Introduction We investigated whether the presence of depressive symptoms among adults with diagnosed diabetes is associated with adverse quality of diabetes care.Research design and methods The study population was drawn from the German national health survey ‘German Health Update’ 2014/2015-European Health Interview Survey and included 1712 participants aged ≥18 years with self-reported diabetes during the past 12 months. Depressive symptoms in the past 2 weeks were assessed by the eight-item depression module of the Patient Health Questionnaire (PHQ-8), with PHQ-8 sum score values ≥10 indicating current depressive symptoms. We selected 12 care indicators in diabetes based on self-reported information on care processes and outcomes. Associations of depressive symptoms with those indicators were examined in multivariable logistic regression models with stepwise adjustments.Results Overall, 15.6% of adults with diagnosed diabetes reported depressive symptoms, which were higher in women than in men (18.7% vs 12.9%). Adjusted for age, sex, education, social support, health-related behaviors, and diabetes duration, adults with depressive symptoms were more likely to report acute hypoglycemia (OR 1.81, 95% CI 1.13 to 2.88) or hyperglycemia (OR 2.10, 95% CI 1.30 to 3.37) in the past 12 months, long-term diabetes complications (OR 2.30, 95% CI 1.55 to 3.39) as well as currently having a diet plan (OR 2.14, 95% CI 1.39 to 3.29) than adults without depressive symptoms. Significant associations between depressive symptoms and other care indicators were not observed.Conclusions The present population-based study of adults with diagnosed diabetes indicates an association between depressive symptoms and adverse diabetes-specific care with respect to outcome but largely not to process indicators. Our findings underline the need for intensified care for persons with diabetes and depressive symptoms. Future research needs to identify underlying mechanisms with a focus on the inter-relationship between diabetes, depression and diabetes-related distress.

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults.Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance.Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.

The SARS-CoV-2 coronavirus has spread rapidly across Germany. Infections are likely to be under-recorded in the notification data from local health authorities on laboratory-confirmed cases since SARS-CoV-2 infections can proceed with few symptoms and then often remain undetected. Seroepidemiological studies allow the estimation of the proportion in the population that has been infected with SARS-CoV-2 (seroprevalence) as well as the extent of undetected infections. The 'CORONA-MONITORING bundesweit' study (RKI-SOEP study) collects biospecimens and interview data in a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). Participants are sent materials to self-collect a dry blood sample of capillary blood from their finger and a swab sample from their mouth and nose, as well as a questionnaire. The samples returned are tested for SARS-CoV-2 IgG antibodies and SARS-CoV-2 RNA to identify past or present infections. The methods applied enable the identification of SARS-CoV-2 infections, including those that previously went undetected. In addition, by linking the data collected with available SOEP data, the study has the potential to investigate social and health-related differences in infection status. Thus, the study contributes to an improved understanding of the extent of the epidemic in Germany, as well as identification of target groups for infection protection.

At a regional and local level, the COVID-19 pandemic has not spread out uniformly and some German municipalities have been particularly affected. The seroepidemiological data from these areas helps estimate the proportion of the population that has been infected with SARS-CoV-2 (seroprevalence), as well as the number of undetected infections and asymptomatic cases. In four municipalities which were especially affected, 2,000 participants will be tested for an active SARS-CoV-2 infection (oropharyngeal swab) or a past infection (blood specimen IgG antibody test). Participants will also be asked to fill out a short written questionnaire at study centres and complete a follow-up questionnaire either online or by telephone, including information on issues such as possible exposure, susceptability, symptoms and medical history. The CORONA-MONITORING lokal study will allow to determine the proportion of the population with SARS-CoV-2 antibodies in four particularly affected locations. This study will increase the accuracy of estimates regarding the scope of the epidemic, help determine risk and protective factors for an infection and therefore also identify especially exposed groups and, as such, it will be crucial towards planning of prevention measures.

Three months after a coronavirus disease (COVID-19) outbreak in Kupferzell, Germany, a population-based study (n = 2,203) found no RT-PCR-positives. IgG-ELISA seropositivity with positive virus neutralisation tests was 7.7% (95% confidence interval (CI): 6.5–9.1) and 4.3% with negative neutralisation tests. We estimate 12.0% (95% CI: 10.4–14.0%) infected adults (24.5% asymptomatic), six times more than notified. Full hotspot containment confirms the effectiveness of prompt protection measures. However, 88% naïve adults are still at high COVID-19 risk.

