Search

Background: Regression analysis is a standard method in medical research. I t is often not clear, however, how the individual components of regression models are to be understood and interpreted. In this article, we provide an overview of this type of analysis and discuss its special features when used in observational studies. Methods: Based on a selective literature review, the individual components of a regression model for differently scaled outcome variables (metric: linear regression; binary: logistic regression; time to event: Cox regression; count variable: Poisson or negative binomial regression) are explained, and their interpretation is illustrated with respect to a study on multiple sclerosis. The prerequisites for the use of each of these models, their applications, and their limitations are described in detail. Results: Regression analyses are used to quantify the relation between several variables and the outcome variable. In randomized clinical trials, this flexible statistical analysis method is usually lean and prespecified. In observational studies, where there is a need to control for potential confounders, researchers with knowledge of the topic in question must collaborate with experts in statistical modeling to ensure high model quality and avoid errors. Causal diagrams are an increasingly important basis for evaluation. They should be constructed in collaboration and should differentiate between confounders, mediators, and colliders. Conclusion: Researchers need a basic understanding of regression models so that these models will be well defined and their findings will be fully reported and correctly interpreted. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the associations between dyscapnia, ventilatory variables, and mortality. We hypothesized that the association between mechanical power or ventilatory ratio and survival is mediated by dyscapnia. Methods: Patients with moderate or severe acute respiratory distress syndrome (ARDS), who received mechanical ventilation within the first 48 h after admission to the intensive care unit for at least 48 h, were included in this retrospective single-center study. Values of arterial carbon dioxide (PaCO 2 ) were categorized into "hypercapnia" (PaCO 2  ≥ 50 mm Hg), "normocapnia" (PaCO 2 36-49 mmHg), and "hypocapnia" (PaCO 2  ≤ 35 mm Hg). We used path analyses to assess the associations between ventilatory variables (mechanical power and ventilatory ratio) and mortality, where hypocapnia or hypercapnia were included as mediating variables. Results: Between December 2017 and April 2021, 435 patients were included. While there was a significant association between mechanical power and hypercapnia (B EM  = 0.24 [95% CI: 0.15; 0.34], P  < .01), there was no significant association between mechanical power or hypercapnia and ICU mortality. The association between mechanical power and intensive care unit (ICU) mortality was fully mediated by hypocapnia (B EM  = -0.10 [95% CI: -0.19; 0.00], P  = .05; B MO  = 0.38 [95% CI: 0.13; 0.63], P  < .01). Ventilatory ratio was significantly associated with hypercapnia (B = 0.23 [95% CI: 0.14; 0.32], P  < .01). There was no significant association between ventilatory ratio, hypercapnia, and mortality. There was a significant effect of ventilatory ratio on mortality, which was fully mediated by hypocapnia (B EM  = -0.14 [95% CI: -0.24; -0.05], P  < .01; B MO  = 0.37 [95% CI: 0.12; 0.62], P  < .01). Conclusion: In mechanically ventilated patients with moderate or severe ARDS, the association between mechanical power and mortality was fully mediated by hypocapnia. Likewise, there was a mediating effect of hypocapnia on the association between ventilatory ratio and ICU mortality. Our results indicate that the debate on dyscapnia and outcome after ARDS should consider the impact of ventilatory variables., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JG received consultant fees and speaker's honoraria from Drägerwerk AG & Co. KGaA and GE HealthCare Technologies, Inc. SK received research support from Cytosorbents and Daiichi Sankyo, lecture honoraria from ADVITOS, Biotest, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Shionogi and Zoll, consultant fees from Fresenius, Gilead, MSD and Pfizer. Maria Schroeder received research support and speaker's honoraria from Pfizer Pharma GmbH.

There is an ongoing debate about anxiety deficits in psychopathy and their possible impact on individual behavior. Data on actual anxiety- and threat-related behavior associated with psychopathy is still limited. We performed a mixed reality study using the elevated plus-maze (EPM) in a non-clinical sample (N = 160) to test anxiety-related behavior in relation to psychopathic personality traits measured through the Brief Questionnaire of Psychopathic Personality Traits (FPP). The psychopathy sum score correlated significantly with all measures of anxiety-related behavior on the EPM. Sensation seeking, but not general levels of acrophobia was moreover associated with psychopathic traits. Multivariate analyses revealed that the subscales Fearlessness and Lack of Empathy of the FPP predicted anxious behavior. Our findings are the first to demonstrate the relationship between psychopathic traits and actual behavior in an anxiety-inducing environment. This supports the low-anxiety hypothesis in psychopathy research. Implications for potentially harmful or risky behavior are discussed., (© 2024. The Author(s).)

Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Wiessner, Licaj, Klein, Bohn, Brand, Castell, Führer, Harth, Heier, Heise, Holleczek, Jaskulski, Jochem, Koch-Gallenkamp, Krist, Leitzmann, Lieb, Meinke-Franze, Mikolajczyk, Moreno Velásquez, Obi, Pischon, Schipf, Thierry, Willich, Zeeb and Becher.)

