The influence of socioeconomic aspects and hospital case volume on survival in colorectal cancer in Saxony, Germany.

BACKGROUND: Colorectal cancer (CRC) is one of the most common types of cancer in Western civilization and responsible for a high number of yearly deaths. Long-term outcome is influenced by many factors, potentially including socioeconomic aspects like income, education, and employment. Furthermore, annual surgical case volume plays a major role in achieving good oncological results. In our retrospective study, we evaluated the effect of socioeconomic deprivation and hospital volume on overall survival (OS) in the federal state of Saxony, Germany. METHODS: All patients with CRC who underwent surgery in Saxony, Germany between 2010 and 2020 and were living in Saxony at the time of diagnosis were included in our retrospective analysis. Uni- and multivariate analyses were conducted considering age, sex, tumor localization, UICC tumor stage, surgical approach (open/laparoscopic), number of resected lymph nodes, adjuvant chemotherapy, year of surgery, and hospital case volume. In addition, our model was adjusted for social disparity using the German Index of Socioeconomic Deprivation (GISD). RESULTS: A total of 24,085 patients were analyzed (15,883 with colon cancer and 8,202 with rectal cancer). Age, sex, UICC tumor stage and tumor localization were distributed as expected for CRC. Median overall survival time was 87.9 months for colon cancer and 110.0 months for rectal cancer. Univariate analysis revealed laparoscopic surgery (colon and rectum P < 0.001), high case volume (rectum: P = 0.002) and low levels of socioeconomic deprivation (colon and rectum P < 0.001) to be significantly associated with better survival. In multivariate analyses, the associations of laparoscopic surgery (colon: HR = 0.76, P < 0.001; rectum: HR = 0.87, P < 0.01), and mid-low to mid-high socioeconomic deprivation (colon: HR = 1.18-1.22, P < 0.001; rectum: HR = 1.18-1.36, P < 0.001-0.01) remained statistically significant. Higher hospital case volume was associated with better survival only in rectal cancer (HR = 0.89; P < 0.01). CONCLUSION: In Saxony, Germany, better long-term survival after CRC surgery was associated with low socioeconomic deprivation, laparoscopic surgery and partly with high hospital case volume. Thus, there is a need to reduce social differences in access to high-quality treatment and prevention and increase hospital patient volume.

Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial.

BACKGROUND: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.

The Clinical Complexity of Penile Cancer: Current Clinical-Epidemiological Data from the Database of the Free State of Saxony/Germany.

OBJECTIVES: The aim of this study was to assess penile cancer incidence, clinical characteristics, treatment options, transparency of clinical quality, and relative survival based on data from the clinical cancer registry. SUBJECTS AND METHODS: A total of 898 patients with tumours of the penis were diagnosed and analysed in the period from 2000 to 2018; they were documented in the 4 regional clinical cancer registries and summarized in the Command Office of these 4 registries. RESULTS: The standardized incidence rate increased from 0.86 in 2000 to 2.67 in 2018. Most tumours were located at the glans (42.9%) followed by the prepuce (19.5%) and corpus penis (6.9%); they were classified into pT1a/pT1b (20.0%/7.0%), pT2 (23.5%), pT3 (12.4%), and pT4 (0.8%). In only 32.0% of all documented cases, a stage-related lymphadenectomy (LND) was carried out. Negative surgical margins were found in only 70% and the Rx status in 15.1%. Primary metastasis was detected in pN1 (5.1%), pN2 (3.9%), pN3 (3.1%), and M1 status in 3.0%, respectively. The predominant therapy was surgery in 78.3%. The proportion of penile partial resections was significantly (p = 0.0045) regredient over the control period. Adjuvant chemotherapy was performed in 4.7%, adjuvant external-beam radiotherapy in 3.0%. The 5-year relative overall survival rate was 74.7% and ranged from 108.0% (stage 0) to 17.1% (stage IV). A total of 29 hospitals performed tumour operations. CONCLUSIONS: The multitude of clinical and epidemiological variables available in clinical cancer registries allows a safe assessment of tumour dynamics themselves, as well as good quality of transparency and broadly acceptable guideline adherence. Deviations from the accepted level of evidence were found in the grading definition, in the high quota of positive surgical margins, in the defensive indication position to the glans resurfacing/reconstruction and diagnostical LND. Based on these relevant findings in the database combined with the low frequency of the tumour in area/clinics/year, we recommended establishing SCCP reference clinics. This work is the first time that European standardized rate-based cancer registry data on penile cancer from Germany has been communicated.

Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany? - results of a cross-sectional study.

BACKGROUND: Previous studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany. METHODS: Data came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor. RESULTS: The logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions. CONCLUSIONS: The implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions.

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial.

BACKGROUND: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. OBJECTIVES: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. METHODS: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. SETTING: Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. PARTICIPANTS: From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). INTERVENTION: The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. MEASUREMENTS: The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. RESULTS: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. CONCLUSIONS: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

[The use of E-Cigarettes in the German Population: Results of the Epidemiological Survey of Substance Abuse 2015]. / Die Nutzung von E-Zigaretten in der deutschen Bevölkerung ­ Ergebnisse des Epidemiologischen Suchtsurvey 2015.

AIM: Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented. METHODS: The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis. RESULTS: E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking. CONCLUSION: E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

[Use of E­cigarettes as an additional tool in a smoking cessation group intervention : Results after 12 months]. / Nutzung und Nutzen der E­Zigarette im Rahmen eines strukturierten verhaltenstherapeutischen Gruppenprogramms : Ergebnisse einer 12-Monats-Nachbefragung.

BACKGROUND: E-cigarettes are considerably safer regarding health issues than conventional cigarettes, but there is uncertainty concerning its use for smoking cessation. OBJECTIVES: How and to what extent are E­cigarettes used by smokers willing to quit? Are E­cigarettes a useful intervention for smokers attending a group intervention for smoking cessation? MATERIALS AND METHODS: One year after attending a group intervention for smoking cessation in Germany, 637 attendants were assessed by telephone. The interview topics were the use of E­cigarettes and tobacco abstinence. RESULTS: Of the attendants that could be interviewed, 12.6% had used E­cigarettes during or after the smoking cessation intervention. At the beginning of the intervention these smokers smoked significantly more cigarettes and were more addicted to cigarettes than the other attendants. After one year significantly less E­cigarette users were abstinent compared to participants that used nicotine replacement therapy or no additional smoking cessation aids. CONCLUSIONS: The application of E­cigarettes is counterproductive for smokers looking for help in an abstinence oriented smoking cessation group. The lack of distinct, easy to follow instructions on the use of E­cigarettes as a cessation tool may impair the process of cessation. Without good guidance smokers may get distracted in their motivation and willingness to stop smoking.

[E-cigarettes: Perceived harmfulness and use for smoking cessation]. / E-Zigaretten: Einschätzung von Gesundheitsgefahren und Nutzung zur Tabakentwöhnung.

BACKGROUND: The perception that e­cigarettes are less harmful than traditional tobacco products can influence the consumption of e­cigarettes. OBJECTIVES: Three questions were examined: (1) How do different population groups perceive health risks of e­cigarettes? (2) Do sociodemographic variables explain differences in the risk assessment of e­cigarettes? (3) Does the perception of health risks predict the use of e­cigarettes for smoking cessation? METHODS: Data came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with a sample size of n = 9204 participants, aged 18 to 64 years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e­cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed. RESULTS: Individuals with lower education rated e­cigarettes as more harmful. Older people and women perceived e­cigarettes as just as harmful. Smokers considered e­cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e­cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes. CONCLUSIONS: Only one-third of the population knows that e­cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e­cigarettes for smoking cessation.