Background:Physical activity is favorable for health,and vigorous sports activity is particularly beneficial.This study investigates the association between changes in sports participation patterns over time and cardio-metabolic and self-perceived health outcomes.Methods:Data from 3752 adults（18-79 years of age） who participated in 2 national health interview and examination surveys in 1997-1999 and 2008-2011 were included,with a mean follow-up time of about 12 years.A change in self-reported sports activity was analyzed with respect to the incidence of type 2 diabetes,coronary heart disease（CHD）,hypertension,obesity,dyslipidemia,metabolic syndrome,and poor self-perceived health.Participants with pre-existing disease or risk factor of interest at baseline were excluded from the analysis.Being sufficiently active in sports was specified as doing sports for at least 1-2 h per week,and 4 activity categories were defined:1) inactive at both time points（inactive-inactive）,2) inactive at baseline and active at follow-up（inactive-active）,3) active at baseline and inactive at follow-up（active-inactive）,and 4) active at both time points（active-active）.Associations between sports activity engagement and health outcomes were estimated by logistic regression models with different stages of adjustments.Results:Not engaging in any regular sports activity at both time points（inactive-inactive） was associated with higher rates of type 2 diabetes（odds ratio（OR）=1.82,95% confidence interval（95%CI）:1.08-3.08）,CHD（OR=1.82,95%CI:1.16-2.84）,hypertension（OR=1.36,95%CI:1.03-1.81）,metabolic syndrome（OR=1.58,95%CI:1.08-2.32）,and poor self-perceived health（OR=2.54,95%CI:1.83-3.53） compared to doing regular sports for a minimum of 1-2 h per week over time（active-active）.In case of change from inactivity to any regular sports activity（inactive-active）,the rate of risk factor occurrence was not statistically different from the active-active reference group except for poor self-perceived health,but it was higher for type 2 diabetes（OR=2.15,95%CI:1.12-4.14） and CHD（OR=1.77,95%CI:1.03-3.03）.Being active at baseline but inactive at follow-up（active-inactive） was not associated with higher disease incidence of type 2 diabetes（OR=0.70,95%CI:0.25-1.97） or CHD（OR=1.20,95%CI:0.49-2.99）,but was associated with higher rates of hypertension（OR=1.61,95%CI:1.11-2.34）,obesity（OR=2.34,95%CI:1.53-3.57）,metabolic syndrome（OR=1.70,95%CI:1.11-2.63）,and poor self-perceived health（OR=2.16,95%CI:1.53-3.07） at follow-up.Conclusion:Even a low weekly quantity（1-2 h） of regular sports activity is partly associated with health benefits.Being formerly but not currently active was not associated with an increased disease incidence,but was associated with a higher risk-factor development compared to the reference group（active-active）.Becoming active was preventive for risk-factor development but was not preventive for disease incidence,which probably means that the health benefits from sports activity are not sustainable and disease incidence is only shifted to a later period in life.For this reason,the promotion of and commitment to regular sports activity should be addressed as early as possible over the lifespan to achieve the best health benefits.

Background The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. Methods A data set of 18,058 adults aged 25-69 years from three population-based national health examination surveys 1990-92, 1997-99 and 2008-11 with complete information for five healthy behavior factors was used. A 'daily intake of both fruits and vegetables, 'sufficient physical exercise', 'no current smoking' and `no current risk drinking' were assessed with self-reports and 'normal body weight' was calculated based on measured body weight and height. A dichotomous 'healthy lifestyle' indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25-34, 35-44, 45-54 and 55-69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990-92 and 2008-11. Results In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990-92 to 13.5% in 1997-99 and to 14.7% in 2008-11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45-54 years. The RC of increasing healthy lifestyle prevalence between 1990-92 and 2008-11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990-92 and 2008-11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. Conclusions The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990-92 to 2008-11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.

Im Kontext des Gesundheitsmonitorings von Kindern und Jugendlichen in Deutschland sind aus der zweiten Folgeerhebung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 2) bislang Ergebnisse zum Trend von häufigen chronischen Erkrankungen und Gesundheitsproblemen, zum Beispiel allergischen Erkrankungen, publiziert worden. Die vorliegende Arbeit ergänzt diese Erkenntnisse um Ergebnisse zu weniger häufigen nichtübertragbaren, körperlichen Erkrankungen und zum Trend von übertragbaren, impfpräventablen Erkrankungen. Es werden Elternangaben zu Diagnosen und Erkrankungen ihrer 0‑ bis 17-jährigen Kinder aus der repräsentativen Querschnitterhebung KiGGS Welle 2 (2014–2017) mit denen aus der KiGGS-Basiserhebung (2003–2006) und KiGGS Welle 1 (2009–2012) verglichen. Die aktuellen KiGGS-Ergebnisse zeigen für die nichtübertragbaren, körperlichen Erkrankungen Epilepsie, Migräne und Herzerkrankungen ein insgesamt kaum verändertes Häufigkeitsprofil. Die Daten aus KiGGS Welle 2 stützen jedoch die Einschätzung einer gestiegenen Häufigkeit von Diabetes mellitus, der bei Kindern und Jugendlichen dennoch weiterhin relativ selten und überwiegend als Typ-1-Diabetes auftritt. Der in zeitlichem Zusammenhang mit veränderten Impfempfehlungen stehende Rückgang von Masern‑, Windpocken- und Keuchhustenerkrankungen zeigt, wie Kinder und Jugendliche von präventiven Maßnahmen profitieren und Krankheiten vermieden werden können. Die Daten zu impfpräventablen Erkrankungen deuten jedoch auf regional unterschiedlich ausgeprägte Immunitätslücken in bestimmten Altersgruppen hin, damit scheint das Präventionspotenzial der Impfempfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut noch nicht ausreichend ausgeschöpft zu sein.