The construct of inclusion of other in the self has been established as one of the most influential measures for relationship closeness in romantic relationships. It is regularly associated with relational well-being, sexual satisfaction, as well as mental health. However, the degree of closeness one desires in the present relationship is person-specific and can differ from the closeness one actually experiences. Exploring these discrepancies, the present study focused on the association between not enough closeness and too much closeness and relationship characteristics, parenting, and extradyadic sexual activity. Data from a population-based sample of 3,161 men and women from the German Health and Sexuality Survey were analyzed using structural equation modeling. Our results confirm closeness discrepancies as prevalent relationship phenomena, while identifying feelings of not enough closeness as much more problematic for the relationship.

The aim of this study was to compare women who have undergone genital cosmetic surgery (FGCS) with women who have not regarding past sexual activities and experiences. It draws on data from the German Health and Sexuality Survey (GeSiD). The subsample of women who had undergone FGCS (n = 32) was compared to a subsample of women who had not had FGCS (n = 96); the samples were matched for age, education, relationship and marital status, and whether participants had born a child. Variables concerning the present relationship, recent/lifetime sexual activities, sexual orientation, pregnancy-related experiences, health, sexual boundary violations/violence, sexual difficulties, and migration background served as main outcome measures. Women who had undergone FGCS reported more often anal intercourse during their last sexual encounter (13% vs. 1%, p = 0.021), a pregnancy ending in miscarriage (34% vs. 16%, p = 0.016), and not to be satisfied with their own appearance (41% vs. 15%, p = 0.002) than women who had not undergone FGCS. The results indicate women's motivations for FGCS beyond the desire to improve genital appearance or function, and that contributing factors might be clinically relevant regarding more general psychological wellbeing., (© 2022. The Author(s).)

Objectives: The relationship between periodontitis and sarcopenia parameters in middle-aged adults is largely unexplored. This study investigated the association between periodontitis and combined handgrip strength and skeletal muscle mass in middle-aged adults., Materials and Methods: A sub-cohort of 1912 individuals with complete periodontal and whole-body dual X-ray absorptiometry examinations from the 2013-2014 wave of the National Health and Nutrition Examination Survey (n = 10,175) were analyzed using fully adjusted multiple linear regression models for associations between periodontitis and skeletal muscle mass index (kg/m 2 ) and combined handgrip strength (kg)., Results: The mean age of the study cohort was 43 (± 8.4) years and 49.4% of the participants were male. In total, 612 participants (32%) were determined to have periodontitis, of which 513 (26.8%) had non-severe (mild or moderate) periodontitis, and 99 (5.2%) had severe periodontitis. In unadjusted regression models, both non-severe and severe periodontitis were associated with SMMI (β non-severe  = 1.01, 95% CI 0.50; 1.52 and β severe  = 1.42, 95% CI 0.59; 2.25) but not with cHGS. After adjusting for age, sex, education, body mass index, bone mineral density, diabetic status, education, total energy intake, total protein intake, and serum vitamin D2 + D3, periodontitis was associated with cHGS (β non-severe  = -2.81, 95% CI - 4.7; - 1.15 and β severe  = - 2.73, 95% CI - 6.31; 0.83). The association between periodontitis and SMMI remained for non-severe periodontitis (β non-severe  = 0.07, 95% CI - 0.26; 0.40 and β severe  = 0.22, 95% CI - 0.34; 0.78)., Conclusion: The present study highlights the need of further prospective research to investigate the nature and direction of the relationship between periodontitis and sarcopenia indicators. Future studies can support the screening, prevention and clinical management of sarcopenia and periodontitis, and emphasize the interdisciplinary and complementary approach between the disciplines of geriatric medicine and periodontology., (© 2023. The Author(s).)

Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Vonneilich, Becher, Bohn, Brandes, Castell, Deckert, Dragano, Franzke, Führer, Gastell, Greiser, Keil, Klett-Tammen, Koch-Gallenkamp, Krist, Leitzmann, Meinke-Franze, Mikolajczyk, Moreno Velasquez, Obi, Peters, Pischon, Reuter, Schikowski, Schmidt, Schulze, Sergeev, Stang, Völzke, Wiessner, Zeeb, Lüdecke and von dem Knesebeck.)

