Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations.

BACKGROUND: Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. METHODS: We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. RESULTS: We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. CONCLUSIONS: High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia".

OBJECTIVES: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. METHODS/DESIGN: Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted. RESULTS: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. CONCLUSIONS: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

Fear of war in Germany: An observational study.

Background: Given the very limited knowledge, the purpose of this study was to identify the current prevalence and correlates of fear of conventional and of nuclear war in the general adult population (Germany). Methods: Data were taken from a representative survey (n = 3091 participants; mid-March 2022). Established items were used to quantify fear of conventional war and fear of nuclear war. Linear regressions were used to examine the correlates of fear of conventional war and fear of nuclear war, adjusting for several covariates. Results: While 5.3 % of the respondents were not at all worried about a conventional war, 44.2 % of the respondents reported some fear and 50.5 % of the respondents reported severe fear of a conventional war. Similarly, 7.7 % of the respondents were not at all worried about a nuclear war, whereas 45.7 % of the respondents reported some fear and 46.6 % of the respondents reported severe fear of a nuclear war. The prevalence rates mainly slightly differed between sociodemographic groups (with the exception of gender and having children) and were thus consistently high. Regressions showed that both higher fear of a conventional war and higher fear of a nuclear war were associated with being female, having children in own household, being married and living together with spouse, having at least one chronic illness and poor self-rated health. Conclusion: Our study showed high prevalence rates for fear of war (both, conventional war and nuclear war). Knowledge about the correlates may assist in tackling individuals at risk for severe fear. Against the background of the current events in Eastern Europe, future research in this area is urgently required.

Vision and hearing problems and psychosocial outcomes: longitudinal evidence from the German Ageing Survey.

PURPOSE: To examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation). METHODS: We used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems. RESULTS: Adjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (ß = 0.17, p < .01) and depressive symptoms (ß = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (ß = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (ß = 0.43, p < 0.05). CONCLUSION: Our longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life.

Religious affiliation and oral health-related quality of life: a cross-sectional study based on a nationally representative survey in Germany.

BACKGROUND: Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL. METHODS: A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses. RESULTS: Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (ß = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (ß = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (ß = 1.89, p < 0.01). CONCLUSION: Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL.

Parkinson's Disease and Subjective Prospects for the Future in Different Life Domains. Findings of a Nationally Representative Sample.

Purpose: To analyze the link between Parkinson's disease and perceived prospects for the future. Patients and Methods: Data were taken from the German Ageing Survey (year 2021; n=4296 individuals, thereof 33 individuals with Parkinson's disease) were used. This is a nationally representative sample of community-dwelling individuals ≥ 40 years in Germany. Perceived prospects for the future in different life domains (ie, living standard, health and general optimism) were used as outcomes. Physician-diagnosed Parkinson's disease served as key independent variable . It was adjusted for several covariates. Results: Individuals with Parkinson's disease had a markedly worse (Cohen's d=0.65) general optimism compared to individuals without Parkinson's disease. After adjusting for various factors, these differences disappeared in multiple linear regressions (ß=-0.04, p=0.72). Moreover, multiple ordered logistic regressions showed that individuals with Parkinson's disease had a worse future self-rated health (OR: 4.10, 95% CI: 1.99-8.47, p<0.001) compared to individuals without Parkinson's disease. Conclusion: Our study first showed that general optimism may be lower among individuals with Parkinson's disease (bivariate analysis). However, this association disappeared when it was adjusted for health-related factors in regression analysis. In sum, our findings indicate that more general future-related factors did not significantly differ between individuals with and without Parkinson's disease. However, there were significant differences in future self-rated health.

[Reasons of Individuals 60 Years and Older in Germany for not Getting Vaccinated against Covid-19]. / Gründe von Menschen ab 60 Jahren in Deutschland, sich nicht gegen Covid-19 impfen zu lassen.