Der Nutzen medikamentöser Sekundärprävention bei koronarer Herzkrankheit (KHK) ist für Frauen und Männer belegt. In der Verordnung dieser Arzneimittel werden aber geschlechtsspezifische Unterschiede beobachtet. Was fehlt, sind Ergebnisse zur zeitlichen Entwicklung der Anwendungsprävalenzen in bevölkerungsbezogenen Studien für Frauen und Männer im Vergleich. Genutzt wurden Daten von Personen mit KHK aus dem Bundes-Gesundheitssurvey (BGS98 1997–1999, n = 411) und aus der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1 2008–2011, n = 440) im Alter von 40–79 Jahren. Die zeitliche Entwicklung medikamentöser Sekundärprävention mit Thrombozytenaggregationshemmern (TAH), Statinen, Betarezeptorenblockern, Mitteln mit Wirkung auf das Renin-Angiotensin-System (RAS-Blocker), Calciumantagonisten und Nitraten zwischen BGS98 und DEGS1 wurde in Trendanalysen mit multivariablen Regressionsmodellen für Frauen und Männer ermittelt. In einer Dekade stieg die Anwendungsprävalenz für TAH (24,0 % vs. 59,6 %), Statine (18,5 % vs. 56,2 %), Betarezeptorenblocker (24,7 % vs. 65,5 %) und RAS-Blocker (31,6 % vs. 69,0 %) an. Sie nahm für Calciumantagonisten (33,3 % vs. 20,5 %) und Nitrate (40,6 % vs. 10,1 %) ab. In BGS98 wiesen Männer höhere Anwendungsprävalenzen von RAS-Blockern auf als Frauen. Signifikante geschlechtsspezifische Unterschiede waren in DEGS1 nur für „Angiotensin-Converting-Enzyme“(ACE)-Hemmer festzustellen. Die Ergebnisse reflektieren eine Verbesserung medikamentöser Sekundärprävention bei KHK für beide Geschlechter.

Objective To examine the association of diagnosed depression with the utilization of health care services and preventive measures among men and women in the general population in Germany. Methods Cross-sectional analysis of data from a representative telephone survey (men N=18,675, women N=24,518, 18 years and older). Self-reported health professional-diagnosed depression (past 12 months) and the use of a range of health care and preventive services were assessed. Results Diagnosed depression was associated with increased health care service utilization in both sexes. Diagnosed depression was associated with higher utilization of some preventive services, such as general health checkups (odds ratio [OR] 1.2), cancer screening (OR 1.2) and flu vaccination (OR 1.3) among women and cancer screening (OR 1.4) among men. Conclusions Health professional-diagnosed depression is associated with increased health service utilization independent of somatic comorbidity and socio-demographic confounders. There was no indication for specific under-treatment with preventive measures among people with depression diagnosis.

BackgroundUse of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse.ObjectivesTo investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany.MethodsParticipants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60-79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline.ResultsAfter a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42-3.41), 1.66(1.03-2.70), 1.56(1.06-2.28), and 1.57(1.07-2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07-3.89), antipsychotics (2.15, 1.11-4.15) and benzodiazepines (1.76, 1.09-2.82), but not antidepressants, were significantly associated with an increased risk of mortality.ConclusionsUse of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.

The health status of older people in Germany can be compared with the health of older people in other European Union (EU) Member States using data on the distribution of limitations in activities of daily living. This concept covers basic limitations in activities of daily living (ADL) such as eating, as well as limitations in instrumental activities of daily living (iADL) such as shopping and managing finances. The second wave of the European Health Interview Survey (EHIS 2) collected data on five ADLs and seven iADLs for people aged 65 or above. An ADL or iADL limitation was defined if a participant reported at least a lot of difficulty in at least one ADL or iADL, respectively. On average, 8.4% of the EU population reported an ADL limitation, with 25.2% reporting an iADL limitation. However, prevalences vary widely between EU Member States and are lower in Germany than the EU average (ADL limitation 6.3%, iADL limitation 14.0%). In general, women, people aged 75 or above, and lower education groups have a higher prevalence of ADL and iADL limitations.