Background: Climate change, in particular the exposure to heat, impacts on human health and can trigger diseases. Pregnant people are considered a vulnerable group given the physiological changes during pregnancy and the potentially long-lasting consequences for the offspring. Evidence published to date on higher risk of pregnancy complications upon heat stress exposure are from geographical areas with high ambient temperatures. Studies from geographic regions with temperate climates are sparse; however, these areas are critical since individuals may be less equipped to adapt to heat stress. This study addresses a significant gap in knowledge due to the temperature increase documented globally., Methods: Birth data of singleton pregnancies (n = 42,905) from a tertiary care centre in Hamburg, Germany, between 1999 and 2021 were retrospectively obtained and matched with climate data from the warmer season (March to September) provided by the adjacent federal meteorological station of the German National Meteorological Service to calculate the relative risk of heat-associated preterm birth. Heat events were defined by ascending temperature percentiles in combination with humidity over exposure periods of up to 5 days. Further, ultrasound data documented in a longitudinal prospective pregnancy cohort study (n = 612) since 2012 were used to identify pathophysiological causes of heat-induced preterm birth., Findings: Both extreme heat and prolonged periods of heat exposure increased the relative risk of preterm birth (RR: 1.59; 95% CI: 1.01-2.43; p = 0.045; RR: 1.20; 95% CI: 1.02-1.40; p = 0.025). We identified a critical period of heat exposure during gestational ages 34-37 weeks that resulted in increased risk of late preterm birth (RR: 1.67; 95% CI: 1.14-1.43; p = 0.009). Pregnancies with a female fetus were more prone to heat stress-associated preterm birth. We found heat exposure was associated with altered vascular resistance within the uterine artery., Interpretation: Heat stress caused by high ambient temperatures increases the risk of preterm birth in a geographical region with temperate climate. Prenatal routine care should be revised in such regions to provide active surveillance for women at risk., Funding: Found in acknowledgements., Competing Interests: Declaration of interests All authors declare no potential conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Population-level data on predictors for attitudes towards sexual behavior are missing for Germany. The current study investigated sexual attitudes in the German population with regard to sociodemographic and sociocultural factors. Data originated from the German Health and Sexuality Survey (GeSiD; N = 4,955) carried out from October 2018 to September 2019. Computer-assisted face to face interviews were conducted with a large self-administered component due to the sensitive topics of the survey. Public acceptance towards several aspects of sexual behavior (extramarital sex, abortion, same sex sexual activities, sex work, promiscuity, sex without love) was investigated. Age, gender, education, religious aspects and migration background were introduced as predictors into logistic regression analyses. Overall, respondents rather rejected promiscuity (61%) and extramarital sex (81%) and rather supported same sex sexual activities (63-70%). Male respondents more likely rejected same sex sexual activities and abortion. Higher education was associated with more acceptance towards the sexual behaviors whereas first generation migrants, Muslim faith and religious devoutness were associated with less acceptance. Results indicate that gender is relevant in terms of sexual attitudes with male respondents tending to have more traditional and heteronormative gender role values. Furthermore, education, culture and religion play an important role concerning the liberality towards sexual behaviors. Acculturation processes of second generation migrants may lead to an adaptation of values. Comprehensive and culturally sensitive sex education may focus on differences concerning sexuality-related norms and values., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest. The role of Miriam G. Gerlich being affiliated to the German Federal Center for Health Education (funder) had no influence on the work of this manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Ludwig et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although treatment options for multiple myeloma (MM) are rapidly evolving, there still remain difficult-to-treat situations, especially in relapsed and/or refractory (r/r) disease. When modern therapies are exhausted, or emergency treatment is needed for high tumor burden, classic chemotherapy combination regimens like the VTd-PACE regimen and its modifications (PACE-M) may also be beneficial as bridging to subsequent treatment options. This single-center retrospective analysis aimed to investigate the outcome of VTd-PACE and PACE-M salvage therapy in 31 heavily pretreated r/r MM patients. The primary objective was the overall response rate (ORR). Secondary objectives were median progression-free survival (mPFS), median overall survival (mOS), safety, and renal response. Median age was 59 years (range 39-75), and 71% of patients were male. R-ISS stratification showed high-risk MM in 48%. The median number of prior therapies was 3, with 23 patients being triple- and 12 penta-refractory (74% and 39%). ORR was 71%, including 23% of patients achieving a very good partial response. Median duration of follow-up was 15 months (range 0-29 months). mPFS and mOS were 3 months (95% CI 0.27-5.74) and 11 months (95% CI 3.66-18.35), respectively. In 26 patients (83.9%), at least one subsequent treatment (stem cell transplant or BCMA-directed) was administered. Renal function significantly improved after VTd-PACE or PACE-M treatment (p = 0.032). Non-hematological adverse events ≥ grade 3 were predominantly infections. VTd-PACE and PACE-M are effective salvage therapies in difficult-to-treat situations in heavily pre-treated r/r MM, including patients with impaired renal function. VTd-PACE and PACE-M can be successfully used as bridging therapy for subsequent treatment., (© 2022. The Author(s).)

Background and Aims: The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample., Methods: Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress., Results: Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months., Discussion and Conclusions: The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

Purpose: The objective of this study was to determine the influence of postanesthesia care unit (PACU) delirium on self-reported cognitive function and perceived health status 3 months after surgery., Methods: This prospective observational cohort study was performed in a PACU at a high-volume prostate cancer center. We used a convenience sample of patients > 60 years undergoing elective radical prostatectomy. Patients with a history of cerebrovascular or neurodegenerative disease were excluded. Fifteen, 30, 45, and 60 following extubation, patients were screened for signs of delirium with the Confusion Assessment Method for the Intensive Care Unit. Three months after surgery self-reported cognitive function was assessed with the Cognitive Failures Questionnaire, and health status was evaluated with the 36-item Short-Form Health Survey (SF-36)., Results: Signs of PACU delirium were present in 32.4% (n = 72/222) of patients, and 80.2% (n = 178/222) completed the 3-month follow-up. The presence of PACU delirium signs was not significantly associated with self-reported cognitive failures (B = 0.60, 95% CI: -1.72; 2.92, p = 0.61) or SF-36 physical component scores (B = 0.19, 95% CI: 0.02; 0.36, p = 0.03) or SF-36 mental component scores (B =  -0.03, 95% CI: -0.18, 0.11, p = 0.66) 3 months after radical prostatectomy., Conclusions: In a cohort of educated, highly functioning, elderly male patients who were assessed immediately after surgery and at a 3-month follow-up, we found no association between PACU delirium and self-reported cognitive failures or perceived health status, which implies that PACU delirium may be an event of limited duration and impact., Trial Registration: The study was registered at ClinicalTrials.gov (Identifier: NCT04168268, Date of registration: November 19, 2019)., (© 2022. The Author(s).)