PURPOSE: To identify the reasons of individuals aged 60 years and older in Germany for not getting vaccinated against Covid-19. METHODS: Data for this study were collected in July/August 2021 from "Kommunikation der Corona-Schutzimpfung in Deutschland" (CoSiD)", a representative survey of the general adult population in Germany. The focus was on individuals aged 60 years and older in our current study (n=1,281 individuals). RESULTS: Approximately 92% of individuals 60 years and older were already vaccinated against Covid-19. Among the older unvaccinated, nearly 60% were opposed to vaccination. Major reasons among older (and also younger) unvaccinated persons for "rather not getting vaccinated"/"definitely not" wanting to be vaccinated against Covid-19 were: (1) too little research on the vaccines or too short a time of research (roughly half of the individuals) and (2 and 3) no confidence/general skepticism or because of side effects (in each case, just over a quarter of the group surveyed). CONCLUSION: To increase the vaccination rate, these three arguments must be countered, for instance, during conversations in the context of medical care.

Prevalence and determinants of loneliness among the oldest old living in institutionalized settings : Study findings from a representative survey.

BACKGROUND: There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes. OBJECTIVE: To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany. MATERIAL AND METHODS: Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models. RESULTS: Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (ß = 0.48, p < 0.05), high education (compared to low education, ß = 0.46, p < 0.05), having a small social network size (ß = -0.02, p < 0.05), having poor self-rated health (ß = -0.25, p < 0.05), and more depressive symptoms (ß = 0.25, p < 0.001). CONCLUSION: A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness.

Perceived Norms and Vaccination against COVID-19 among the General Adult Population in Germany: Results of a Nationally Representative Survey.

OBJECTIVE: to examine whether perceived norms are associated with vaccination against COVID-19 (also stratified by age group). STUDY DESIGN: nationally representative survey. METHODS: Data were taken from a sample of the general adult population (n = 3829, 16 to 94 years). Data collection took place from early July to early August 2021, and 3 different groups (1: not yet vaccinated and no intention to vaccinate against COVID-19; 2: not yet, but intended to vaccinate against COVID-19; 3: yes, at least one vaccination against COVID-19) were distinguished in the analyses. Data were adjusted for several sociodemographic and health-related factors. Perceived norms served as key independent variables (1: number of important friends and relatives who would like me to get vaccinated; 2: number of important friends and relatives who already have been vaccinated or still want to do so; 3: how your general practitioner (GP) thinks about Corona vaccination). RESULTS: Multiple logistic regression showed that, in particular, the number of important friends/relatives who would like an individual to get vaccinated is associated with the actual COVID-19 vaccination status among individuals aged 16 to 59 years. Interestingly, all 3 indicators for perceived norms are associated with the likelihood of COVID-19 vaccination status among individuals aged 60 years and over. CONCLUSIONS: Our study adds to the understanding of the association between perceived norms and COVID-19 vaccination status. This highlights potential pathways to increase vaccination rates to further combat the later stages of the pandemic.

Oral health, anxiety symptoms and depressive symptoms: findings from the survey of health, ageing and retirement in Europe.

BACKGROUND: There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge. METHODS: Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis. RESULTS: Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (ß = 0.11, P < 0.001) and higher depressive symptoms (ß = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (ß = 0.02, P < 0.001) and higher depressive symptoms (ß = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (ß = -0.35, P < 0.001) and lower depressive symptoms (ß = -0.36, P < 0.001). CONCLUSION: Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required.

Long-term care need, loneliness, and perceived social isolation during the COVID-19 pandemic: evidence from the German Ageing Survey.

