| 1. |
- Carr, Sinclair, et al.
(författare)
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Alcohol Consumption Levels and Health Care Utilization in Germany. Results from the GEDA 2014/2015-EHIS Study
- 2022
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Ingår i: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 68:3, s. 151-160
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Due to large inconsistencies in previous studies, it remains unclear how alcohol use is related to health care utilization. The aim of this study was to examine associations between alcohol drinking status with utilization of outpatient and inpatient health care services in Germany. Methodology: Survey data of the GEDA 2014/2015-EHIS study with n = 23,561 German adults were analyzed (response rate: 27 %). Respondents were categorized as lifetime abstainers, former drinkers, and non-weekly drinkers, as well as weekly low-risk drinkers and risky drinkers. Outpatient services included GP, specialist, and hospital visits; inpatient services included hospital overnight stays in the last 12 months. For both settings, binary logistic regression models were applied, adjusted for possible confounders. Results: For specialist visits, elevated odds were found among former drinkers (odds ratio (OR) = 1.93, 95 % confidence interval (95 % CI) = 1.50-2.49), non-weekly drinkers (OR = 1.24, 95 % CI = 1.05-1.47), weekly low-risk drinkers (OR = 1.39, 95 % CI = 1.17-1.67), and risky drinkers (OR = 1.28, 95 % CI = 1.04-1.57) compared to lifetime abstainers. In contrast, lower odds for inpatient service use were found among non-weekly drinkers (OR = 0.76, 95 % CI = 0.62-0.93), low-risk drinkers (OR = 0.66, 95 % CI = 0.53-0.81), and risky drinkers (OR = 0.65, 95 % CI = 0.51-0.84). No differences were observed for GP and outpatient hospital visits. Conclusions: While the increased odds of consulting a specialist are consistent with higher health care needs among former and current drinkers, the lower use of inpatient care among current drinkers is contrary to known health risks associated with alcohol consumption and evidence from hospitalized populations. The findings also highlight the need to differentiate between lifetime abstainers and former drinkers in their use of health services.
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| 2. |
- Frischknecht, Ulrich, et al.
(författare)
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Screening auf problematischen Alkoholkonsum – Erhebung zur Umsetzung der S3-Leitlinienempfehlungen in der transdisziplinären Versorgung einer Modellregion : [Screening for Problematic Alcohol Consumption – A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region]
- 2022
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Ingår i: Das Gesundheitswesen. - : Georg Thieme Verlag KG. - 0941-3790 .- 1439-4421. ; 84:01, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- Aim Recording the frequency of screenings for problematic alcohol consumption by professionals involved in the health care of respective patients. The German S3-guideline screening, diagnosis and treatment of alcohol-related disorders recommends the use of questionnaire-based screenings for all patients in all settings.Methods Cross-sectional survey on screening frequency among general practitioners, gynecologists, psychiatrists, child- and adolescent therapists, psychotherapists, social workers and midwives. Logistic regression was used to explore how healthcare professionals' attributes were associated with the implementation of screenings.Results With response rates of about 20%, health care professionals reported using screening instruments for an average of 6.9% of all patients during the previous four weeks. Most of the time, custom-made questions were used instead of the recommended instruments (AUDIT, AUDIT-C). Higher screening rates were reported for patients with newly diagnosed hypertension (21.2%), alcohol-related disorders (43.3%) and mental disorders (39.3%). Knowledge of the guideline was associated with implementation of screenings (OR=4.67; 95% KI 1.94-11.25, p<0.001).Conclusions Comprehensive screening for problematic alcohol use with questionnaire-based instruments in accordance with guidelines is far from being routinely implemented in the studied health care settings. Measures to increase the knowledge of the guidelines are necessary in order to increase the frequency of alcohol screening in health care.
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| 3. |
- Kraus, Ludwig, et al.