Background: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. Methods: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018-2019, interviewed 4,955 people aged 18-75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. Results: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). Conclusions: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people.

Although online pornography use appears to be a mainstream activity, there is little information, particularly outside of the USA, about how consumers perceive its impact on their sexuality. Considering increasing concerns about pornography use, this lack of evidence has sociocultural and clinical ramifications - especially because the recently proposed Moral Incongruence model (MI) suggests that some individuals may see their pornography use as problematic independently of the frequency of use. Using data from 4,177 adults from the 2018-2019 national probability-based German Health and Sexuality Survey, we explored self-perceived impact of pornography use on personal sex life and the role of MI. Most participants (61.7%) reported no impact of pornography. Women were characterized by significantly higher odds of reporting positive relative to no impact, while men had higher odds of reporting mixed/negative compared to no impact. Participants in both the positive and the mixed impact group reported a significantly higher frequency of pornography use than participants in the no impact group. In line with the MI model, we observed a significant relationship between participants' religious upbringing and self-perceived negative (relative to mixed) impact of pornography use. Social relevance and clinical implications of the findings are discussed.

Introduction: The COVID-19 pandemic had numerous consequences for general, mental and sexual health. As gender differences in sexual compulsivity (SC) have been reported in the past and SC has been connected to adverse events and psychological distress, the current study aims at investigating associations between these factors in the context of contact restrictions in the course of the COVID-19 pandemic in Germany., Methods: We collected data for five time points in four retrospective measurement points in an online convenience sample (n T0 = 399, n T4 = 77). We investigated the influence of gender, several pandemic-related psychosocial circumstances, sensation seeking (Brief Sensation Seeking Scale), and psychological distress (Patient-Health-Questionnaire-4) on the change of SC (measured with an adapted version of the Yale-Brown Obsessive Compulsive Scale) between T0 and T1 (n = 292) in a linear regression analysis. Additionally, the course of SC over the time of the pandemic was explored with a linear mixed model., Results: Male gender was associated with higher SC compared to female gender over all measurement points. An older age, being in a relationship, having a place to retreat was associated with a change to lower SC during the first time of the pandemic. Psychological distress was associated with SC in men, but not in women. Men, who reported an increase of psychological distress were also more likely to report an increase of SC., Discussion: The results demonstrate that psychological distress seems to correlate with SC differently for men and women. This could be due to different excitatory and inhibitory influences on men and women during the pandemic. Furthermore, the results demonstrate the impact of pandemic related psychosocial circumstances in the times of contact restrictions.

Background: Sexual dysfunction and heavy substance use (alcohol, tobacco, and cannabis) play an important role in the development of depression, while frequent substance use affects sexual dysfunction., Aim: This study aimed to investigate the association between sexual dysfunction and depression among German adults in a nationally representative sample and the effect of alcohol, tobacco, and cannabis use on this association using moderator analysis., Methods: Data come from the German Health and Sexuality Survey (GeSiD) with N = 4,955 men and women aged between 18 and 75 years. We used multiple logistic regression analysis to examine the moderation effect of substance use between sexual dysfunction and depression by including an interaction term., Outcomes: Self-reported diagnosed and treated depression within the last 12 months and the moderation effect of substance use on the association between sexual dysfunction and depression., Results: Men and women with at least 1 sexual dysfunction were more likely to be affected by depression as compared to those without sexual dysfunction. A moderation effect of frequent cannabis use was found between sexual dysfunction and depression among women., Clinical Implications: Clinicians and therapists addressing addiction, depression, and dysfunction should keep the complex interactions in mind., Strengths & Limitations: This study provides new data on the association between sexual dysfunction and depression among German adults in a nationally representative sample and the moderation effect of substance use on this association. Further studies should disentangle the pathways between sexual dysfunction, cannabis use, and depression through moderated mediation analyses., Conclusion: Frequent cannabis use plays a moderating role in the association between sexual dysfunction and depression among German adult women. Belau MH, Wiessner C, Becher H, et al. Frequent Cannabis use Moderates the Relationship between Sexual Dysfunction and Depression Among Female German Adults. J Sex Med 2022;19:940-949., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Closeness, in the sense of inclusion of other in the self, has been found to be an important factor for relationship well-being, satisfaction and pair-bonding. In the past ten years, the self-expansion theory has also been incorporated into sex research, although studies are still very scarce and not without limitations. The present research aimed at further elucidating the relevance of relational factors for couple's sexuality, and to clarify the role inclusion of other in the self plays for sexual satisfaction and sexual distress. A broadly representative sample of 3,046 men and women aged 18 to 75 was taken from the German Health and Sexuality Survey (GeSiD). Throughout analyses, inclusion of other in the self and love were positively related to sexual satisfaction. Furthermore, inclusion of other in the self was negatively related to how strongly someone was distressed by experiencing sexual problems. Closeness seems to have a compensatory role especially for women with sexual problems, protecting them from experiencing sexual distress. In future research, couple's sexual satisfaction should not be compartmentalized from relational aspects. Results clearly promote the Inclusion of Other in the Self Scale as an interesting tool for both research and treatment.