BACKGROUND: There is a complete lack of studies focusing on the association between care degree (reflecting the long-term care need) and loneliness or social isolation in Germany. AIMS: To investigate the association between care degree and loneliness as well as perceived social isolation during the COVID-19 pandemic. METHODS: We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. We used wave 8 of the German Ageing Survey (analytical sample: n = 4334 individuals, mean age was 68.9 years, SD: 10.2 years; range 46-100 years). To assess loneliness, the De Jong Gierveld instrument was used. To assess perceived social isolation, the Bude and Lantermann instrument was used. Moreover, the level of care was used as a key independent variable (absence of care degree (0); care degree 1-5). RESULTS: After adjusting for various covariates, regressions showed that there were no significant differences between individuals without a care degree and individuals with a care degree of 1 or 2 in terms of loneliness and perceived social isolation. In contrast, individuals with a care degree of 3 or 4 had higher loneliness (ß = 0.23, p = 0.034) and higher perceived social isolation scores (ß = 0.38, p < 0.01) compared to individuals without a care degree. DISCUSSION/CONCLUSIONS: Care degrees of 3 or 4 are associated with higher levels of both loneliness and perceived social isolation. Longitudinal studies are required to confirm this association.

Community centers for older adults and psychosocial factors: Evidence from the German Ageing Survey.

INTRODUCTION: There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)-which is important for successful aging. METHODS/DESIGN: Data were taken from a nationally representative sample-the German Ageing Survey-including older community-dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations. RESULTS: In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65-97 years). After adjusting for various socioeconomic, lifestyle-related, and health-related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (ß = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender. CONCLUSIONS: The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings.

Neighbourhood cohesion, loneliness and perceived social isolation prior and during the COVID-19 pandemic. Longitudinal evidence from the German Ageing Survey.

PURPOSE: To investigate the longitudinal association between neighbourhood cohesion and loneliness as well as perceived social isolation prior and during the COVID-19 pandemic (stratified by sex). METHODS: Longitudinal data were taken from a nationally representative sample (German Ageing Survey) of inhabitants aged 40 years and over in Germany prior (wave 6: year 2017) and during the COVID-19 pandemic (wave 8: November 2020 until February 2021; n = 6688 observations, mean age was 67.4 years). The De Jong Gierveld tool was used to measure loneliness and the Bude and Lantermann tool was used to measure perceived social isolation. Neighbourhood cohesion was assessed based on different items. RESULTS: FE regressions showed that decreases in closeness of contact with neighbours were associated with increases in loneliness and perceived social isolation levels among men, but not women. In contrast, decreases in different indicators of involvement in neighbourhood activities were associated with increases in loneliness and perceived social isolation levels among women, but not men. CONCLUSION: Changes in neighbourhood factors are differently associated with loneliness and perceived social isolation among middle-aged and older women and men. Gender-specific efforts to avoid loneliness and social isolation are, therefore, needed.

Utilization of internet for religious purposes and psychosocial outcomes during the COVID-19 pandemic.

BACKGROUND: Prior to the COVID-19 pandemic, research findings pointed towards an alleviating effect of religion on depressive symptoms and loneliness. However, it is not clear whether such a relationship persisted when worships were mostly held as online events. Consequently, this study investigates the link between religion-related internet utilization, particularly for online worships, depressive symptoms, and loneliness during the lockdown period. METHODS: Data were derived from a representative sample of German individuals aged 40 years and above, which was conducted in June and July 2020. Utilization of internet for religious purposes was treated as a dichotomous variable. RESULTS: Regarding bivariate analysis, individuals that used the internet for religious purposes were significantly older, and more likely to be female or to live in an urban setting. Furthermore, they had significantly more severe depressive symptoms. According to multiple linear regression, internet usage for religious purposes was both associated with more depressive symptoms, R² = .30, F(11, 3367) = 113.01, ß = 0.39, p = .050, and higher loneliness levels, R² = .09, F(11, 3367) = 25.75, ß = 2.24, p = .025. CONCLUSIONS: It seems possible that the alleviating effect of religion on depressive symptoms and loneliness did not hold during the COVID-19 pandemic, which may imply that online worships are not perfect replacements for traditional worships in terms of their social and health benefits.

Frequency and correlates of mild cognitive impairment and dementia among the oldest old - Evidence from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)".

