Prevalence of Colorectal Neoplasia 10 or More Years After a Negative Screening Colonoscopy in 120 000 Repeated Screening Colonoscopies.

Importance: Screening colonoscopy to prevent and early detect colorectal cancer is recommended to be repeated in 10-year intervals, which goes along with high demands of capacities and costs. Evidence of findings at screening colonoscopies conducted 10 or more years after a negative colonoscopy result is sparse, and it remains unclear whether screening colonoscopy intervals could possibly be prolonged. Objective: To assess the prevalence of advanced colorectal neoplasms (ADNs) at least 10 years after a negative screening colonoscopy in a very large cohort of repeated screening colonoscopy participants in Germany. Design, Setting, and Participants: This registry-based cross-sectional study on screening colonoscopy findings reported to the German screening colonoscopy registry during January 2013 to December 2019 included data on screening colonoscopies that were offered to the German general population 55 years or older since 2002; virtually all screening colonoscopies among individuals covered by Statutory Health Insurance (approximately 90% of eligible adults) are reported to the national registry. A total of 120 298 repeat screening colonoscopy participants 65 years or older were identified who had a previous negative screening colonoscopy at least 10 years prior. The findings were compared with all screening colonoscopies conducted at 65 years or older during the same period (1.25 million). The data were analyzed from March to July 2022. Main Outcomes and Measures: Prevalence of colorectal cancers and ADNs (advanced adenomas and cancers). Results: Of 120 298 participants, 72 349 (60.1%) were women. Prevalence of ADN was 3.6% and 5.2% among women and men 10 years after a negative screening colonoscopy and gradually increased to 4.9% and 6.6%, respectively, among those who had a negative colonoscopy 14 years or longer prior compared with 7.1% and 11.6% among all screening colonoscopies. Sex-specific and age-specific prevalence of ADNs at repeated colonoscopies conducted 10 or more years after a negative colonoscopy were consistently at least 40% lower among women than among men, lower at younger vs older ages, and much lower than among all screening colonoscopies (standardized prevalence ratios for cancers: 0.22-0.38 among women, 0.15-0.24 among men; standardized prevalence ratios for ADNs: 0.49-0.62 among women, 0.50-0.56 among men). Conclusions and Relevance: The results of this cross-sectional study suggest that ADN prevalence at screening colonoscopies conducted 10 or more years after a negative screening colonoscopy is low. Extension of the currently recommended 10-year screening intervals may be warranted, especially for female and younger participants without gastrointestinal symptoms.

Database Supported Long-term Management of Chronic Diseases - Data from the German Disease Management Programmes as a Source for Continuing Medical Education.

Disease Management Programmes (DMPs) have been introduced by German Federal Government in 2002 to improve long-term care for patients with specific chronic diseases. Digitisation has been a requirement to reliably document patient data in DMPs. This report presents data from six DMPs in the German federal state of North Rhine-Westphalia. It demonstrates that high level long-term quality of care can be achieved and maintained. But beyond clinical purposes DMP data are also an invaluable source to supply content in CME.

A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention. DISCUSSION: If the intervention proves effective, it may be included into the DMPs for T2DM and CHD. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.

Prescription Rates for Antiplatelet Therapy (APT) in Coronary Artery Disease (CAD) - What Benchmark are We Aiming at in Continuing Medical Education (CME)?

Physicians always aim to improve their patients' health. CME should be designed not only to provide knowledge transfer, but also to influence clinical decision-making and to close performance gaps. In aretrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in atotal of 3,405 practices in 2019 in aDMP in the region of North Rhine, Germany. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction/acute coronary syndrome, or who have been treated with percutaneous coronary intervention or bypass surgery. Patients mean age was 72.7 ± 11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2 ± 4.7 years, and mean cumulative number of DMP visits was 27 ± 17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for amissing APT prescription per practice were between .0044% and .0062% for male and female CAD patients, respectively. Rates for amissing APT prescription per practice and DMP visit were .0002% for both sexes. These results suggest that a DMP can achieve high attainment rates for APT in CAD. To further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups.

[Estimating prevalent microvascular complications of diabetes mellitus in Germany. Analysis of statutory health insurance data in 2012 and 2013]. / Einschätzungen zur Prävalenz mikrovaskulärer Folgeerkrankungen bei Diabetes mellitus in Deutschland. Analyse von Versichertendaten aller gesetzlichen Krankenkassen für die Jahre 2012 und 2013.