Neurodegenerative proteinopathies are characterized by the intracellular formation of insoluble and toxic protein aggregates in the brain that are closely linked to disease progression. In Alzheimer's disease and in rare tauopathies, aggregation of the microtubule-associated tau protein leads to the formation of neurofibrillary tangles (NFT). In Parkinson's disease (PD) and other α-synucleinopathies, intracellular Lewy bodies containing aggregates of α-synuclein constitute the pathological hallmark. Inhibition of the glycoside hydrolase O-GlcNAcase (OGA) prevents the removal of O-linked N -acetyl-d-glucosamine (O-GlcNAc) moieties from intracellular proteins and has emerged as an attractive therapeutic approach to prevent the formation of tau pathology. Like tau, α-synuclein is known to be modified with O-GlcNAc moieties and in vitro these have been shown to prevent its aggregation and toxicity. Here, we report the preclinical discovery and development of a novel small molecule OGA inhibitor, ASN90. Consistent with the substantial exposure of the drug and demonstrating target engagement in the brain, the clinical OGA inhibitor ASN90 promoted the O-GlcNAcylation of tau and α-synuclein in brains of transgenic mice after daily oral dosing. Across human tauopathy mouse models, oral administration of ASN90 prevented the development of tau pathology (NFT formation), functional deficits in motor behavior and breathing, and increased survival. In addition, ASN90 slowed the progression of motor impairment and reduced astrogliosis in a frequently utilized α-synuclein-dependent preclinical rodent model of PD. These findings provide a strong rationale for the development of OGA inhibitors as disease-modifying agents in both tauopathies and α-synucleinopathies. Since tau and α-synuclein pathologies frequently co-exist in neurodegenerative diseases, OGA inhibitors represent unique, multimodal drug candidates for further clinical development.

Background: Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany., Methods: We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a populationbased probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%)., Results: 26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding socio - demographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13)., Conclusion: The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.

Neonatal passive immunity, derived from transplacental transfer of IgG antibodies from mother to fetus during pregnancy, can mitigate the risk for severe infections in the early postnatal period. Understanding the placenta as the gateway organ in this process, we aimed to evaluate the influence of specific factors modulating the transplacental IgG transfer rate (TPTR) in 141 mother/neonate pairs. We further evaluated the potential health advantage elicited by maternal IgG with regard to respiratory tract infections during infancy and early childhood. Data and biological samples collected within the prospective longitudinal pregnancy cohort study PRINCE (Prenatal Identification of Children's Health) were used for these analyses. We tested IgG antibody levels against seven pathogens (measles, mumps, rubella, tetanus, diphtheria, pertussis and influenza A) by ELISA and detected seropositivity in 72.6-100% of pregnant women and in 76.3-100% of their neonates, respectively. Cord blood IgG levels reached 137-160% of levels detected in maternal blood. Strikingly, assessment of TPTR for all seven antigens highlighted that TPTR strongly depends on individual placental function. Subsequent in-depth analysis of anti-influenza A IgG revealed a link between cord blood levels and uterine perfusion, measured by uterine artery pulsatility index. Moreover, higher cord blood anti-influenza A IgG levels were associated with a significantly reduced risk for respiratory tract infections during the first six months of life, indicating a high degree of cross-reactivity and possible pathogen-agnostic effects of anti-influenza A antibodies. Taken together, our data suggest that early life immunity is modulated by maternal IgG levels and individual placental features such as perfusion. Vaccination of pregnant women, i.e. against influenza, can increase neonatal antibody levels and hereby protect against early life respiratory infections. Consequently, specific guidelines should evolve in order to safeguard neonates born from pregnancies with poorer placental capacity for vertical transfer of protective antibodies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Global migration trends have led to a more diverse population in health care services everywhere, which in turn has set off a paradigm shift away from medical paternalism toward more patient autonomy. Consequently, physicians need to provide a more precise patient-centred healthcare. Professional interpreting appears to play a crucial part in tackling the challenges of language barriers adequately. The aim of this study was to conduct process evaluation through the implementing of video remote interpreting (VR) and telephone remote interpreting (TR) within primary care facilities in the northern German metropolis of Hamburg., Methods: We conducted a three-armed exploratory pilot trial, which compared VR to TR and to a control group (CG) in different primary care settings. We assessed feasibility of implementation, as well as the acceptance of interpreting tools among their users. In addition, we compared the quality of communication as perceived by patients and physicians, as well as the enabling of patient-centred medicine over all three study groups using quantitative questionnaires., Results: 13 practices (7 GPs, 3 Gynaecologists, 3 Paediatricians) took part in this trial. 183 interpreting calls were documented, 178 physicians as well as 127 patients answered their respective questionnaires. The implementation of the VR- und TR-tools went smoothly and they were broadly accepted by their users. However, the tools were used significantly less often than we had anticipated. With regards to quantitative questionnaires, VR scored significantly better than the control group in terms of the perceived quality of communication by both, patients and physicians and enabled of patient-centred medicine., Conclusion: Our main findings were the discrepancy between the assumed high demand of professional interpreting solutions on the one hand and the low willingness of practices to participate on the other. The rather low utilisation rates were also noteworthy. This discrepancy indicates a lack of awareness concerning the adverse effects of using informal or no interpreter in medical settings, which needs to be rectified. Due to the small sample size, all statistical results must be viewed with caution. However, our results show that remote interpreting represents a promising approach to tackling language barriers in primary care settings., (© 2022. The Author(s).)

