Psychosocial health and quality of life in ICSI and naturally conceived adolescents: a cross-sectional comparison.

PURPOSE: Psychosocial health (PH) and quality of life (QoL) are important health outcomes. We compared PH and QoL of adolescents conceived with intrazytoplasmatic sperm injection (ICSI) and of naturally conceived controls. The impact of disclosure of ICSI-conception on QoL and PH was quantified. METHODS: The cross-sectional sample consisted of 545 ICSI-conceived adolescents and 427 unmatched singleton controls aged 14-18 years. Adolescents reported PH with the 'Strengths and Difficulties Questionnaire' (low values indicating high PH), and QoL with the KINDL questionnaire (high values indicating high QoL). Because of clustering of multiples within families, adjusted linear regressions with generalized estimating equations were used to compare ICSI- and naturally conceived adolescents. Missing values were treated by multiple imputation. Minimal importance was defined as half a standard deviation. RESULTS: Both ICSI and control adolescents had high PH (low mean 'total difficulties' score: 9 of 40) and high QoL (mean 'total KINDL' score: 75 of 100). Differences were generally in favour of the ICSI group. Significant differences occurred for 'impact of behavioural problems' (p = 0.033), the 'total KINDL' score (p = 0.021) and the dimensions 'physical wellbeing' (p = 0.031) and 'school' (p = 0.005), but all differences were far below minimal importance. About 80% of ICSI adolescents were informed about their mode of conception. PH and QoL were slightly higher in informed adolescents; behavioural difficulties ('total behavioural problems' and 'conduct problems') were significantly lower (p = 0.013 and p = 0.003), behavioural strengths ('prosocial behaviour') and 'physical QoL' significantly higher (p = 0.004 and p = 0.018), but differences remained clearly below minimal importance. CONCLUSIONS: Our results are reassuring for parents using ICSI and their children. Speaking openly about an ICSI conception in the family may be beneficial.

Parental expectations before and after 12-month experience with video consultations combined with regular outpatient care for children with type 1 diabetes: a qualitative study.

AIM: To explore parents' expectations of the perceived barriers to and benefits of 1 year of monthly video consultations combined with regular outpatient care of children with type 1 diabetes. METHODS: The Virtual Diabetes Outpatient Clinic for Children and Youth (VIDIKI) study was a controlled, multicentre, perennial study with 240 participants from northern Germany. Fifty-four qualitative interviews with parents were analysed using qualitative content analysis. Before the intervention, 30 interviews were conducted to assess parents' expectations, and after 1 year, 24 interviews evaluated the experienced benefits and barriers to video consultations. RESULTS: Four main topics were identified from parents' responses to the video consultation. The main advantages of the video consultation compared with standard care were a higher frequency of contact for optimized insulin dosing and saving time; difficulties with internet connections were identified as the main barrier. A feeling of increased confidence with respect to insulin dosing was directly associated with telemedicine. Digital prescriptions and meeting the same diabetologist in both outpatient and telemedical care were mentioned as important improvements. The majority of interviewees preferred intervals of 4-6 weeks between video consultations. CONCLUSION: The higher frequency of contact with the diabetes team was considered a great relief by parents of children with type 1 diabetes. Apart from the time savings and flexibility in appointments, the most important advantages were the higher frequency of contact leading to short-term therapy adjustments and an increase in the ability to adjust therapy independently. (German Clinical Trials Registry No: DRKS00012645).

Incidence of pemphigoid diseases in Northern Germany in 2016 - first data from the Schleswig-Holstein Registry of Autoimmune Bullous Diseases.

BACKGROUND: Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell-matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. OBJECTIVES: To establish a registry prospectively recruiting all AIBD patients in a geographically well-defined region in Northern Germany (Schleswig-Holstein). METHODS: Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig-Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig-Holstein, stratified by birth year and sex. RESULTS: Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age-standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85-90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti-p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. CONCLUSIONS: This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings.

Pubertal development and reproductive hormone levels of singleton ICSI offspring in adolescence: results of a prospective controlled study.

