germany using a sensitive screening approach.

Validation of protein and potassium intakes assessed from 24 h recalls against levels estimated from 24 h urine samples in children and adolescents of Turkish descent living in Germany: results from the EVET! Study.

OBJECTIVE: Nutrition-related health problems such as obesity are frequent among children and adolescents of Turkish descent living in Germany, yet data on their dietary habits are scarce. One reason might be the lack of validated assessment tools for this target group. We therefore aimed to validate protein and K intakes from one 24 h recall against levels estimated from one 24 h urine sample in children and adolescents of Turkish descent living in Germany. DESIGN: Cross-sectional analyses comprised estimation of mean differences, Pearson correlation coefficients, cross-classifications and Bland-Altman plots to assess the agreement between the nutritional intake estimated from a single 24 h recall and a single 24 h urine sample collected on the previous day. SETTING: Dortmund, Germany. SUBJECTS: Data from forty-three study participants (aged 5-18 years; 26% overweight) with a traditional Turkish background were included. RESULTS: The 24 h recall significantly overestimated mean protein and K intake by 10·7 g/d (95% CI of mean difference: 0·6, 20·7 g/d) and 344 mg/d (95% CI 8, 680 mg/d), respectively. Correlations between intake estimates were r = 0·25 (P = 0·1) and 0·31 (P = 0·05). Both methods classified 70% and 69% of the participants into the same/adjacent quartile of protein and K intake and misclassified 7% and 7%, respectively, into the opposite quartile. Bland-Altman plots indicated a wide scattering of differences in both protein and K intake. CONCLUSIONS: Among children and adolescents of traditional Turkish descent living in Germany, one 24 h recall may only be valid for categorizing subjects into high, medium or low consumers.

Validation of protein intake assessed from weighed dietary records against protein estimated from 24 h urine samples in children, adolescents and young adults participating in the Dortmund Nutritional and Longitudinally Designed (DONALD) Study.

OBJECTIVE: To date, only a few nutritional assessment methods have been validated against the biomarker of urinary-N excretion for use in children and adolescents. The aim of the present study was to validate protein intake from one day of a weighed dietary record against protein intake estimated from a simultaneously collected 24 h urine sample. DESIGN: Cross-sectional analyses including 439 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study from four age groups (3-4, 7-8, 11-13 and 18-23 years). Mean differences, Pearson correlation coefficients (r), cross-classifications and Bland-Altman plots were used to assess agreement between methods. RESULTS: Weighed dietary records significantly underestimated mean protein intake by -6.4 (95 % CI -8.2, -4.7) g/d or -11 %, with the difference increasing across the age groups from -0.6 (95 % CI -2.7, 1.5) g/d at age 3-4 years to -13.5 (95 % CI -18.7, -8.3) g/d at age 18-23 years. Correlation coefficients were r = 0.7 for the total study sample and ranged from r = 0.5 to 0.6 in the different age groups. Both methods classified 85 % into the same/adjacent quartile for the whole study group (83-86 % for the different age groups) and 2.5 % into the opposite quartile (1.9-3.1 % for the different age groups). Bland-Altman plots for the total sample indicated that differences in protein intake increased across the range of protein intake, while this bias was not obvious within the age groups. CONCLUSIONS: Protein intake in children and adolescents can be estimated with acceptable validity by weighed dietary records. In this age-heterogeneous sample, validity was lower among adolescents and young adults.

Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval. / Höhere Detektionsraten biologisch aggressiver Mammakarzinome im Mammografie-Screening als im 2-jährigen Intervall.

PURPOSE: Assessment of age group-dependent detection rates of invasive breast cancers among participants in mammography screening including the interval, classified into immunohistochemical subtypes indicating the intrinsic tumor aggressiveness. MATERIALS UND METHODS: The target population comprises women aged 50 - 69 years. All invasive breast cancers diagnosed in one screening (sc) unit during the implementation phase 1/2006 - 12/2010 or identified by the cancer registry during the biennial interval (iv) were categorized based on hormonal-receptor status (HR) and Her2-expression (Her2) into the following subtypes: a) HR+ Her2-, b) HR+ Her2 +, c) HR- Her2 + or d) HR- Her2- (triple-negative); Her2 + and triple-negative types were defined as aggressive. The calculated detection rates (DR, ‰) were based on 53 375 sc-examinations and for the interval on 52 887 sc-negative examinations. RESULTS: The DRs of all subtypes were higher in screening versus the interval: (a) 4.95 ‰ (n = 264) vs. 1.00 ‰ (n = 53); b) 0.92 ‰ (n = 49) vs. 0.25 ‰ (n = 13); c) 0.36 ‰ (n = 19) vs. 0.06 ‰ (n = 3); d) 0.39 ‰ (n = 21) vs. 0.19 ‰ (n = 10). 77.4 ‰ (89/115) of all aggressive breast cancers including the following 2-year interval were diagnosed by screening. The sum of the DR of aggressive cancers was 1.67 ‰ in screening and 0.49 ‰ in the interval; the corresponding DRs for women aged 60 - 69 years [sc: 2.24 ‰ (51/22 814), iv: 0.58 ‰ (13/22 536)] were higher than among women aged 50 - 59 years [sc: 1.24 ‰ (38/30 561), iv: 0.43 ‰ (13/30 351)]. CONCLUSION: Screening has the potential for earlier diagnosis of aggressive tumor types as its detection rate is about three-fold higher compared to the interval. Within the target group, participants aged 60 - 69 years are at risk based on absolute numbers. They show a nearly two-fold higher detection rate of Her2-positive or triple-negative tumors compared to the age group 50 - 59 years. KEY POINTS: · Her2-positive and triple-negative detection rates are higher in screening than in the interval.. · 77 % of aggressive subtypes are diagnosed by screening, 23 % during the 2-year interval.. · The detection rate is highest among women aged 60 - 69 years in screening.. CITATION FORMAT: · Prange A, Bokhof B, Polzer P et al. Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval. Fortschr Röntgenstr 2019; 191: 130 - 136.

Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies.

BACKGROUND: Polypharmacy, common in elderly multimorbid adults, leads to increased iatrogenic health risks. Yet, no consistent approach to stopping medicines exists in primary healthcare. OBJECTIVES: Our objective was to synthesize qualitative studies exploring the perspectives and experiences of general practitioners (GPs) and older patients in reducing polypharmacy and to discover approaches already being practiced. METHODS: We conducted a search in the PubMed, Cochrane Library, Web of Science Core Collection, and Scopus databases to identify qualitative studies in the primary care setting addressing multimorbid older patients and polypharmacy reduction. The seven-step model of meta-ethnography allowed for cross-interpretation between studies considering their original context and developing theories. RESULTS: A total of 14 studies from the perspectives of patients (n = 6) and providers (n = 8) were included, although discontinuing medicines only occurred as a sub-theme in patient studies. Emerging key concepts for patients were experimenting with medicines, attitudes and experiences towards medicines, necessity of prioritizing treatments, relationship to GP, and system-related contributors. For GPs, they covered assumptions about elderly patients, interface prescribing problems, evidence-based guidelines, failure to meet the challenge of complex decision-making, and solutions. DISCUSSION: Complex medication regimens and uncertainties in decision making are challenges for both GPs and patients. For patients, symptom experiences with medicines, relationship with their prescriber, and fragmented care are at the forefront; for GPs, it is the decision-making responsibility in the context of unsuitable guidelines, time constraints, and deficient multidisciplinary co-operation. Heuristics such as prioritizing and individualizing treatments and relaxation of guidelines emerged. These strategies require professional awareness of the problem and establishing a trusting, patient-centered consultation style and supportive work conditions.

Agreement between different survey instruments to assess incident and prevalent tumors and medical records - results of the Heinz Nixdorf Recall Study.

OBJECTIVE: The validity of participants' self-reports via questionnaires or interviews in epidemiological studies remains questionable. We examined the agreement of tumors, reported via different survey instruments, with medical records. METHODS: Within the Heinz Nixdorf Recall Study, comprising 4814 subjects aged 45-75 years, tumors were assessed via different survey tools at baseline and 8-year-follow up (FU): personal interviews (CAPI), self-administered questionnaires (SA-Q), physical examinations, short questionnaire/non-responder questionnaire (S-/N-Q) and telephone interviews. Information on each self-reported tumor was coded via ICD-10, WHO-Version 2010, and evaluated against medical records. RESULTS: During FU, 95% of 1083 self-reported incident tumors in 623 individuals, at baseline, 65% of 473 prevalent tumors in 406 individuals could be evaluated. Agreement of the main assessment tools, CAPI and SA-Q, with medical records was 90.1% and 88.4% (FU) and 91.0% (baseline-CAPI). Best agreement was in tumors of prostate (baseline-CAPI: 97.8%; 5-year-FU-CAPI: 96.9%, SA-Q: 95.7%) and breast (baseline-CAPI: 93.2%; 5-year-FU-CAPI: 100.0%, SA-Q: 98.8%). DISCUSSION: Agreement of CAPI and SA-Q with medical records was good. To assess incident tumors, SA-Q emerged as favorable, as it is least expensive and easy to be applied. Especially for tumors of prostate and breast, cost-intensive and time-consuming validation with medical records may not be necessary.

Elevated levels of high-sensitivity C-reactive protein are associated with mild cognitive impairment and its subtypes: results of a population-based case-control study.

As high-sensitivity C-reactive protein (hsCRP) seems to be associated with an increased risk of cognitive decline, this nested case-control study examined the relation of hsCRP and mild cognitive impairment (MCI) at different time points. 148 MCI cases (106 amnestic, 42 non-amnestic (aMCI/naMCI)) and 148 matched controls were identified from a prospective population based cohort study of 4,359 participants (aged 50-80). HsCRP levels were measured 5 years before (baseline) and at the time of neuropsychological testing (follow-up). Odds ratios (OR) for hsCRP quartiles serum levels were calculated for the two time points using logistic regression analyses and were adjusted for cardiovascular covariates. In the fully adjusted model, baseline hsCRP levels were significantly associated with both MCI and aMCI (OR = 2.29, 95% confidence interval (CI), 1.01-5.15, first versus fourth quartile, respective OR = 2.73, 95% CI, 1.09-6.84). At follow-up, the fourth hsCRP quartile was associated with MCI (OR = 3.60, 95% CI, 1.55-8.33), aMCI (OR = 3.73, 95% CI, 1.52-9.17) and naMCI (OR = 3.66, 95% CI, 1.00-13.77). Elevated hsCRP levels, even detected five years before diagnosis, are associated with an at least twofold increased probability of MCI. These findings suggest that inflammation plays an important role in the development and presence of cognitive impairment.