Objective: To provide normative data for the Digit Symbol Substitution Test (DSST) of the Wechsler Adult Intelligence Scale, 3rd edition (WAIS-III) in a population-based sample of community-dwelling older adults in Germany according to age, sex, and level of education.Method: The sample comprised 1385 participants aged 65–79 years from the nationwide representative 'German Health Interview and Examination Survey for Adults' (DEGS1, 2008–2011). Participants with known cognitive impairment or dementia, other medical conditions affecting cognition, or currently using psychotropic drugs were excluded. Educational level was categorized as low, medium, and high according to the Comparative Analyses of Social Mobility in Industrial Nations (CASMIN) scale. Normative values for the DSST according to age, sex, and level of education were estimated by multiple linear regression using population weights.Results: Mean age was 71.1 years, 48.6% were men and low, medium, and high education levels were 62.8, 24.6, and 12.6%, respectively. Younger age, female sex, and higher level of education were significantly associated with higher DSST scores. Regression-based normative data for the DSST is provided according to age, sex, and level of education. In addition, a normative score calculator is provided.Conclusions: These are the first age-, sex-, and education-specific normative data for older individuals for the DSST of the WAIS-III in Germany. These normative data will enable future population-level analyses on impaired cognitive function according to DSST.

Comparability of 25-hydroxyvitamin D (25(OH)D) measurements is hampered by method-related differences in measurement values. International standardization of laboratory assays has been suggested to solve this problem.

To estimate the 10-year risk of fatal cardiovascular disease (CVD) in the 40 to 69 year old general population in Germany stratified by sex and to analyze differences between socio-economic status (SES), region and community size in individuals without CVD. The analysis is based on the newly recalibrated SCORE Deutschland risk charts and considered other comorbidities for the classification of the high CVD risk group according to the guidelines of the European Society of Cardiology.In 3,498 participants (40-69 years) from the German Health Examination Survey for Adults 2008-2011 (DEGS1) without a history of CVD (myocardial infarction, coronary heart disease, heart failure, stroke) we estimated the proportion with a low (SCORE <1%), moderate (SCORE 1-<5%) and high 10-year CVD mortality risk (SCORE ≥5% or diabetes, renal insufficiency, SBP/DPB ≥180/110 mmHg or cholesterol >8 mmol/l). The prevalence of low, moderate and high risk was 42.8%, 38.5% and 18.8% in men and 73.7%, 18.1% and 8.2% in women. The prevalence of high risk was significantly lower in women with a high compared to a low SES (3.3% vs. 11.2%) and in communities with ≥100.000 inhabitants compared to <20.000 inhabitants (5.4% vs.10.9%). There were no significant associations between predicted CVD mortality risk and SES or community size in men and regions in men and women. Among the high risk group, 58.2% of men and 9.8% of women had SCORE ≥5%, leaving the majority of women (60.1%) classified as high risks due to diabetes and SCORE <5%.Our results suggest the persistence of socioeconomic disparities in predicted cardiovascular mortality in women and support the need of large-scale prevention efforts beyond individual lifestyle modification or treatment. Furthermore, the importance of additional comorbidities for the high risk group classification is highlighted.

Background and Purpose Data on recent time trends in stroke mortality by subtypes and regions are lacking for Germany. We investigated sex- and age-standardized trends in stroke mortality in Germany for different stroke subtypes from 1998 to 2015 and assessed potential regional variations between the former Eastern and former Western part of Germany. Methods Mortality and population data from the German Federal Statistical Office were used to calculate sex- and age-standardized mortality rates for hemorrhagic stroke, ischemic stroke, and total strokes from 1998 to 2015 for all age groups. Joinpoint regression was used to examine trends and its changes. Estimations were stratified for Eastern and Western part of Germany. Results From 1998 to 2015, age-standardized total stroke mortality decreased by >50% in men (from 78.0 to 34.1 per 100 000) and women (from 62.1 to 28.4 women per 100 000). The decrease was more pronounced for ischemic stroke mortality (rate change: men, -66%; women, -63%) than for hemorrhagic stroke mortality (men, -40%; women, -31%). Total and ischemic stroke mortality declined more in Eastern than in Western part of Germany. From 1998 to 2015, there were no differences in the decline between the regions in hemorrhagic stroke mortality. Total stroke mortality was higher in Eastern compared with Western part of Germany throughout the study period. Differences in subtype- and sex-specific mortality between the regions decreased from 1998 to 2015. Conclusions Between 1998 and 2015, stroke mortality declined substantially in Germany with differing time trends in stroke subtypes between sexes and regions. Differences in stroke mortality rates between East and West Germany are negligible 24 years after the German reunification.