Leipzig University

Importance Better understanding of patients’ attitudes toward deprescribing specific medications will inform future deprescribing interventions. Objective To investigate older adults’ attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing. Design, Setting, and Participants This survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire. Exposures Patient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country. Main Outcomes and Measures The primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?” Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing. Results Of 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998). Conclusions and Relevance In this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use.

Anxiety disorders and/or depressive disorders co-occurring with hematological cancer are an additional burden for patients. Experiential avoidance (EA; efforts to avoid negative emotions, thoughts, or memories) is an empirically evident transdiagnostic factor for the onset and maintenance of anxiety and depressive disorders in non-cancer populations. There is lack of evidence on the impact of EA in predicting anxiety and depression in cancer patients. A total of 291 patients with hematological cancer (60% male, mean age 55 years) were included in this cross-sectional observational study. Participants were assessed using the Structured Clinical Interview for DSM-5 mental disorders (SCID-5). EA was assessed via self-report using the Brief Experiential Avoidance Questionnaire (BEAQ). Hierarchical binomial logistic regression was conducted in order to estimate the impact of EA on anxiety and depressive disorders. A total of 38 patients (13.3%) met the diagnostic criteria for a current anxiety disorder, while 49 patients (17.2%) met the criteria for a current depressive disorder. In bivariate analyses, EA was significantly elevated in patients with an anxiety disorder in comparison to those without (54.4 vs. 48.9; p = 0.01). The same was true for depressive disorder (54.9 vs. 48.6; p < 0.01). After controlling for relevant sociodemographic and medical factors, EA did not predict anxiety or depressive disorder in separate regression models. The presence of an anxiety disorder was significantly predicted by female sex, younger age and elevated comorbidity burden. In contrast, the presence of a depressive disorder was predicted by comorbidity burden. Sociodemographic and medical predictors have greater predictive potential than EA regarding current anxiety and depressive disorder in hematological cancer patients.

Background The aim of the study was to analyze the impact of adherence to the intervention components on the effectiveness of AgeWell.de, a multi-domain lifestyle intervention against cognitive decline, on function in everyday activities, quality of life, depressiveness and social isolation. Objective Studying the effect of adherence on health-related outcomes. Methods Participants were aged 60–77 years at baseline and at risk (Cardiovascular Risk Factors, Ageing and Dementia Score (CAIDE) ≥9). Adherence to the components nutrition, enhancement of physical and social activities and cognitive training was analyzed in two ways, first continual within the intervention group (n = 378, mean age = 69.1 years, 52.7% female) and second as dichotomous split (75% adherence) and in reference to the control group (received infomaterial and regular health advice; n = 441, mean age = 69 years, 53% female). Generalized linear regression models were then run on the health outcomes functioning in everyday activities, quality of life, depressive symptoms, and social inclusion. Results Health-related quality of life and depressiveness were improved in participants with better adherence to nutritional counselling and enhancement of physical and social activities. Better adherence to social activities was relevant for function in everyday activities. Effects of high adherence to cognitive training was found for improvements in depressiveness when comparing it to the control group. No effect was found on social inclusion when considering the particular components. Conclusions The extent of adherence to most components influenced health-related outcomes such as health-related quality of life and depressiveness. With this study, the effectiveness of AgeWell.de can be understood in greater depth. Trial Registration German Clinical Trial Register (DRKS; ID: DRKS00013555).

Patient-centered outcomes, and in particular the concept of oral health-related quality of life (OHRQoL), have been receiving increasingly more attention in dentistry in recent years. OHRQoL is a construct that measures the impact of oral diseases or conditions on a person’s total health and well-being. Thus, it represents the patient’s self-perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DH), which is a common condition characterized by transient tooth pain arising from exposed dentine in response to different stimuli, may bother the patient during eating, drinking, oral hygiene habits, and sometimes even breathing. These potential limitations on everyday activities are important, as they can affect the patient’s overall quality of life. The aims of this chapter are to introduce the concept of OHRQoL, to describe the instruments that can be used to evaluate OHRQoL in patients with DH, to discuss research findings that have reported that DH substantially impairs OHRQoL, and to discuss how OHRQoL could be more broadly incorporated into assessment of patients diagnosed with DH, to provide more data on the severity and impact of problems being reported.

Patients treated with an allogeneic hematopoietic stem cell transplantation (allo-SCT) face a significant mortality risk, which might trigger existential distress. We aimed to investigate how hematology health care professionals (HCPs) address life-threatening conditions with allo-SCT recipients and their relatives, and what are challenging and supportive aspects. We conducted a multicenter cross-sectional survey, assessing: (1) HCPs’ approaches to address life threat, using a self-developed questionnaire with 19 items categorized in four dimensions (proactive, cautious, reactive, avoiding), (2) challenges/support needs, using self-developed multiple-choice questions, and (3) personal attitudes towards death (Death Acceptance subscale of the Life Attitude Profile-Revised; Death Attitude Profile-Revised). Statistics included association, regression and exploratory factor analysis. We included 104 participants (52 physicians, 45 nurses, 7 psycho-oncologists) from the settings of SCT, general hematology and intensive care. Physicians predominantly addressed life threat proactively, while nurses tended to raise the topic when prompted by patients or a clinical worsening. Overall, 10% of HCPs stated to avoid the topic, even in case of a high risk of death. HCPs’ approaches correlated weakly with their attitudes towards death. A main challenge was to talk with patients/relatives repressing the risk of death (72%). More time resources for these conversations (71%), and mentoring by palliative-care specialists (67%) or psycho-oncologists (65%) were the most frequent support needs. This comprehensive survey reveals strong differences between professions in addressing life threat, and possible influence from personal death attitudes. Further confirmatory research in larger samples is needed to tailor communication trainings on life threat in multi-professional teams. Registration:German Clinical Trials Register, DRKS00027290, date of registration: 2022-01-10.