BACKGROUND: Data sources for the systematic and ongoing analysis of prevalence of microvascular complications of diabetes mellitus are limited in Germany. For the first time, we estimated the complications prevalence based on claims data of all statutory health insurance (SHI) providers according to the Data Transparency Act. METHODS: Health claims data of the reporting years 2012 and 2013 were analyzed. The reference population was identified as insured persons with a diabetes diagnosis according to the international classification of disease. Diabetes was defined as documentation of at least two confirmed diabetes diagnoses in an outpatient setting or one diagnosis in an inpatient setting (ICD codes E10-E14). Complications were defined based on the following ICD codes: nephropathy (N08.3), retinopathy (H36.0), polyneuropathy (G63.2), diabetic foot syndrome (DFS; E10-14.74, E10-14.75), chronic kidney disease (N18.-), and treatment with dialysis (Z49.1, Z49.2, Z99.2). Results were compared to prevalence estimates based on routine data and registries in Germany and abroad. RESULTS: In 2013, diabetes was documented for 6.6 million persons with SHI (2012: 6.5 million). In 2013, chronic kidney disease (15.0%) was the most frequent complication, followed by diabetic polyneuropathy (13.5%), nephropathy (7.6%), retinopathy (7.0%), DFS (6.1%), and treatment with dialysis (0.56%). While results for diabetic retinopathy, nephropathy, and polyneuropathy are lower than prevalence estimates from other type 2 diabetes studies, they are comparable for chronic kidney disease, treatment with dialysis, and DFS. CONCLUSION: Continuous analysis of health claims data is highly valuable for the diabetes surveillance. However, detailed analyses are required for verification and harmonization of case definitions and documentation practice.

Secondary data in diabetes surveillance - co-operation projects and definition of references on the documented prevalence of diabetes.

In addition to the Robert Koch Institute's health surveys, analyses of secondary data are essential to successfully developing a regular and comprehensive description of the progression of diabetes as part of the Robert Koch Institute's diabetes surveillance. Mainly, this is due to the large sample size and the fact that secondary data are routinely collected, which allows for highly stratified analyses in short time intervals. The fragmented availability of data means that various sources of secondary data are required in order to provide data for the indicators in the four fields of action for diabetes surveillance. Thus, a milestone in the project was to check the suitability of different data sources for their usability and to carry out analyses. Against this backdrop, co-operation projects were specifically funded in the context of diabetes surveillance. This article presents the results that were achieved in co-operation projects between 2016 and 2018 that focused on a range of topics: from evaluating the usability of secondary data to statistically modelling the development of epidemiological indices. Moreover, based on the data of the around 70 million people covered by statutory health insurance, an initial estimate was calculated for the documented prevalence of type 2 diabetes for the years 2010 and 2011. To comparably integrate these prevalences over the years in diabetes surveillance, a reference definition was established with external expertise.

[Is There an Association Between DMP Enrollment and Disability Pension in Rehabilitants With Type 2 Diabetes?] / Besteht bei Rehabilitanden mit Typ-2-Diabetes ein Zusammenhang zwischen DMP-Einschreibung und Bezug einer Erwerbsminderungsrente?

Efficacy of treatment of working-age patients with diabetes mellitus can be increased by rehabilitative measures. This treatment option is explicitly mentioned in the guidelines of the disease management program (DMP) for type 2 diabetes (T2D). With research data from the pension insurance fund, it is shown that for rehabilitation patients with T2D and DMP enrolment, the chance of disability pension is 23% lower than without DMP enrolment, irrespective of relevant covariates.

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy.

BACKGROUND & AIMS: A higher incidence of proximal interval cancers after colonoscopy has been reported in several follow-up studies. One possible explanation for this might be that proximally located adenomas have greater malignant potential. The aim of the present study was to assess the risk of malignancy in proximal versus distal adenomas in patients included in a large screening colonoscopy database; adenoma shape and the patients' age and sex distribution were also analyzed. METHODS: Data for 2007-2012 from the German National Screening Colonoscopy Registry, including 594,614 adenomas identified during 2,532,298 screening colonoscopies, were analyzed retrospectively. The main outcome measure was the rate of high-grade dysplasia (HGD) in adenomas, used as a surrogate marker for the risk of malignancy. Odds ratios (ORs) for the rate of HGD found in adenomas were analyzed in relation to patient- and adenoma-related factors using multivariate analysis. RESULTS: HGD histology was noted in 20,873 adenomas (3.5%). Proximal adenoma locations were not associated with a higher HGD rate. The most significant risk factor for HGD was adenoma size (OR 10.36 ≥1 cm vs <1 cm), followed by patient age (OR 1.26 and 1.46 for age groups 65-74 and 75-84 vs 55-64 years) and sex (OR 1.15 male vs female). In comparison with flat adenomas as a reference lesion, sessile lesions had a similar HGD rate (OR 1.02) and pedunculated adenomas had a higher rate (OR 1.23). All associations were statistically significant (P ≤ .05). CONCLUSIONS: In this large screening database, it was found that the rates of adenomas with HGD are similar in the proximal and distal colon. The presence of HGD as a risk marker alone does not explain higher rates of proximal interval colorectal cancer. We suggest that certain lesions (flat, serrated lesions) may be missed in the proximal colon and may acquire a more aggressive biology over time. A combination of endoscopy-related factors and biology may therefore account for higher rates of proximal versus distal interval colorectal cancer.