[Trends in educational inequalities in smoking among adolescents in Germany : Evidence from four population-based studies]. / Zeitliche Entwicklung von Bildungsunterschieden im Rauchverhalten von Jugendlichen in Deutschland : Ergebnisse aus vier bevölkerungsweiten Studien.

BACKGROUND: In Germany, smoking prevalence among adolescents has significantly declined since the early 2000s. However, data show that adolescent smoking rates considerably differ between different types of secondary schools. The aim of our study was to examine how educational inequalities in adolescent smoking behaviour have developed over time. METHODS: Data were used from four population-based studies (each consisting of repeated cross-sectional surveys from 2001-2015): the representative surveys of the Federal Centre for Health Education, the German Health Interview and Examination Survey for Children and Adolescents, the Health Behaviour in School-aged Children Study, and the European School Survey Project on Alcohol and Other Drugs. Each study comprised different age groups (within the age range of 11-17 years) and used different smoking measures. Adolescents' educational status was based on the attended type of secondary school. Absolute and relative educational inequalities were presented as prevalence differences and prevalence ratios, respectively. RESULTS: Despite methodical differences, all four studies similarly reveal that adolescent smoking rates have significantly declined in all educational groups. However, lower smoking rates among secondary school students attending higher educational tracks could be observed. While absolute educational inequalities tended to decrease over time, relative inequalities between educational groups remained rather stable or even increased. DISCUSSION: Declining adolescent smoking rates suggest that smoking may have lost some of its attractiveness for young people. Our findings further emphasize the importance of tobacco control measures such as raising cigarette taxes, smoking bans, and increasing minimum legal age for tobacco purchase. As relative educational inequalities in adolescent smoking rates did not diminish over time, setting- and target group-specific interventions should focus more on students in middle and lower secondary school tracks.

"This Treatment Can Really Help Me"-A Longitudinal Analysis of Treatment Readiness and Its Predictors in Patients Undergoing Alcohol and Drug Rehabilitation Treatment.

BACKGROUND: There is evidence that patients entering alcohol or drug treatment have different levels of treatment readiness and change their motivation differently over time. Nonetheless, existing studies mainly use single measures of motivation and do not consider individual differences. This study addresses 2 questions: (i) How does treatment readiness change in patients with alcohol and drug use dependence over the course of an inpatient rehabilitation treatment?; and (ii) Can changes in treatment readiness be explained by sociodemographic and substance use-related characteristics? METHODS: Data from 177 alcohol-dependent patients and 152 drug-dependent patients were collected in 2 inpatient rehabilitation centers in Germany. Three single-item indicators of treatment readiness were assessed weekly over the course of the treatment. Sociodemographic and substance use-related characteristics were assessed at baseline. To model developments of treatment readiness that may be different for each patient, multilevel analyses for longitudinal data were used. RESULTS: The overall effect of time on treatment readiness was not significant, indicating that average motivation across all patients did not change over the course of the treatment. However, individuals showed different initial states and different rates of change. School education, employment status, earlier substance use treatments, and craving predicted treatment readiness. Interactions with time were found for craving and marital status. CONCLUSIONS: The results suggest that it is necessary to consider individual differences when evaluating treatment motivation in alcohol- and drug-dependent patients. The identification of variables predicting motivation may help to improve substance abuse treatment contents and outcomes.

Acute alcohol intoxication among adolescents-the role of the context of drinking.