STUDY QUESTION: Are there any differences in the pubertal development and reproductive hormone status during adolescence between singletons following ICSI therapy or spontaneous conception (SC)? SUMMARY ANSWER: Pubertal development and reproductive hormone levels are largely similar between ICSI and SC adolescents, except for a tendency towards lower inhibin B levels as well as significantly higher estradiol levels and a lower testosterone-to-estradiol-ratio in male adolescents. WHAT IS KNOWN ALREADY: Previous data are scarce and partly inconclusive regarding pubertal development in female ICSI adolescents as well as demonstrating a tendency towards lower inhibin B serum levels in male ICSI offspring. STUDY DESIGN, SIZE, DURATION: Prospective controlled study including 274 singleton ICSI-conceived adolescents (141 girls, 133 boys) followed up for the third time, and 273 SC controls (142 girls, 131 boys) from seven German registration offices (Aachen, Eichstätt, Erfurt, Lübeck, Hamburg, Heidelberg and Schwerin). PARTICIPANTS/MATERIALS, SETTING, METHODS: Pubertal development assessed by Tanner staging (breast, genital and pubic hair development), age at menarche and reproductive hormone levels were analyzed in ICSI and SC adolescents at the mean age of 16.5 years. Differences were analyzed by multinomial regression (Tanner stages) or t test and linear regression for hormonal assessments. MAIN RESULTS AND THE ROLE OF CHANCE: Both female and male ICSI and SC adolescents showed adequate pubertal maturation according to their age, and the mean age at menarche (at 12.7 versus 12.8 years) was similar. Tanner stages as well did not display any relevant or significant differences between the groups. Reproductive hormone levels in female adolescents not using hormonal contraception were largely similar before and after adjustment for several factors such as preterm birth, Tanner stages, BMI or physical activity. In male ICSI adolescents, a tendency towards lower inhibin B (-14.8 pg/ml, 95% CI: -34.2 to 4.6 pg/ml), significantly higher estradiol (2.6 ng/l, 95% CI: 0.0 to 5.2 ng/l) and a significantly lower testosterone-to estradiol ratio (-0.047, 95% CI: -0.089 to -0.004) was found. LIMITATIONS, REASONS FOR CAUTION: The all-over response rate and the willingness to participate in the blood test and medical examination were very low in the control group. Participating control families may have greater health awareness, and selection bias cannot be ruled out. Hormonal data in the females were measured irrespective of the cycle day and restricted to those not using hormonal contraception. Some parameters from the questionnaire data such as usage of hormonal contraception might suffer from reporting bias. As this is an observational study, we can draw only limited causal conclusions from the findings. WIDER IMPLICATIONS OF THE FINDINGS: Differences in male reproductive hormones may indicate altered testicular function. However, at this time possible consequences for later reproductive success are unknown. STUDY FUNDING/COMPETING INTEREST(S): DFG research grant KA 1643/4-1. The authors declare no conflict of interest.

Time trends in incidence and mortality of cutaneous melanoma in Germany.

OBJECTIVES: To characterize incidence and mortality trends of cutaneous melanoma (CM) in Germany to extrapolate these data until 2030. METHODS: We evaluated data from the Centre for Cancer Registry Data (1999-2012) and from the Saarland Cancer Registry (1970-2012). Age-standardized (according to the European Standard Population, WHO 1976) incidence and mortality rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)] and crude incidence and mortality rates [crude incidence rates (CIRs) and crude mortality rates (CMRs)] were analysed. RESULTS: In entire Germany, ASIRs increased by 55% to 19.2 and CIRs by 77% to 26.0 new cases per 100 000 from 1999 to 2012. ASMRs remained stable, whereas CMR increased by 58% to 4.1 for males and by 30% to 3.0 for females per 100 000. In the Federal State of Saarland, ASIRs increased more than four-fold to 13.1, CIRs increased six-seven fold to 18.5/100 000 from 1970 to 2012. In the same period, ASMRs increased three-fold in males and two-fold in females to 2.5 and 1.6, whereas CMRs increased 5.5-fold in males and 3.5-fold in females to 3.9 and 3.2/100 000, mainly caused by steep increases of CIRs and CMRs in age groups ≥60 years. Projected CIRs will rise to 44-46 for males and 38-40 for females in 2030. Steepest increases were extrapolated for patients ≥60 years, especially for males, but are also expected for age groups of 40-59 years. In contrast, CIRs are anticipated to stabilize for subjects <40 years. CONCLUSIONS: There is a constant increase in incidence and mortality rates for CM in Germany. As the German population is ageing and the current population has already accumulated high levels of UV exposure, a further increase in melanoma incidence is projected for the future without signs of levelling-off.