Even though several SARS-CoV-2 vaccines have shown high effectiveness in the prevention of COVID-19 in healthy subjects, vaccination response in patients with plasma-cell-related disorders (PCD) remains widely unknown. Here, we report on an analysis describing the serological response after prime-boost SARS-CoV-2 vaccination in PCD patients, as compared to a healthy control group, and on possible influencing factors of serological responses. Blood samples were analyzed for the presence of quantitative anti-SARS-CoV-2 spike RBD Ig. A total of 82 patients were included; 67 received mRNA-, eight vector-based and four heterologous vaccinations. SARS-CoV-2 antibody titers (SP-AbT) were assessed in a mean of 23 days (SD ± 11 days) after the first and in a mean 21 days (SD ± 9) after prime-boost vaccination. A positive SP-AbT was detected in 31.9% of PCD patients after the first vaccination, and in 88.9% (44/49) after prime-boost vaccination, which was significantly less likely than that in the control group (100%, 78/78) ( p = 0.008). Furthermore, we have been able to validate our previously suggested threshold of 30 CD19+ B lymphocytes/µL as being predictive for SP-AbT development. Despite anti-CD38 directed therapy, quadruplet treatment, higher age and missing deep remission, which correlated negatively with SP-AbT appearance, SP-AbT formation is possible in a majority of myeloma patients after prime-boost vaccination.

Background: Sexually transmitted infections (STIs) are a relevant risk factor for the sexual health of individuals and the population. Therefore, the level of awareness and knowledge about STIs in different population groups is of particular interest for specific prevention work., Objectives: The aim of this study was to analyze the awareness of and knowledge about nine STIs in the German population. To do so, the study examined correlations with sociodemographic variables, sexuality-related characteristics, and subjective satisfaction with the level of information., Methods: The GeSiD study "German Health and Sexuality Survey" collected representative quantitative data from 4955 persons via face-to-face interviews on the state of knowledge about STIs. As a selection procedure, a two-step random sample was collected. Firstly, 200 sample points (municipalities) were initially selected proportionally across Germany. Secondly, a random sample of addresses was drawn from the respective residents' registration offices. The participation rate was 30.2%; the average age was 46.3 years., Results: Knowledge about HIV/AIDS was widespread in all age groups, but other STIs were significantly less known. Older people and respondents with a low level of education were particularly poorly informed. Local social disadvantage and a family history of migration were also negatively correlated with knowledge about STIs. A higher number of sexual partners is related to a better level of knowledge. In addition, persons who do not describe their sexual orientation as heterosexual as well as those with a history of STIs were well informed., Conclusion: Heterosexual adults in Germany are insufficiently informed about the risks of STIs. Therefore, target-group-specific efforts are needed to improve knowledge about STIs in order to reduce sexual risk behavior and improve the utilization of prevention programs among socially disadvantaged groups., (© 2021. The Author(s).)

Until 2020, there was no representative sex survey for Germany with published data. The GeSiD study "Health and Sexuality in Germany" is the first nationwide, representative sex survey. The aim of this paper is to provide a brief introduction to the German health and sexuality (GeSiD) survey.A total of 4955 persons (2336 men, 2619 women) aged 18-75 years were interviewed between 2018 and 2019. The computer-assisted face-to-face interviews had an extensive self-completion section and asked about a wide range of sexual behaviour and sexual health topics. Data on sexual identity, relationships, sexual behaviour, and sexual health were assessed. Data show, among other things, that only a minority of respondents had ever talked to a healthcare provider about HIV/AIDS or other sexually transmitted infections (STIs).Data show a clear need for education, information dissemination, and training in the area of sexual health., (© 2021. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

The German Health and Sexuality Survey (GeSiD) was carried out in 2018/2019 to provide up-to-date measures of sexual behavior, sexual attitudes and sexual lifestyles of the adult population. We describe the methods used in GeSiD which surveyed the general population in Germany aged 18-75 years (with oversampling of younger adults aged 18-35 years). This article focuses on study design, recruitment, and response rate and discusses the strategies implemented to enhance the response rate compared to the pilot study. Overall, 4.955 interviews were completed with a response rate of 30.2%. The data were weighted by age, gender, education, nationality, and region to reduce possible bias. Compared to the German 2018 census, the weighted sample provides good representativeness for selected respondent characteristics. The computer-assisted interviews consisted of a combination of face-to-face and self-completion components. They covered a broad perspective on sexual health, which included topics such as online sexual activities, pleasure, sexual dysfunction, and sexual violence. Reliable data on sexual and reproductive health in Germany are urgently needed for evidence-based prevention and health promotion work, to inform sexual health policy and for cross-national comparisons of the development of sexual behavior in Europe.