(författare)
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Alcohol screening and alcohol interventions among patients with hypertension in primary health care : an empirical survey of German general practitioners
- 2017
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Ingår i: Addiction Research and Theory. - : Informa UK Limited. - 1606-6359 .- 1476-7392. ; 25:4, s. 285-292
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol is one of the least intervened risk factors in the management of hypertension at the primary care level. In order to improve alcohol interventions, a better understanding of knowledge, attitudes and clinical practice of lifestyle interventions in the management of hypertension is needed.Method: As a part of a European study (France, Germany, Italy, Spain, UK), 211 German general practitioners (GPs) were recruited in Bavaria and Hamburg and surveyed via an Internet-based questionnaire. Results were compared with the European sample (n=2870).Results: One-third of the patients seen by German GPs had hypertension (36.2%, standard deviation (SD): 14.6) and among cases with hypertension, less than half were ever screened for alcohol (4.5 out of 10 patients). The foremost reasons for not screening for alcohol were that alcohol was not considered a major risk factor for hypertension plus the lack of knowledge of appropriate alcohol screening instruments. The majority of German GPs managed patients with hazardous drinking levels themselves or in their practice (71.3%, 95% confidence interval (CI): 64.6-77.2%), but only 42.0% (95% CI: 35.2-49.0%) managed alcohol dependent patients. German screening rates were slightly lower but interventions of screened positive patients higher than the European average.Conclusions: Rates of alcohol screening in patients with hypertension in primary health care may be increased by improving GPs knowledge of alcohol as a major risk factor for hypertension, increasing GPs education on alcohol and screening instruments, and providing reimbursement. This may increase treatment of alcohol problems in patients with hypertension and reduce hypertension.
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| 4. |
- Kraus, Ludwig, et al.
(författare)
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Estimating high‐risk cannabis and opiate use in Ankara, Istanbul and Izmir
- 2017
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Ingår i: Drug and Alcohol Review. - : Wiley. - 0959-5236 .- 1465-3362. ; 36:5, s. 626-632
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and Aims. Information on high-risk drug use in Turkey, particularly at the regional level, is lacking. The present analysis aims at estimating high-risk cannabis use (HRCU) and high-risk opiate use (HROU) in the cities of Ankara, Istanbul and Izmir. Design and Methods. Capture–recapture and multiplier methods were applied based on treatment and police data stratified by age and gender in the years 2009 and 2010. Case definitions refer to ICD-10 cannabis (F.12) and opiate (F.11) disorder diagnoses from outpatient and inpatient treatment records and illegal possession of these drugs as recorded by the police. Results. High-risk cannabis use was estimated at 28 500 (8.5 per 1000; 95% confidence interval 7.3–10.3) and 33 400 (11.9 per 1000; 95% confidence interval 10.7–13.5) in Ankara and Izmir, respectively. Using multipliers based on capture–recapture estimates for Izmir, HRCU in Istanbul was estimated up to 166 000 (18.0 per 1000; range: 2.8–18.0). Capture–recapture estimates of HROU resulted in 4800 (1.4 per 1000; 95% confidence interval 0.9–1.9) in Ankara and multipliers based on these gave estimates up to 20 000 (2.2 per 1000; range: 0.9-2.2) in Istanbul. HROU in Izmir was not estimated due to the low absolute numbers of opiate users. Discussion and Conclusions. While HRCU prevalence in both Ankara and Izmir was considerably lower in comparison to an estimate for Berlin, the rate for Istanbul was only slightly lower. Compared with the majority of European cities, HROU in these three Turkish cities may be considered rather low. [Kraus L, Hay G, Richardson C, Yargic I, Ilhan N M, Ay P, Karasahin F, Pinarci M, Tuncoglu T, Piontek D, Schulte B Estimating high-risk cannabis and opiate use in Ankara, Istanbul and Izmir Drug Alcohol Rev 2016;00:000-000]
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| 5. |
- Kraus, Ludwig, et al.