Interval cancers after skin cancer screening: incidence, tumour characteristics and risk factors for cutaneous melanoma.

BACKGROUND: The rate of interval cancers is an established indicator for the performance of a cancer-screening programme. METHODS: We examined the incidence, tumour characteristics and risk factors of melanoma interval cancers that occurred in participants of the SCREEN project, which was carried out 2003/2004 in Schleswig-Holstein, Germany. Data from 350 306 SCREEN participants, who had been screened negative for melanoma, were linked to data of the state cancer registry. Melanoma interval cancers were defined as melanomas diagnosed within 4-24 months after SCREEN examination. Results were compared with melanomas of the pre-SCREEN era (1999-2002), extracted from the cancer registry. RESULTS: The overall relative incidence of melanoma interval cancers in terms of observed/expected ratio was 0.93 (95% CI: 0.82-1.05; in situ: 1.61 (1.32-1.95), invasive: 0.71 (0.60-0.84)). Compared with melanomas of the pre-SCREEN era, the interval melanomas were thinner and had a slightly greater proportion of lentigo maligna melanomas whereas nodular melanomas were less frequent. INTERPRETATION: The results indicate a moderate performance of the SCREEN intervention with an excess of in situ melanomas. In part, the findings might be due to specifics of the SCREEN project, in particular a short-term follow-up of patients at high risk for melanoma.

Assessing health-related quality of life in urology - a survey of 4500 German urologists.

BACKGROUND: Urological diseases and their treatment may negatively influence continence, potency, and health-related quality of life (HRQOL). Although current guidelines recommend HRQOL assessment in clinical urology, specific guidance on how to assess HRQOL is frequently absent. We evaluated whether and how urologists assess HRQOL and how they determine its practicality. METHODS: A random sample of 4500 (from 5200 identified German urologists) was drawn and invited to participate in a postal survey (an initial letter followed by one reminder after six weeks). The questionnaire included questions on whether and how HRQOL is assessed, general attitudes towards the concept of HRQOL, and socio-demographics. Due to the exploratory character of the study we produced mainly descriptive statistics. Chi2-tests and logistic regression were used for subgroup-analysis. RESULTS: 1557 urologists (85% male, with a mean age of 49 yrs.) participated. Most of them (87%) considered HRQOL assessment as 'important' in daily work, while only 7% reported not assessing HRQOL. Patients with prostate carcinoma, incontinence, pain, and benign prostate hyperplasia were the main target groups for HRQOL assessment. The primary aim of HRQOL assessment was to support treatment decisions, monitor patients, and produce a 'baseline measurement'. Two-thirds of urologists used questionnaires and interviews to evaluate HRQOL and one-quarter assessed HRQOL by asking: 'How are you?'. The main barriers to HRQOL assessment were anticipated questionnaire costs (77%), extensive questionnaire length (52%), and complex analysis (51%). CONCLUSIONS: The majority of German urologists assess HRQOL as part of their clinical routine. However, knowledge of HRQOL assessment, analysis, and interpretation seems to be limited in this group. Therefore, urologists may benefit from a targeted education program. TRIAL REGISTRATION: The clinical trial was registered with the code VfD_13_003629 at the German Healthcare Research Registry ( www.versorgungsforschung-deutschland.de ).

[Can Psychometric Tests Predict Success in the Selection Interview for Medical School? A Cross-Sectional Study at One German Medical School]. / Können psychometrische Tests den Erfolg im Auswahlgespräch zum Medizinstudium vorhersagen? Eine Querschnittsstudie an einer deutschen Hochschule.