OBJECTIVES: Since there is limited knowledge with regard to the frequency and correlates of mild cognitive impairment and dementia among the oldest old based on large representative data (including institutionalized individuals), our objective was to fill this research gap. METHODS: For our study, data came from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)". This study included community-dwelling and institutionalized individuals aged 80 years and over (n = 1,173, mean age: 86 years) residing in the most populous state of Germany (North Rhine-Westphalia). The DemTect was used to quantify cognitive impairment (i.e., probable mild cognitive impairment and probable dementia). RESULTS: Overall, 73.1% of the individuals were not cognitively impaired, 17.0% of the individuals had probable mild cognitive impairment and 9.9% of the individuals had probable dementia. Compared to individuals without cognitive impairment, individuals with probable mild cognitive impairment were more likely to be male, live in an institutionalized setting, have a lower educational level, have a smaller network size, and have lower functional abilities. Moreover, compared to individuals without cognitive impairment, individuals with probable dementia were more likely to be older, live in an institutionalized setting, have a lower educational level, have a smaller network size, not be multimorbid, and have lower functional abilities. CONCLUSIONS: Our study identified several sociodemographic and health-related factors which are associated with probable mild cognitive impairment and probable dementia among the oldest old. This knowledge may help to address individuals at risk for mild cognitive impairment and dementia.

[Use of and Attitudes toward Tests for the Detection of SARS-CoV-2 and Corresponding Antibodies: Results of a Nationally Representative Survey in Late Summer 2021]. / Inanspruchnahme von und Einstellungen zu Tests zum Nachweis von SARS-CoV-2 und entsprechenden Antikörpern. Ergebnisse einer bevölkerungsrepräsentativen Befragung im Spätsommer 2021.

OBJECTIVE: There is a lack of knowledge regarding utilization of and attitudes towards tests for the detection of SARS-CoV-2 in Germany. Our work aimed to reduce this gap. METHODS: Data were taken from a nationally representative online survey (August 24th to 3rd September 2021, n=3,075; mean age: 44.5 years). Utilization of and attitudes toward Covid-19-tests were quantified in detail. RESULTS: In sum, 79.1% of respondents had already undergone an appropriate test to detect SARS-CoV-2 test (mainly rapid antigen testing at rapid testing centers and self-testing) or an antibody test. With the exception of a PCR test, Covid-19 tests were rarely perceived as uncomfortable. Respondents were most likely to prefer a rapid antigen test in a rapid testing center. The main reasons for using self-testing as well as rapid antigen testing at rapid testing centers were (i) protection of others, (ii) for their own health precautions, and (iii) traveling. The main reasons for not using self-testing/rapid antigen testing at the workplace/training center were: (i) already vaccinated against Covid-19/recovered from Covid-19, followed by (ii) the home office workplace, and (iii) a lack of perceived benefit. Nearly 80% were somewhat or very satisfied, with access to testing at the workplace/training center and rapid testing centers. CONCLUSION: Our work described the use of and aspects of attitudes toward tests for the detection of SARS-CoV-2 in Germany in late summer 2021. At that time, such test offers were already used quite often and were predominantly perceived as not being very unpleasant. The protection of other individuals was one of the main reasons for the use of such tests. Future research in this area is desirable (e. g., among the oldest old and in times when free-of-charge testing is no longer offered).

Does Oral Health-Related Quality of Life Differ by Income Group? Findings from a Nationally Representative Survey.

OBJECTIVES: Clarify the association between income group and oral health-related quality of life. METHODS: Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values. RESULTS: Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen's d = -0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen's d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen's d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (ß = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (ß = -0.28, p < 0.10). CONCLUSIONS: The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.

Pet ownership, loneliness, and social isolation: a systematic review.