We study different domination problems of attacking and non-attacking rooks and queens on polyominoes and polycubes of all dimensions. Our main result proves that maximum independent domination is NP-complete for non-attacking queens and for non-attacking rooks on polycubes of dimension three and higher. We also analyze these problems for polyominoes and convex polyominoes, conjecture the complexity classes, and provide a computer tool for investigation. We have also computed new values for classical queen domination problems on chessboards (square polyominoes). For our computations, we have translated the problem into an integer linear programming instance. Finally, using this computational implementation and the game engine Godot, we have developed a video game of minimum domination of queens and rooks on randomly generated polyominoes.

Cardiac magnetic resonance imaging (MRI) has become a vital noninvasive imaging modality in modern cardiology, offering essential diagnostic information, risk stratification and treatment planning, especially in ischemia and myocarditis assessments. Together with echocardiography, cardiac MRI is a core competency in the field. A growing demand for cardiac MRI necessitates a robust infrastructure for high-quality patient care. The recent decision by the German Federal Joint Committee (G-BA) to evaluate cardiac MRI for ischemia and myocarditis assessments marks a significant step toward integrating this technology into contract physician services and improving accessibility. This development requires service providers to exhibit expertise and use modern equipment. The number of certified cardiologists in cardiac MRI surged from 71 in 2012 to 446 in 2024, reflecting a strong foundation for meeting demands. Comprehensive training programs with defined competency levels (I–III) are crucial for specialist qualification. Integrating cardiac MRI training into cardiology residency programs, aligned with international standards, aims to enhance quality assurance and ensure improved access to this diagnostic tool for better patient care.

An international multicenter study was designed and carried out to evaluate the color vision screener (CVS) test for normal trichromats and congenital color deficients. Over 400 participants from nine international Colour Assessment and Diagnosis (CAD) testing centers completed the CVS and the CAD test on calibrated visual displays. The CVS had a sensitivity and specificity [95% confidence intervals] of 1.00 [0.98–1.00] and 0.99 [0.97–1.00] with a positive and negative predictive index of 0.94 and 1.00 for an assumed prevalence of 8%. The CVS is quick, efficient, and easy to use, and its sensitivity is equivalent to the optimal published Ishihara protocol.

Extensively studied blood–brain barrier (BBB) in‐vitro models are established on 2D cell culture inserts. However, they do not accurately represent 3D in‐vivo microenvironments due to lack of direct neurovascular unit cellular contacts. Here, the establishment and characterization of a self‐assembled 3D BBB spheroid model using human‐induced pluripotent stem cell (hiPSC)‐derived brain capillary endothelial‐like cells (iBCECs) in combination with primary human astrocytes (ACs) and pericytes (PCs) are reported. This investigation compares 3D spheroids with 2D mono‐cultured iBCECs derived from two different hiPSC lines and two differentiation strategies. It is observed that spheroid properties vary depending on the differentiation strategy or type of hiPSC line applied for model generation. However, spheroids demonstrate in‐vivo like tight junction ultrastructure and, in comparison to 2D models, higher transcript expression of BBB specific genes. Furthermore, they possess characteristic barrier integrity, barrier functionality, and protein expression. It is inferred that hiPSC‐derived BBB spheroids hold a strong potential as a reliable future BBB in‐vitro test system.

In the United States, 1 in 5 Americans develop keratinocyte carcinoma (KC) by age 70, placing the disease among the five most expensive cancers based on Medicare expenditure. Current preventative measures have failed to stem rising KC rates, highlighting the need for alternative strategies. Evolving evidence indicates that lasers conventionally used to treat photoaging, may provide protective effects against the development of KC and precursor lesion, actinic keratosis (AK). This review first delves into existing evidence on fractional infrared laser-based KC and AK prevention. Next, the work discusses potential underlying mechanisms that might explain fractional infrared lasers’ prophylactic effects. A comprehensive literature search of PubMed and Web of Science databases was conducted from inception to April 2024 using preselected search terms. Interventional human and animal studies, epidemiological analyses, and case reports on fractional infrared laser-based prevention of KC or AK were screened according to predefined inclusion/exclusion criteria. Included evidence demonstrates that ablative fractional lasers reduce and delay development of AK/KC, shown in two controlled trials of photodamaged patients and two murine studies (i.e. Er: YSGG and CO2 lasers). Weaker evidence of KC prevention by nonablative infrared lasers is provided by a retrospective cohort study. In the laser literature, three mechanisms are proposed to drive these prophylactic effects, including the ability of infrared lasers to (i) remove DNA-damaged epidermal cells, (ii) activate the insulin-like growth factor-1 pathway by reducing fibroblast senescence, and (iii) initiate immunomodulating effects. Based on current evidence, infrared fractional lasers show promise particularly for secondary KC prevention in photodamaged populations.

Wind turbines may cause negative environmental impacts, such as residential disamenities or adverse effects for ecologically protected areas. Spatial planning policies are a common instrument to address these impacts, e.g. by excluding areas from wind power. While the targeted environmental impacts may be effectively reduced, spatial planning policies can cause trade-offs with untargeted environmental impacts. We assess these trade-offs in a spatial optimization model based on high-resolution GIS data of the potential areas for onshore wind power in Germany. We find that considerable trade-offs exist between environmental impacts, but not for the average levelized cost of electricity (LCOE) of wind power production. Combinations of spatial planning policies result in higher trade-offs. Additionally, we identify five underlying drivers for the size of trade-offs.