(författare)
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Estimation of the Number of People With Opioid Addiction in Germany
- 2019
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Ingår i: Deutsches Ärzteblatt International. - : Deutscher Arzte-Verlag GmbH. - 1866-0452. ; 116:9, s. 137-143
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Tidskriftsartikel (refereegranskat)abstract
- Background: Opioid addiction is one of the most common substance-related disorders worldwide, and morbidity and mortality due to opioid addiction place a heavy burden on society. Knowing the size of the population that is addicted to opioids is a prerequisite for the development and implementation of appropriate health-policy measures.Methods: Our estimate for Germany for 2016 is based on an enumeration of opioid-addicted persons who were entered in a registry of persons receiving substitution therapy, an enumeration of persons receiving outpatient and inpatient care for addiction without substitution therapy, an extrapolation to all addiction care facilities, and an estimation of the number of opioid-addicted persons who were not accounted for either in the substitution registry or in addiction care.Results: The overall estimate of the number of opioid-addicted persons in Germany in 2016 was 166 294 persons (lower and upper bounds: 164 794 and 167 794), including 123 988 men (122 968 to 125 007) and 42 307 women (41 826 to 42 787). The estimates for each German federal state per 1000 inhabitants ranged from 0.1 in Brandenburg to 3.0 in North Rhine-Westphalia and 5.5 in Bremen. The average value across Germany was 3.1 per 1000 inhabitants.Conclusion: Comparisons with earlier estimates suggest that the number of persons addicted to opioids in Germany has hardly changed over the past 20 years. Despite methodological limitations, this estimate can be considered highly valid. Nearly all persons who are addicted to opioids are in contact with the addiction care system.
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| 6. |
- Manthey, Jakob, et al.
(författare)
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Alcohol Use in Germany and Europe during the SARS-CoV-2 Pandemic
- 2020
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Ingår i: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 66:5, s. 247-258
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to examine changes in alcohol consumption during the Sars-CoV-2 pandemic in Germany in comparison to changes in other European countries. Method: Analyses of sociodemographic and socio-economic data, as well as reports on alcohol use changes since the pandemic collected through a European online survey (N=40,064) in 21 countries. Weights based on gender, age and education were applied to account for sample bias. Results: Since the beginning of the pandemic, alcohol consumption has decreased on average. The decline is primarily due to a reduction in heavy episodic drinking occasions. As compared to other European countries, alcohol consumption in Germany has declined less sharply. This is mainly due to an increase in alcohol consumption among women as well as among people who report negative impacts on jobs and finances and among people with risky consumption patterns. Conclusion: In order to counter negative consequences of increased alcohol consumption in sub-groups during the pandemic, cutting the availability of alcohol through reasonable taxation and fostering alcohol screening activities in primary health care settings is needed.
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| 7. |
- Manthey, Jakob, et al.
(författare)
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Versorgung von Personen mit riskantem Alkoholkonsum und schwerer Alkoholkonsumstörung in Bremen : bedarfsgerecht und leitlinienkonform?
- 2020
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Ingår i: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. - : Springer Science and Business Media LLC. - 1436-9990 .- 1437-1588. ; 63, s. 122-130
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Tidskriftsartikel (refereegranskat)abstract
- Hintergrund: Riskanter Alkoholkonsum und schwere Alkoholkonsumstörungen sollten wegen gesundheitlichen Folgeschäden rechtzeitig erkannt werden. Die S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ empfiehlt daher die routinemäßige Anwendung von Screeningverfahren, z. B. in Allgemeinarztpraxen. Wird ein riskanter Konsum festgestellt, soll eine Kurzintervention erfolgen. Bei schwerer Alkoholkonsumstörung ist eine Entzugsbehandlung angezeigt, bei Komplikationsrisiken in stationärer Form.Ziel der Arbeit: Schätzung des Anteils von Personen mit riskantem Konsum und schwerer Alkoholkonsumstörung in leitlinienkonformer Versorgung im Bundesland Bremen.Material und Methoden: Die Prävalenz riskanten Konsums (weibl.: ≥12 g/Tag; männl.: ≥24 g/Tag) und schwerer Alkoholkonsumstörungen (weibl.: ≥60 g/Tag; männl.: ≥90 g/Tag) wurde über den Pro-Kopf-Konsum von Reinalkohol geschätzt. Behandlungsraten wurden auf Grundlage von Umfragedaten (für riskanten Konsum) sowie mittels Sekundärdaten vollstationärer Krankenhausaufenthalte (für schwere Alkoholkonsumstörung) geschätzt. Die Schätzungen beziehen sich auf die Bevölkerung ab 15 Jahre im Bundesland Bremen im Jahr 2016.Ergebnisse: Nur 2,9 % aller Personen mit riskantem Alkoholkonsum wurden durch ihre Hausärzt*innen gescreent; die Hälfte davon (1,4 %) erhielt eine Kurzintervention. 7,1 % der Personen mit einer schweren Alkoholkonsumstörung wurden vollstationär behandelt. Stationäre Entzugsbehandlungen wurden bei 14,1 % der Personen mit einer schweren Alkoholkonsumstörung durchgeführt, bei denen ein stationärer Entzug erforderlich ist. Unterdurchschnittliche Behandlungsraten wurden bei 21- bis 39-Jährigen registriert.Diskussion: Riskanter Konsum und schwere Alkoholkonsumstörungen sind in Bremen unzureichend versorgt, insbesondere bei 21- bis 39-Jährigen.