PURPOSE: Several publications explored a relationship between pet ownership and lower levels of loneliness and social isolation. However, to the best of our knowledge, no systematic review has yet synthesized the evidence on these associations. Thus, this systematic review aims to evaluate the findings regarding the relations between pet ownership, loneliness, and social isolation. METHODS: PubMed, CINAHL, and PsycInfo were searched in January 2022. Observational studies relying on appropriate instruments to assess the exposure and the outcome variables were included. Two reviewers independently executed study selection, data extraction, and quality assessment. RESULTS: n = 24 studies were included. Among adult samples, the studies examining the relationship between pet ownership and social isolation found that owning a pet was associated with lower levels of social isolation. Concerning loneliness, studies that were conducted after the outbreak of COVID-19 mostly showed that pet ownership can contribute to lower levels of loneliness, but did not reveal an overall significant association until then. In turn, the studies that examined child and adolescent samples suggest that pet ownership was related to reduced loneliness before COVID-19. Furthermore, most of the studies did not reveal any differences between dogs, cats, and other kinds of pets regarding their relationship to loneliness and social isolation. CONCLUSION: All in all, only a part of the studies detected a significant association between pet ownership, loneliness and social isolation. However, the COVID-19 pandemic seemed to strengthen this relationship, so that future research is required to assess the longevity of this potential effect.

Association between migration and oral health-related quality of life: results from a nationally representative online survey.

PURPOSE: To analyze the link between individuals with and without migration background and oral health-related quality of life (also stratified by sex). METHODS: Data in this cross-sectional study were taken from a nationally representative survey (n = 3075, August/September 2021). The Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. Two-part models were calculated, adjusting for various covariates. RESULTS: Individuals with migration background had lower oral health-related quality of life (total sample, Cohen's d = - 0.30; in men, d =- 0.44; in women, d =- 0.22). Two-part models also revealed that the migration background was associated with a higher likelihood of OHIP-G5 scores of one or higher (total sample and in both sexes). Moreover, migration background was positively associated with the extent of oral health-related quality of life (conditional on OHIP-G5 scores of one or higher; total sample and in men). Furthermore, regressions showed that migration background was associated with lower oral health-related quality of life (total sample and in both sexes). CONCLUSIONS: Our study emphasized the link between having a migration background and lower oral health-related quality of life among both women and men. Maintaining oral health among individuals with a migration background is a key challenge. Culturally and socially sensitive actions should provide easy accessible oral health information and preventive measures in order to lower access barriers in dental care for individuals with migration background.

Prevalence of Prefrailty and Frailty Among Older Adults in Germany: A Systematic Review, Meta-Analysis and Meta-Regression.

Background: Various studies have identified the prevalence of prefrailty and frailty among older adults in Germany. Nevertheless, there is no review systematically synthesizing these studies. Thus, our aim was to close this gap in knowledge. Moreover, another aim was to perform a meta-analysis to synthesize the pooled prevalence of prefrailty and frailty. A further aim was to explore potential sources of heterogeneity based on a meta-regression. Methods: A number of three electronic databases (PubMed, PsycINFO, and CINAHL) were searched (plus an additional hand search). The observational studies that determine the prevalence of frailty among older adults aged 65 years and above in Germany were included, whereas disease-specific samples were excluded. Data extraction included the description of the sample, operationalization of frailty, statistical analysis, sample characteristics and main findings. The established Joanna Briggs Institute (JBI) standardized critical appraisal instrument for prevalence studies was used for evaluating the quality of the studies. Important steps were performed by two reviewers. Results: In sum, a number of 12 studies were included. The prevalence of frailty varied from about 2.4 to 25.6%. The pooled prevalence of frailty was 13.7% (95% CI: 9.0 to 18.5%). There was a significant heterogeneity among the studies (I 2 = 98.9%, p < 0.001). The pooled prevalence of prefrailty was 40.2% (95% CI: 28.3 to 52.1%; I 2 = 99.6%, p < 0.001). Some evidence of a publication bias exists. Meta-regressions showed that some of the heterogeneity was explained by the tool to quantify frailty and the average age of the respective sample. Conclusion: Particularly, the high prevalence of prefrailty should be highlighted since it is important to prevent individuals in old age from developing to frail status. This knowledge is important for the German society as a whole and for relevant stakeholders. Systematic Review Registration: PROSPERO, identifier: CRD42021293648.