This study aims (1) to describe the context of drinking among adolescents with acute alcohol intoxication (AAI) by gender, (2) to explore temporal changes in the context of drinking and (3) to analyse the association between the context of drinking and blood alcohol concentration (BAC). A retrospective chart review of 12- to 17-year-old inpatients with AAI (n = 1441) of the years 2000 to 2006 has been conducted in five participating hospitals in Germany. Gender differences in the context of drinking were tested with t test and chi2 test. Differences over time were analysed using logistic regressions. Multivariate linear regression was used to predict BAC. Girls and boys differed in admission time, drinking situation, drinking occasion and admission context. No temporal changes in drinking situation and in admission to hospital from public locations or places were found. Higher BAC coincided with male gender and age. Moreover, BAC was higher among patients admitted to hospital from public places and lower among patients who drank for coping. CONCLUSION: The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures. What is known: • The context of drinking, e.g. when, where, why and with whom is associated with episodic heavy drinking among adolescents. What is new: • Male and female inpatients with acute alcohol intoxication differ with regards to the context of drinking, i.e. in admission time, drinking situation, drinking occasion and admission context. • Being admitted to hospital from public places is associated with higher blood alcohol concentration.

Consumption Patterns of Nightlife Attendees in Munich: A Latent-Class Analysis.

BACKGROUND: The affinity for substance use among patrons of nightclubs has been well established. With novel psychoactive substances (NPS) quickly emerging on the European drug market, trends, and patterns of use are potentially changing. OBJECTIVES: (1) The detection of subgroups of consumers in the electronic dance music scene of a major German metropolitan city, (2) describing the consumption patterns of these subgroups, (3) exploring the prevalence and type of NPS consumption in this population at nightlife events in Munich. METHODS: A total of 1571 patrons answered questions regarding their own substance use and the emergence of NPS as well as their experience with these substances. A latent class analysis was employed to detect consumption patterns within the sample. RESULTS: A four class model was determined reflecting different consumption patterns: the conservative class (34.9%) whose substance was limited to cannabis; the traditional class (36.6%) which especially consumed traditional club drugs; the psychedelic class (17.5%) which, in addition to traditional club drugs also consumed psychedelic drugs; and an unselective class (10.9%) which displayed the greatest likelihood of consumption of all assessed drugs. "Smoking mixtures" and methylone were the new substances mentioned most often, the number of substances mentioned differed between latent classes. CONCLUSION: Specific strategies are needed to reduce harm in those displaying the riskiest substance use. Although NPS use is still a fringe phenomenon its prevalence is greater in this subpopulation than in the general population, especially among users in the high-risk unselective class.

Prediction of Long-Term Outcomes in Young Adults with a History of Adolescent Alcohol-Related Hospitalization.

AIMS: Empirical data concerning the long-term psychosocial development of adolescents admitted to inpatient treatment with alcohol intoxication (AIA) are lacking. The aim of this study was to identify the factors that, at the time of admission, predict future substance use, alcohol use disorders (AUD), mental health treatment, delinquency and life satisfaction. METHODS: We identified 1603 cases of AIA treated between 2000 and 2007 in one of five pediatric departments in Germany. These former patients were invited to participate in a telephone interview. Medical records were retrospectively analyzed extracting potential variables predicting long-term outcomes. RESULTS: Interviews were conducted with 277 individuals, 5-13 [mean 8.3 (SD 2.3)] years after treatment, with a response rate of 22.7%; of these, 44.8% were female. Mean age at the interview was 24.4 (SD 2.2) years. Logistic and linear regression models revealed that being male, using illicit substances and truancy or runaway behavior in adolescence predicted binge drinking, alcohol dependence, use of illicit substances and poor general life satisfaction in young adulthood, explaining between 13 and 24% of the variance for the different outcome variables. CONCLUSIONS: This naturalistic study confirms that known risk factors for the development of AUD also apply to AIA. This finding facilitates targeted prevention efforts for those cases of AIA who need more than the standard brief intervention for aftercare.

Does a Change Over All Equal a Change in All? Testing for Polarized Alcohol Use Within and Across Socio-Economic Groups in Germany.