Background The final exam grade is the main selection criterion for medical school application in Germany. For academic success, it seems to be a reliable predictor. Its use as the only selection criterion is, however, criticised. At some universities, personal interviews are part of the selection process. However, these are very time consuming and are of doubtful validity. The (additional) use of appropriate psychometric instruments could reduce the cost and increase the validity. This study investigates the extent to which psychometric instruments can predict the outcome of a personal selection interview. Methods This is a cross-sectional study on the correlation of the results of psychometric instruments with those of the personal selection interview as part of the application process. As the outcome, the score of the selection interview was used. The NEO - Five Factor Inventory, the Hospital Anxiety and Depression Scale (HADS) and the questionnaire to identify work-related behaviour and experience patterns (AVEM) were used as psychometric interviews. Results There was a statistically significant correlation with the results of the personal selection interview for the sum score of the depression scale from the HADS and the sum score for the dimension of life satisfaction of the AVEM. In addition, those participants who did not previously complete an application training achieved a better result in the selection interview. Conclusion The instruments used measure different aspects than the interviews and cannot replace them. It remains to be seen whether the selected parameters are able to predict academic success.

Survival with nonmelanoma skin cancer in Germany.

BACKGROUND: Nonmelanoma skin cancer (NMSC) is the most common cancer in Germany, but detailed information on survival is lacking. OBJECTIVES: To provide survival estimates for female and male patients with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), sarcoma, adenocarcinoma and Merkel cell carcinoma. Further subgroup analyses were carried out by age, tumour stage and body site. METHODS: In total 459 640 patients diagnosed with NMSC in 1997-2011 were included from population-based cancer registers, covering a population of 33 million inhabitants. Age-standardized absolute and relative 5-year and 10-year survival were calculated using period analysis. RESULTS: The absolute and relative 5-year survival were 87·1% and 102·9% for BCC, 77·6% and 93·6% for SCC, 82·1% and 96·0% for sarcoma, 71·4% and 85·7% for adenocarcinoma and 60·0% and 70·7% for Merkel cell carcinoma, respectively. Higher age, female sex and advanced stage were associated with lower survival. CONCLUSIONS: A comprehensive overview of NMSC survival in Germany is provided. The differences between the NMSC subtypes require a more differentiated consideration of patient survival. The survival advantage of patients with BCC may be related to health-promoting factors related to the BCC diagnosis, such as changes to a healthier lifestyle.

Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS).

UNLABELLED: Twenty-five-year follow-up data of the Canadian National Breast Cancer Screening Study (CNBSS) indicated no mortality reduction. What conclusions should be drawn? After conducting a systematic literature search and narrative analysis, we wish to recapitulate important details of this study, which may have been neglected: Sixty-eight percent of all included cancers were palpable, a situation that does not allow testing the value of early detection. Randomisation was performed at the sites after palpation, while blinding was not guaranteed. In the first round, this "randomisation" assigned 19/24 late stage cancers to the mammography group and only five to the control group, supporting the suspicion of severe errors in the randomisation process. The responsible physicist rated mammography quality as "far below state of the art of that time". Radiological advisors resigned during the study due to unacceptable image quality, training, and medical quality assurance. Each described problem may strongly influence the results between study and control groups. Twenty-five years of follow-up cannot heal these fundamental problems. This study is inappropriate for evidence-based conclusions. The technology and quality assurance of the diagnostic chain is shown to be contrary to today's screening programmes, and the results of the CNBSS are not applicable to them. KEY POINTS: • The evidence base of the Canadian study (CNBSS) has to be questioned.• Severe flaws in the randomization process and test methods occurred. • Problems were criticized during and after conclusion of the trial by experts.• The results are not applicable to quality-assured screening programs. • The evidence base of this study must be re-analyzed.

[The Health-Related Quality of Life as Measured with the SF-12v1 in Elderly People Living in Luebeck 2010/11 in Comparison with the German Norm Data in 1994]. / Die bevölkerungsbezogene Lebensqualität gemessen mit dem SF-12v1 bei 51- bis 80-jährigen Lübeckern in den Jahren 2010/11 im Vergleich zur Deutschen Normstichprobe von 1994.

