Deutsches Arzteblatt international最新文献

Background: Cervical cancer is the fourth most common type of cancer in women worldwide. Its incidence and mortality have been declining in Germany since 1971, when cervical cancer screening began to be offered to all women in the German statutory health care system. In this study, we examine the trends in incidence and survival since 2003.

Methods: We analyzed data from the epidemiological cancer registries of 10 German federal states concerning the incidence of cervical cancer (ICD-10 C53) from 2003 to 2021. The data, obtained via the Center for Cancer Registry Data at the Robert Koch Institute, were classified according to tumor stage, histological subtype, histopathological grade, and patient age. Survival rates were calculated with Cox regression models.

Results: During the study period, the mean age at diagnosis was 53.5 years. The 5-year overall survival rate did not change (2003 and 2017: 65.4% in both years). The age-standardized incidence of squamous cell carcinoma declined from 11.5 per 100 000 women in 2003 to 7.7 per 100 000 in 2021. 25.4% of women with the disease were ≥ 65 years old; compared to younger women, they more often had stage T3 and T4 disease and grade G3 tumors, and their 5-year survival rate was lower. 10.8% of the women with cervical cancer were under 35 years old. The incidence fell most sharply in this age group, from 5.1 per 100 000 women per year in 2003 to 3.1 per 100 000 per year in 2021, and women in this age group were also the most likely to have stage T1a or T1b disease.

Conclusion: The incidence of squamous cell carcinoma of the cervix declined most markedly in the youngest age group, and this may be attributable to vaccination against HPV. The 5-year survival rates have not changed. The impact on survival of the organized screening program and treatment in certified gynecological cancer centers remains to be seen.

Background: People with severe multiple sclerosis (PsMS) have multidimensional, complex needs. COCOS-MS is an exploratory study of the effect of cross-sectoral care and case management (CCM) on these patients' quality of life, palliative care needs, and psychological distress, as well as caregivers' burden.

Methods: We conducted a randomized, controlled, phase II trial (DRKS00022771) with two parallel treatment arms: standard care versus CCM in addition to standard care over a 12-month period. A trial-specific CCM manual was used. The target variables were recorded in standardized fashion at baseline (T0) and every three months thereafter (T1 until the end of the intervention at T4, then T5 three months after the end of the intervention to determine sustainability). The primary endpoint was the change in the patients' quality of life (HALEMS) from baseline to month 12 in a group comparison. A modified intention-to-treat (mITT) was performed based on a mixed linear model with repeated measures over time (ARH1-structured covariance matrix). Values of p less than 0.05 were considered significant.

Results: 80 PsMS were randomly assigned 1:1 to one of the two treatment arms (male: female 1:2, median age 55 years [IQR 49-62], EDSS 6.5 [6-7.5], dropout rate 10%). There was no significant improvement in HALEMS after one year (T4) in the group comparison (-0.08 [-0.31, 0.15], p = 0.503; NNT = 22). Secondary endpoints such as subjective health status, psychological distress, and palliative care needs showed a clear response at the end of the intervention. After the intervention ended, the values approached the baseline level.

Conclusion: The primary endpoint did not reach significance in this health services research feasibility study. For further development of the study design, the focus will be on the psychological and palliative factors in which PsMS-a reference group for long-term neurological conditions-were found to benefit from the CCM.

Background: Both radical prostatectomy (RP) and radiotherapy (RT) are recommended as standard treatments for prostate cancer. The prospective comparisons available to date provide only limited information.

Methods: We used data from the database of our university cancer center to compare the metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of all patients with prostate cancer who underwent either RP or RT in the period 2014-2024. Stage-, age-, and frailty-specific sensitivity analyses were carried out.