Background: Current research examining sexual aggression against males is rare and representative studies often do not sufficiently differentiate between male and female affected persons, male and female offending person, as well as between different types of sexual aggression., Objective: We investigated the prevalence of sexual aggression against males perpetrated by males and females distinguished by the type of sexual aggression and examined differences between sexual aggression against males committed by males and females in characteristics of the sexual aggression., Participants and Setting: We examined representative self-report data collected in the German Health and Sexuality Survey (GeSiD; n = 4,955). A total of 305 male participants (12.3 % of all male participants) experienced at least one incident of sexual aggression., Method: We investigated differences between characteristics of male- and female-perpetrated sexual aggression against males in cases of (1) sexual aggression against minors by adults, (2) sexual aggression among minors/peers, and (3) sexual aggression among adults. Characteristics of sexual aggression included were frequency, relation of accused person, disclosure, participant's age at first incident, and accused person's age at first incident., Results: Our results revealed that the proportion of sexual aggression by females against males is rather low in cases of sexual aggression against minors by adults (9 %) compared with sexual aggression among minors/peers (56 %) and among adults (52 %). Although the majority of characteristics of sexual aggression were similar, some differences between male- and female-perpetrated sexual aggression were found., Conclusions: Sexual aggression against males appears to be an under-researched phenomenon, especially when it is perpetrated by a female person. More research on sexual aggression against males as well as on the differences between male- and female-perpetrated sexual aggression is therefore considered necessary., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples t -tests and Wilcoxon tests. Effect sizes were calculated using Pearson's r . Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection, p = 0.002/ r = 0.59; affect differentiation, p = 0.007/ r = 0.53; self-perception, p = 0.002/ r = 0.58; impulse control, p = 0.007/ r = 0.53; self-worth regulation, p = 0.008/ r = 0.52; self-regulation, p = 0.004/ r = 0.56; experiencing affect, p = 0.009/ r = 0.53; bodily self, p = 0.008/ r = 0.54; OPD-SQ total score, p = 0.007/ r = 0.52; internal communication, p = 0.001/ r = 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active, p = 0.004/ r = 0.60; Oedipal conflict passive, p = 0.009/ r = 0.51; individuation versus dependency conflict active, p = 0.01/ r = 0.52; guilt conflict passive, p < 0.001/ r = 0.70; self-worth conflict passive, p = 0.001/ r = 0.70; passive mode, p < 0.001/ r = 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Koops, Wiessner, Ehrenthal and Briken.)

Objective: Audio-visual interventions have been used to provide relevant patient information to reduce pre-operative anxiety in children. The aim of the study was to investigate whether self-reported state anxiety in children could be reduced by presenting a child-friendly educational video on the day of surgery. Methods: A prospective, single-blinded, two-armed, randomized controlled study was designed with three measurement time points including 90 children (6-17 years) and their parents. In the intervention group (IG), the children and their parents were shown a child-friendly video explaining the perioperative procedures that would be applied during the hospital stay, in addition to receiving standard information. In the control group (CG), children and parents received standard information provided by the nursing staff. The primary outcome was any change in the children's pre-operative state anxiety levels, as measured by the State-Trait Operation Anxiety Inventory (STOA). A secondary outcome was patient satisfaction regarding the received information. Results: Anxiety was significantly reduced in both groups after receiving either the intervention plus standard information or the standard information only. No significant difference in anxiety reduction was observed between the IG and the CG. However, the children and parents in the IG reported fewer worries than those in the CG. Conclusion: A child-friendly, educational video can be an additional tool for providing patient information and reducing pre-operative anxiety in children and their parents. Further studies should focus on the timing of the intervention and on age- and developmentally appropriate information formats and contents to address children's pre-operative anxiety. Clinical Trial Registration: Patient Anxiety Reduction in Children by Using Simple Explanation Videos, ID: NCT0441377; www.clinicaltrials.gov, Data Sharing Statement: Deidentified individual participant data will not be made available., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Härter, Barkmann, Wiessner, Rupprecht, Reinshagen and Trah.)

Background: The fetal adrenal gland receives rising awareness as a predictor of spontaneous preterm birth. We hereby provide longitudinal growth assessments of the fetal adrenal gland in a low risk population with an additional focus on trajectories in fetuses born preterm., Methods: Fetal adrenal gland was assessed via transabdominal ultrasound at gestational weeks (gw) 24-26, 28-30, and 34-36 in a low-risk pregnancy cohort. Longitudinal trajectories of the total gland and the mark (so called fetal zone) as well as ratio of fetal zone width/ total widths (w/W) were analyzed using repeated ANOVA analyses. To compare trajectories of the ratio w/W for preterm and term fetuses respectively, as well as women with and without clinical signs of preterm labor, the propensity score method was applied., Results: Fetal zone width increased over the course of pregnancy (p < 0.0001), while the ratio w/W decreased (p < 0.0001) (n = 327). Comparing the trajectories of the ratio w/W in fetuses born preterm (n = 11) with propensity-score matched term born fetuses (n = 22), a decrease between gw 24-26 and 28-30 was observed in both groups, which continued to decrease for the term born fetuses. However, in preterm born fetuses, the ratio increased above the term born values at gw 34-36., Conclusion: Our study provides for the first time longitudinal growth data on the fetal adrenal gland and supports the hypothesis that fetal zone enlargement is associated with preterm birth which could play an important role in risk-prediction.