BACKGROUND: Health-related quality of life (HRQL) is deemed to be a meaningful endpoint when evaluating therapy and prevention interventions. For comparison purposes not only patient data but also representative population samples can serve as reference data. We aim to describe differences between the Luebeck population sample (LBS, year 2010/11) and the German norm population from 1994. Moreover, the influence of diabetes mellitus and hypertension on HRQL is analysed. METHODS: The LBS is a representative sample of 10 000 elderly people living in Luebeck aged 51-80 years, an age group susceptible to chronic diseases. Not only the SF-12v1, but also the item "actual health status in comparison to the last year" of the SF-36 and a list of comorbidities have been applied. Descriptive statistics are given for age, sex and disease groups. A comparison with data from the DNSP going back to 1994 is made using unstandardised data as well as age- and gender-standardised data. RESULTS: 5 835 individuals (response rate 60%) did participate in the survey (48% male, mean age 63.9 years, SD 7.7). PSC and MSC could be computed for 80% of them. Unstandardised values are 44.3±10.8 for the PSC and 50.4±10.3 for the MSC. Applying standardisation by age and gender, PSC values were comparable between the LBS and DNSP (except for the age group 51-60 years). MSC values were significantly lower in the LBS. The "general health Status" does not significantly differ whereas the "actual health status in comparison to the last year" is significantly lower in the LBS than in the DNSP (p<0.001). CONCLUSIONS: The LBS comprises more individuals than older studies in an age group relevant for chronic diseases. RESULTS hint to a comparable physical HRQL but a worse mental HRQL in the current data set. It remains unclear why persons between 51 and 60 years assess their physical HRQL worse than in the DNSP. A further open question is why the "actual health status in comparison to the last year" is assessed more negatively. Changed context conditions in working and social life may have an influence.

[Implementing an Organised Colorectal Cancer Screening Programme in Germany: Opportunities and Challenges]. / Einführung eines organisierten Darmkrebs-Screenings in Deutschland: Chancen und Herausforderungen.

BACKGROUND: Each year in Germany, about 65,000 people are diagnosed with colorectal cancer (CRC) and more than 25,000 people die of the disease. The majority of these cases could be avoided by a more effective screening programme. Recently, a law came into force that offers a great opportunity in this regard. It calls for introducing an organised CRC screening programme in Germany, which includes an invitation system as well as further measures for quality assurance and programme evaluation. To realise this opportunity, challenges of implementation need to be considered. The aim of this review article is to elaborate the challenges of an organised CRC screening in Germany in order to derive the need for action regarding successful implementation. METHODS: This review article is based on a selective literature search, including current guidelines and recommendations. RESULTS AND CONCLUSION: In the context of CRC screening, but also by colonoscopies performed for other indications (e.g., due to symptoms), precancerous lesions (adenomas) are detected and removed in a relevant proportion of the target population, which requires a surveillance examination after 3 or 5 years according to current recommendations. Therefore, an efficient invitation system for CRC screening should be designed to allow for a flexible interval depending on previous findings, which differs from mammography screening with its fixed interval. A prerequisite would be the standardised documentation of all colonoscopies irrespective of the indication, given that a substantial proportion of colonoscopies in Germany are performed outside of the screening program. Still, the work load regarding documentation could be less than for mammography screening. Another challenge in terms of organisation results from the parallel offer of 2 different screening tools (colonoscopy and faecal occult blood test). To realise the potential of an organised CRC screening, it seems important to devote sufficient time and resources for developing an efficient and feasible concept, while there might be interim options to avoid further delay regarding the initial invitation of the target population. Given that expertise from, amongst others, gastroenterology, epidemiology, clinical chemistry and health communication is required, an interdisciplinary approach appears essential.

[Limitations of Social Participation in General Population - Normative Data of the IMET based on a Population-Based Survey in Northern Germany]. / Einschränkungen der Teilhabe in der Bevölkerung - Normdaten für den IMET auf der Basis eines Bevölkerungssurveys in Norddeutschland.