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| 8. |
- Möckl, Justin, et al.
(författare)
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Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage
- 2023
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data.Methods: The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord – Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen’s total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment].Results: Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.4% (n = 11,427) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal state (F10.3–4). One in 10 individuals with alcohol dependence (n = 1,577) used one or more addiction-specific care services during the observation period. Specifically, 3.7% (n = 675) received outpatient addiction care, 3.9% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 2.6% (n = 405) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients.Conclusion: Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate.
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| 9. |
- Pennells, Lisa, et al.
(författare)
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Equalization of four cardiovascular risk algorithms after systematic recalibration : individual-participant meta-analysis of 86 prospective studies
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 40:7, s. 621-
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Tidskriftsartikel (refereegranskat)abstract
- Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after ‘recalibration’, a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at ‘high’ 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29–39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22–24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44–51 such individuals using original algorithms, in contrast to 37–39 individuals with recalibrated algorithms.Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
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| 10. |
- Persson, Fredrik, 1973, et al.
(författare)
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Studies of genomic imbalances and the MYB-NFIB gene fusion in polymorphous low-grade adenocarcinoma of the head and neck.
- 2012
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Ingår i: International journal of oncology. - : Spandidos Publications. - 1791-2423 .- 1019-6439. ; 40:1, s. 80-4
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Tidskriftsartikel (refereegranskat)abstract
- Polymorphous low-grade adenocarcinoma (PLGA) is a malignancy predominantly originating from the minor salivary glands. The molecular events underlying the pathogenesis of PLGA is poorly understood and no recurrent genetic aberrations have so far been identified. We used genome-wide, high-resolution aCGH analysis to explore genomic imbalances in 9 cases of PLGA. Because of the well-known morphologic similarities between PLGA and adenoid cystic carcinoma (ACC) we also analyzed all tumors for expression of the recently identified ACC-associated MYB-NFIB gene fusion. aCGH analysis revealed that the PLGA genome contains comparatively few copy number alterations (CNAs). Gains/losses of whole chromosomes or chromosome arms were more than twice as common as partial CNAs. Two cases showed gain of chromosome 8 and one case each gain of chromosome 9, loss of chromosome 22 and loss of the Y chromosome. One case showed loss of the entire 6q arm and one case an interstitial deletion of a 33-Mb segment within 6q22.1-q24.3. This region contains the MYB oncogene and the candidate tumor suppressor gene PLAGL1. RT-PCR analysis revealed that one of the 9 PLGAs expressed the ACC-associated MYB-NFIB gene fusion, illustrating the diagnostic difficulties associated with the diagnosis of these morphologically partly overlapping entities. Taken together, our findings indicate that the PLGA genome is genetically stable and contains comparatively few CNAs which is in line with the clinical observation that PLGA is a slow-growing, low-grade carcinoma with low metastatic potential.
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