Results: Of 2685 patients with prostate cancer, 1999 (74%) underwent RP and 686 (26%) underwent RT. The RP patients were younger (66 vs. 74 years); a higher percentage of the RP patients than of the RT patients had high-risk prostate cancer (60% vs. 43%), stage cT3 (47% vs. 9.6%), and stage cN1 (11 vs. 5.2%), while the RT patients more commonly had ECOG status 1-2 (16% vs. 6.7%; p<0.001 for all comparisons). Univariate analyses of MFS mostly favored RT, while univariate analyses of OS mostly favored RP. These differences, however, were no longer seen after adjustment for patient and tumor characteristics in multivariable Cox regression models, nor were they seen in sensitivity analyses of D'Amico risk groups, age categories, or ECOG status. Lastly, in 2:1 propensity-score-matched analyses, no differences between RP and RT were found in any of the oncol - ogical outcome measures (p≥0.15 for MFS, CSS, and OS).

Conclusion: The findings of this real-world study of prostate cancer patients who underwent either RP or RT suggest equally effective cancer control by the two methods when the statistical analysis is adjusted for patient and tumor characteristics. At present, patients with high-risk prostate cancer und unfavorable disease stages more commonly undergo RP.

Background: Accommodation is the eye's ability to dynamically adjust its refractive power in order to focus images at varying distances sharply onto the retina. Presbyopia is the progressive deficit of accommodation that develops as an individual becomes older. An estimated 1.8 billion people worldwide have presbyopia.

Methods: This narrative review is based on pertinent publications retrieved by a PubMed search using the terms "presbyopia," "presbyopic," "intraocular lens," "corneal inlay," and "presbyLasik," with particular attention given to prospective and retrospective studies, systematic reviews, and meta-analyses published in English or German up to February 2025. Additionally, clinical and surgical experiences from the Universitätsklinikum Frankfurt am Main (Germany) were taken into account.

Results: Many different techniques for the correction of presbyopia have been developed and studied, both nonsurgical and surgical. They differ from one another in invasiveness, the range of corrected vision, and expected optical and visual quality outcomes. Proper patient selection and precise preoperative diagnostic evaluation are prerequisites for success. The highest spectacle independence rate, of 96%, was achieved in a study with only 27 patients, in which multifocal intraocular lenses were implanted during cataract surgery or refractive lens exchange, with postoperative satisfaction exceeding 90%.

Conclusion: Presbyopia can be corrected by either nonsurgical or surgical means. However, the restoration of natural accommodation or a fully equivalent mechanism has not yet been achieved.

Background: Insomnia in children and adolescents can be associated with poorer cognitive, emotional, social, and academic development. At present, no estimates of the prevalence of insomnia and its risk factors among adolescents in Germany are available from which the potential need for treatment could be assessed.

Methods: We conducted an online survey of a representative German sample of 1128 children and adolescents (age 10-17) and one parent for each. Levels of severity of insomnia as defined by the ICD-11 criteria were assessed by means of standardized selfreporting with use of the internationally established Insomnia Severity Index. The point prevalences of the levels of severity were calculated via relative frequencies. Potential risk factors for insomnia (sociodemographic factors, obesity, media consumption time, depression, anxiety, parental insomnia) were assessed with validated screening questionnaires and investigated in a multinomial regression model for the prediction of insomnia in childhood.

Results: The following point prevalences were determined: mild insomnia, 26.6%; moderate insomnia, 21.4%; severe insomnia, 1.6%. The most important risk factors for moderate and severe insomnia were existing anxiety (odds ratio and 95% confidence interval 4.54 [2.09; 9.88] and 7.96 [1.72; 36.94], respectively) and parental insomnia (2.49 [1.66; 3.72] and 3.30 [1.06; 10.30], respec tively). The most important risk factor for mild and moderate insomnia was depression (1.83 [1.49; 2.24]), while older age (adolescents versus 10- to 13-year-olds) was protective ([0.51; 1.00]).

Conclusion: Many children and adolescents meet the ICD-11 criteria for insomnia according to their self-assessment. Critical life events and stressful experiences were not found to have any significant association with insomnia. A primarily nonpharmacological treatment approach involving the child and parents is indicated to alleviate the, often considerable, psychological strain on the family and prevent chronification of insomnia with adverse effects on the development of the child.