BACKGROUND: Medical rehabilitation in Germany is characterized by the biopsychosocial model of the ICF. Its complexity makes it less suitable for studies in rehabilitation sciences. For an implementation of the ICF, specific assessment instruments that are able to measure activity and participation efficiently in rehabilitation are needed. Instruments measuring social participation are rarely available in German language and have been employed only in a handful of empirical works. The "Index zur Messung von Einschränkungen der Teilhabe" (IMET) was developed in 2005 and measures participation of people with different chronic diseases as described in the ICF. The IMET has been applied in many studies in rehabilitation science, but as reference values were not available so far, the results could not be classified. METHOD: In a population survey, 5 004 residents in Luebeck were randomly selected by the registration office and sent a short questionnaire. The questionnaire contained questions on the overall state of health, quality of life, prevalence of chronic diseases and limitations of participation (IMET). RESULTS: The completed questionnaire was returned by 2 755 of 4 692 eligible people (58.7%). 731 residents declined participation. Therefore, the participation quota is 43.1%. The mean age of participants was 53 years (SD: 17.1), 53% were women.Limitations of participation varied according to sex and age. Men tended to be more limited in their participation. As expected, limitations in participation increased with age. Participants with a low level of education showed a significantly higher rate of participation restrictions than people with a higher level of education. The IMET correlated significantly with the health status and quality of life as well as with the prevalence of various chronic diseases. DISCUSSION: The random sample of Luebeck inhabitants comprised people between 19 and 79 years of age. The age distribution of our sample deviated from the German population with younger people being underrepresented, and older people being overrepresented. With respect to the educational level, the random sample of the Hanseatic city showed a larger proportion of people with higher education.In this population sample, there was a sex and age-related variation in restriction in participation and this correlated highly with content-related constructs. Norm values for the IMET enable classification of limitations of participation for people undergoing rehabilitation or patients suffering from chronic diseases.

[Are speed cameras able to reduce traffic noise disturbances? An intervention study in Luebeck]. / Reduktion der Lärmbelästigung durch Geschwindigkeitsmessanlagen? Eine Interventionsstudie in Lübeck.

BACKGROUND: Disturbance by traffic noise can result in health problems in the long run. However, the subjective perception of noise plays an important role in their development. OBJECTIVES: The aim of this study was to determine if speed cameras are able to reduce subjective traffic noise disturbance of residents of high-traffic roads in Luebeck? METHODS: In August 2012 a speed camera has been installed in 2 high-traffic roads in Luebeck (IG). Residents living 1.5 km in front of the installed speed cameras and behind them received a postal questionnaire to evaluate their subjective noise perception before (t0), 8 weeks (t1) and 12 months (t2) after the installation of the speed camera. As controls (CG) we asked residents of another high-traffic road in Luebeck without speed cameras and residents of 2 roads with several consecutive speed cameras installed a few years ago. Furthermore, objective measures of the traffic noise level were conducted. RESULTS: Response rates declined from 35.9% (t0) to 27.2% (t2). The proportion of women in the CG (61.4-63.7%) was significantly higher than in the IG (53.7-58.1%, p<0.05), and responders were significantly younger (46.5±20.5-50±22.0 vs. 59.1±17.0-60.5±16.9 years, p<0.05). A reduction of the perceived noise disturbance of 0.2 point, measured on a scale from 0 (no disturbance) to 10 (heavy disturbance), could be observed in both IG and CG. Directly asked, 15.2% of the IG and 19.3% of the CG reported a traffic noise reduction at t2. The objective measure shows a mean reduction of 0.6 dB at t1. CONCLUSION: The change of noise level of 0.6 dB, which could only be experienced by direct comparison, is in line with the subjective noise perception. As sole method to reduce traffic noise (and for health promotion) a speed camera is insufficient.

[Incidence of melanoma and changes in stage-specific incidence after implementation of skin cancer screening in Schleswig-Holstein]. / Inzidenz des malignen Melanoms und Veränderung der stadienspezifischen Inzidenz nach Einführung eines Hautkrebsscreenings in Schleswig-Holstein.