Background: The 11 th edition of the International Statistical Classification of Diseases (ICD-11) is due to come into force in 2022. The goal of the present partial evaluation of the GeSiD study findings is to provide the first ever estimate of the prevalence of different types of sexual dysfunction in Germany as defined by the diagnostic guidelines that are soon to take effect., Methods: The representative GeSiD study was carried out in 4955 men and women who belonged to a doubly stratified random sample of data from residence registration offices across Germany. The participation rate was 30.2%. Various types of sexual dysfunction were ascertained for the first time by means of a screening instrument based on the new ICD-11 guidelines., Results: The reported prevalence of one or more sexual problems, including mild distress, in the previous 12 months was 33.4% in men (95% confidence interval [31.0; 35.9]) and 45.7% in women [43.0; 48.4]. Some 80.4% of men and 72.1% of women stated that they had had at least one sexual contact in the past year. Sexual dysfunction causing marked distress, as per the ICD-11 guidelines, was reported by 13.3% [11.6; 15.1] of the sexually active men (most commonly, erectile dysfunction in 6.6% and early ejaculation in 4.5%), and by 17.5% [15.6; 19.6] of the sexually active women (most commonly, hypoactive sexual desire in 6.9% and orgasmic dysfunction in 5.8%). Orgasmic dysfunction was approximately twice as common in women as delayed ejaculation was in men. The prevalence of erectile dysfunction increased with age, while that of early ejaculation decreased. Women felt particularly impaired by pain associated with sexual activity., Conclusion: The findings of this study indicate the importance of sexual dysfunction as an obstacle to sexual health. The study provides the first prevalence estimates for the new ICD-11 guidelines and simultaneously offers a screening instrument for sexual dysfunction that can be used economically in routine practice.

Background: Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far., Objectives: Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test)., Methods: Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents., Results: Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99)., Conclusion: PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.

Introduction: A major goal in living donor kidney transplantation is to reduce the physical burden for the donor. Key-hole surgery for donor nephrectomy is a safe procedure, but concerns regarding donor safety during the learning phase might be the reason for surgeons' reluctance to change to a minimal invasive approach., Material and Methods: We analyzed the first 100 retroperitoneoscopic donor nephrectomies (RPDN) performed at our institution and compared the results to the last 50 mini incision donor nephrectomies (MIDN) regarding donor and recipient outcome, and analyzed the learning curves of RPDN., Results: The learning phase of RPDN was very short with significantly shorter operative times compared to MIDN (118 vs. 175 min, p < 0.001) and significantly fewer surgical complications (p = 0.03). RPDN patients rated the physical burden (p = 0.01) as lower, and they felt less bothered by the surgical scar (p = 0.03)., Conclusion: Introducing RPDN is safe, even during the learning phase of the surgeons. Changing surgical technique from MIDN to RPDN reduces the surgical burden of the procedure. Our study might encourage more transplant centres to adopt a minimally invasive approach., (Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Paracetamol is the first choice for antipyretic or analgesic treatment throughout pregnancy. Products with Paracetamol are readily available over the counter and therefore easily accessible for self-medication. Epidemiological data on Paracetamol intake pattern during pregnancy and its potential immunological effects are sparse. We aimed to analyze a possible association between Paracetamol medication and numbers of hematopoietic stem cells (HSC) in cord blood., Methods: The objective was addressed in the PRINCE (PRENATAL DETERMINANTS OF CHILDREN'S HEALTH) study, a population-based prospective pregnancy cohort study initiated in 2011 at the University Medical Center in Hamburg, Germany. 518 healthy pregnant women with singleton pregnancies were recruited during the first trimester. Three examinations were scheduled at the end of the 1st (gestational week 12-14), the 2nd (gestational week 22-24) and the 3rd trimester (gestational week 34-36). For 146 of these women, cord blood flow cytometry data were available. Paracetamol intake was assessed for each trimester of pregnancy., Findings: Among the 518 enrolled women, 40% took Paracetamol as main analgesic treatment during pregnancy. The intake frequency and dosage of Paracetamol varied between the women and was overall low with a tendency towards higher frequencies and higher dosages in the third trimester. Paracetamol intake, particularly during the third trimester, resulted in decreased relative numbers of HSCs in cord blood, independent of maternal age, first-trimester BMI, parity, gestational age and birth weight (-0.286 (95% CI -0.592, 0.021), p=0.068)., Interpretation: Prenatal Paracetamol intake, especially during the third trimester, may be causally involved in decreasing HSCs in cord blood., (Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.)