Deutsches Arzteblatt international最新文献

Background: Germany experienced a steady rise in the prevalence of past-12-months cannabis use from 2012 to 2021. In 2024, cannabis was partially legalized for recreational use. Against this background, it is important to systematically examine consumption patterns in the early phase after legalization.

Methods: Data are from the 2012 (n2012 = 9084), 2015 (n2015 = 9204), 2018 (n2018 = 9267), 2021 (n2021 = 9046), and 2024 (n2024 = 7534) waves of the Epidemiological Survey of Substance Abuse (ESA), a repeated cross-sectional survey of Germanspeaking adults in private households.

Results: The prevalence of past 12-month cannabis use rose steadily from 4.6% in 2012 to 8.8% in 2021. The prevalence in 2024 was 9.8%, an additional increase compared to 2021, but the difference is not statistically significant. Most cannabis users consumed marijuana (92.3%), predominantly in the form of joints (88.6%). One-quarter of them (25.7%) also belonged to a cannabis social club. The most frequently stated motivation for using cannabis was "to get high or have fun" (66.8%), followed by "to reduce stress or relax" (61.3%).

Conclusion: In the early post-legalization period, there was a small, non-significant increase in the prevalence of cannabis use in Germany compared with 2021. Given the legalization is very recent, it is too soon to observe any clear effect.

Background: Approximately 70 550 women receive a diagnosis of breast cancer in Germany each year. Ovarian cancer is much rarer, with approximately 7180 new cases per year. A woman's individual risk of breast and ovarian cancer can be quantitatively estimated with tools that are available online; these are playing an increasingly important role in genetic counseling. Environmental factors, lifestyles, and discoveries in epigenetics all need to be taken into account. An understanding of potential preventive measures for patients at elevated genetic risk of gynecological malignancies is becoming increasingly important for precise counseling in clinical practice.

Methods: We conducted a literature search in PubMed up to September 2025, taking into account current guidelines on primary, secondary, and tertiary prevention for women at elevated genetic risk of gynecological malignancies, with a particular focus on familial breast and ovarian cancer.

Results: The lifetime risk of breast cancer in women with a pathogenic variant of the BRCA1 or BRCA2 gene is approximately 70%. For ovarian cancer, it is approximately 44% and 17%, respectively. Primary prevention includes risk-reducing surgery such as mastectomy and oophorectomy/salpingectomy, as well as the use of certain preventive drugs. An intensified early detection program for breast cancer is a secondary prevention measure. Tertiary prevention includes the option of further risk-reducing measures, such as contralateral mastectomy and the use of PARP inhibitors, for women already under treatment for hereditary breast or ovarian cancer.

Conclusion: This article highlights the wide range of preventive options available for hereditary gyne - cological malignancies.

Background: Monitoring the use of psychoactive substances and the prevalence of substance-related disorders in the general population enables estimation of the extent of substance abuse and its effects on health and society.

Methods: Data are from the Epidemiological Survey of Substance Abuse (ESA) for 2024 (n = 7534, aged 18-64 years). Prevalence rates were calculated for the use of tobacco, alcohol, cannabis, illegal drugs, and medications, and for individuals who met the DSM-IV criteria for dependency or abuse. Rates were extrapolated to the German resident population aged 18 to 64 (51 480 168 people).

Results: The most commonly used substance was alcohol, with a 30-day prevalence of 68.6% (35.3 million people), followed by nonopioid analgesics (31.5%) and conventional tobacco products (21.8%). The 12-month prevalence of cannabis use was 9.8% (5.1 million people). Dependence prevalences were 4.2% for alcohol, 8.3% for tobacco, 1.0% for cannabis, 0.1% for amphetamines, 0.1% for cocaine, 2.8% for analgesics, and 1.5% for hypnotics and sedatives. Abuse prevalences were 5.6% for analgesics, 0.5% for cannabis, 0.1% for cocaine, 0.1% for amphetamines, 1.1% for hypnotics and sedatives, and 3.3% for alcohol.

Conclusion: The use of psychoactive substances in Germany is still widespread. Because of the effects of psychoactive substance use on health and society, continual monitoring is essential for the early detection of trends and the institution of targeted preventive and interventional measures.

Background: Patients with coccygodynia have chronic pain in the area of the coccyx that is worse on sitting. The prevalence of this condition is unknown, but women are affected much more frequently than men, in a 5:1 ratio.

Methods: In this narrative review, we present the relevant diagnostic techniques and conservative, interventional, and surgical treatment options.

Results: The mobility of the coccyx is assessed with dynamic x-rays in the seated and upright positions. Although there have been a number of small-scale randomized therapeutic trials, the evidence concerning the treatment of coccygodynia is derived mainly from observational studies. Manual therapies such as pelvic-floor training, the use of elastic therapeutic tape, analgesic drugs, and sitting cushions have reportedly yielded mixed results, with limited to clinically relevant efficacy. Interventional techniques, including local steroid infiltration, ganglion impar block, and radiofrequency therapies, can markedly improve symptoms for many patients. In intractable cases, surgical removal of the coccyx (coccygectomy) is an option. In a meta-analysis, 84% of patients obtained relief of pain and 76% returned to work. After at least 36 months of follow-up, the mean degree of pain relief was rated at 5.4 on a scale of 1 to 10. Wound dehiscence arose in 5% of patients, and 3% underwent repeated surgery.

Conclusion: Coccygodynia requires special diagnostic evaluation, including dynamic imaging and interdisciplinary pain assessment. Patients with coccygodynia are at risk for pain chronification. In such cases, multimodal evaluation is indicated. Conservative treatment should be tried first, potentially including interventional methods of reducing pain. Coccygectomy should only be considered in intractable cases with demonstrated instability.