A pilot project in skin cancer screening (SCREEN) was conducted in Schleswig-Holstein from July 2003 to June 2004. Although the impact of this screening on the stage-specific incidence of melanoma is of great importance for screening evaluation, it remains unknown. In theory, an effective skin cancer screening program should result in a medium-term incidence decrease of melanomas with a prognostically unfavorable stage. This is studied on a population-based level by using cancer registry data. Based on data from the Cancer Registry of Schleswig-Holstein for 1999-2009, stage-specific (T-category of the TNM-classification system) age-standardized incidence rates were calculated. After implementation of the SCREEN project, the incidence of prognostically favorable melanomas (in situ and T1) was higher than before, while the incidence of advanced melanomas (T2, T3, and for women also T4) decreased considerably. The classification of tumor stages changed during the project period, which may have contributed to an artificial decrease of the stages with a poor prognosis. Nevertheless, the results are in agreement with the observed decrease of melanoma mortality in the screening region.

[Screening for colorectal, skin, breast and prostate cancer. Essential knowledge for counseling]. / Screening auf Kolorektal-, Haut-, Brust- und Prostatakrebs. Basiswissen für die Beratung.

The major goal of cancer screening programs is the reduction of disease-specific mortality by detecting malignant tumors in an early and still curable stage. Sensitive screening tests are used in apparently healthy people and conspicuous findings are referred for further investigations. Taking the personal disease risk into account, persons considering participation in a screening program should be informed about the methods, benefits and disadvantages of the screening program. This information, together with personal preferences, is the basis for a well-informed decision for or against participation in a screening program. This article imparts essential knowledge that is needed for individual medical counseling on screening for colorectal, skin, breast and prostate cancer.

[Collection and processing of personal data to evaluate cancer screening programmes - results of a survey of the German population in light of the bill 'early detection of cancer and cancer registries']. / Erfassung und Verarbeitung von persönlichen Daten zur Evaluation von Krebsfrüherkennungsprogrammen - Ergebnisse einer Bevölkerungsbefragung im Kontext des Krebsfrüherkennungs- und -registergesetzes.

In a representative German sample, 62.1% of participants of cancer screening interventions indicated willingness to provide personal data for data-linkage with cancer registries. An agreement of over 90% is deemed necessary to conduct a meaningful population-based evaluation. The 'early detection of cancer and cancer regis-tries' bill proposed a procedure based on the use of pseudonyms only. This way personal consent is not required but participants are granted the right to object.

Survival from colorectal cancer in Germany in the early 21st century.

BACKGROUND: Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis. METHODS: We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002-2006. RESULTS: The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002-2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon. CONCLUSION: Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.

Skin cancer screening participation and impact on melanoma incidence in Germany--an observational study on incidence trends in regions with and without population-based screening.

BACKGROUND: The SCREEN (Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany) project involved population-wide skin cancer screening with whole-body examination by general physicians and dermatologists. It was conducted in the German state of Schleswig-Holstein (July 2003-June 2004), but not in the German state of Saarland. METHODS: The population-based registries of Schleswig-Holstein and Saarland provided data on melanoma incidence before, during, and after SCREEN to assess the association of skin cancer screening with incidence. RESULTS: Approximately 19% of the Schleswig-Holstein population participated in SCREEN (women: 27%, men: 10%). A total of 52% of all melanomas diagnosed during SCREEN in Schleswig-Holstein were detected as part of the project. Melanoma incidence increased during SCREEN (invasive melanoma in women: +8.9 per 100,000 (95% confidence intervals (CI): 6.1; 11.7); men: +4.0 per 100,000 (95% CI: 1.6; 6.4)) and decreased afterwards (women: -10.6 per 100,000 (95% CI: -13.3; -7.9); men: -4.1 per 100,000 (95% CI: -6.5; -1.7)). Similar changes were not observed in Saarland that had no such project. The differences between the two states were greatest among women, the group with the greater SCREEN participation. CONCLUSION: The SCREEN project had a substantial impact on melanoma incidence. This is consistent with the impact of effective screening for other cancers.