AIMS: This study aimed at testing whether drinking volume and episodic heavy drinking (EHD) frequency in Germany are polarizing between consumption levels over time. Polarization is defined as a reduction in alcohol use among the majority of the population, while a subpopulation with a high intake level maintains or increases its drinking or its EHD frequency. The polarization hypothesis was tested across and within socio-economic subgroups. METHOD: Analyses were based on seven cross-sectional waves of the Epidemiological Survey of Substance Abuse (ESA) conducted between 1995 and 2012 (n = 7833-9084). Overall polarization was estimated based on regression models with time by consumption level interactions; the three-way interaction with socio-economic status (SES) was consecutively introduced to test the stability of effects over socio-economic strata. Interactions were interpreted by graphical inspection. RESULTS: For both alcohol use indicators, declines over time were largest in the highest consumption level. This was found within all SES groups, but was most pronounced at low and least pronounced at medium SES. CONCLUSION: The results indicate no polarization but convergence between consumption levels. Socio-economic status groups differ in the magnitude of convergence which was lowest in medium SES. The overall decline was strongest for the highest consumption level of low SES.

Age, period and cohort effects on time trends in alcohol consumption in the Swedish adult population 1979-2011.

AIMS: In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. METHODS: APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. RESULTS: Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume show a small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. CONCLUSIONS: High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden.

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany.

AIMS: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. METHODS: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. RESULTS: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. CONCLUSIONS: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial.

BACKGROUND: Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. METHODS: A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio--Demographic and Service Receipt Inventory-European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. DISCUSSION: This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035. Registered 03 June 2013.

Psychometric properties of the Cannabis Abuse Screening Test in Hungarian samples of adolescents and young adults.

AIM: The aim of our study was to analyze psychometric properties of the Cannabis Abuse Screening Test (CAST). METHODS: Our sample comprised Hungarian high school (n = 476; male 56.3%; mean age 19.0 years, SD = 0.65 years) and college students (n = 439; male 65.1%; mean age 23.9 years, SD = 1.56 years) who reported cannabis use in the past year. The sample covered the five biggest universities of Hungary. Besides the CAST, participants responded to the Munich-Composite International Diagnostic Interview. Factor structure was analyzed by a confirmatory factor analysis. Receiver operating characteristic curve analysis was made to assess cut-off scores. Data collection took place in 2010. RESULTS: CAST proved to be a reliable (Cronbach's α 0.71 and 0.76) one-dimensional measure. Regarding both cannabis dependence and cannabis use disorders, a cut-off of 2 points proved to be ideal in both samples, resulting in optimal specificity, negative predictive values and accuracy, but less than optimal positive predictive values (dependence) and low sensitivity (cannabis use disorder). DISCUSSION AND CONCLUSIONS: In line with former results, the CAST proved to be an adequate measure for the screening of cannabis-related problems among adolescents and young adults in an Eastern European country where this scale has not been studied before.

Population-Based Clinical Cancer Registration in Germany.

INTRODUCTION: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. METHODS: Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). RESULTS: All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019-2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. DISCUSSION: The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented.

Validation of the Cannabis Abuse Screening Test in a sample of cannabis inpatients.

The present study aims at validating the Cannabis Abuse Screening Test (CAST) in a clinical sample of adolescent and young adult cannabis users seeking treatment. Applying a classical test theory approach using DSM-IV diagnoses as gold standard, two versions of the CAST questionnaire are compared. The sample consisted of 140 subjects aged 15-26 years (mean 18.9) recruited from two cannabis treatment centers. Gold standard diagnoses were assessed using the Adolescent Diagnostic Interview-Light. Internal structure and consistency of the CAST were assessed by principal component analysis and Cronbach's α. Optimal thresholds were defined using receiver operating characteristic analysis. Both the binary and the full test version revealed unidimensional structures with moderate to satisfactory internal consistency (α = 0.66 and 0.73). Screening properties were unsatisfactory when the CAST was compared against cannabis dependence. With regard to cannabis use disorders, both test versions yielded comparable and good sensitivity and specificity at cut-off 3 (binary: 92.2%, 66.7%) and 6 (full: 93.0%, 66.7%). Overall, the full CAST may be used for screening cannabis use disorders in clinical settings. Further research may use validation methods that do without gold standard.