Selecting and defining indicators for diabetes surveillance in Germany.

Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance.

[Integration of secondary data into national diabetes surveillance : Background, aims and results of the secondary data workshop at the Robert Koch Institute]. / Integration von Sekundärdaten in die Nationale Diabetes-Surveillance : Hintergrund, Ziele und Ergebnisse des Sekundärdaten-Workshops am Robert Koch-Institut.

Epidemiological data provide evidence that diabetes mellitus is a highly relevant public health issue in Germany as in many other countries. The Robert Koch Institute (RKI) is in the process of building a national diabetes surveillance system that is aimed at establishing indicator-based public health monitoring of diabetes population dynamics using primary and secondary data. The purpose of the workshop was to conduct an inventory of available secondary data sources and to discuss data contents, data access, data analysis examples in addition to the options for ongoing data use for diabetes surveillance.

The J1 adolescent health check-up: analysis of data from the German KiGGS survey.

BACKGROUND: We analyzed data from the Robert Koch Institute's KiGGS survey regarding the J1 adolescent health check-up in order to determine what information this check-up provides. METHODS: Descriptive statistical analysis of J1 participation with respect to social, demographic, medical and psychological factors, with logistic regression analysis of the risk associated with non-participation. RESULTS: 32.9% of all adolescents in Germany aged 14 to 17 had a J1 check-up. Thus, the J1 participation rate has remained low since the introduction of the J1 in Germany. The main conditions that were more commonly found in adolescents who had a J1 check-up were thyroid disorders (4.1% vs. 2.9%), and scoliosis (14.8% vs. 10.5%). Adolescents were only half as likely to have a J1 check-up if they were under the care of a general practitioner, rather than a pediatrician (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.36-0.60). Foreign adolescents were only half as likely to have a J1 check-up as German ones (OR 0.51, 95% CI 0.31-0.84). CONCLUSION: There is compelling evidence that scoliosis and thyroid disorders, in particular, are underdiagnosed if a J1 check-up is not performed. Thus, elevating the J1 participation rate should be a priority. If a J1-check up were performed in the nearly two-thirds of all adolescents who currently do not undergo one, many latent health problems could be recognized and treated in timely fashion.

Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective.

The present study evaluates the effect of cognitive training, of psychoeducational training and of physical training on cognitive functioning, physical functioning, physical health, independent living and well-being in older people. Also the combination of physical training with cognitive training or psychoeducational training, respectively, was evaluated. In contrast to most training studies with older people, training effects were evaluated in a longitudinal perspective over 5 years to analyse long-term-results of cognitive and physical activity on older adults. Training effects were evaluated compared to a no-treatment-control group. Subjects were 375 community residents aged 75-93 years. Up to 5 years after baseline examination, significant training effects were observed in the group exposed to the combined cognitive and physical training. The physical and cognitive status in the participants of this group could be preserved on a higher level compared to baseline, and the participants displayed fewer depressive symptoms than the no-treatment-control group. The results are discussed in the light of recent research regarding the effects of mental and physical activity on brain function in older adults.

[Quantitative determination of coronary vascular calcinosis (coronary calcium score) with double-helical CT]. / Quantitative Bestimmung des Koronargefässkalkes (Koronarkalziumscore) mit der Zweizeilenspiral-CT.

Coronary heart disease is a common disease, with the typical characteristic of coronary sclerosis, an abnormal calcification of the heart's blood vessels. The amount of coronary calcification is in direct correlation to the extent of coronary heart disease. With the double-detector-helical-CT it is possible to detect and quantify these calcifications. The correlation of the "Calcium-Scoring" with the results of coronary-angiography, myocardial scintigraphy and clinical findings shows the value of this method of coronary heart diagnostic. False negative results, based on low calcified fatty stenotic plaques and false positive results, based on high calcificated plaques without significant stenosis should be taken into account.