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Zusammenfassung: Zielsetzung: In 2021 wurde die bundesweite Medienkampagne „Deine Chance“ der damaligen Beauftragten der Bundesregierung für Sucht- und Drogenfragen und des Bundesministeriums für Gesundheit durchgeführt, um Raucherinnen und Raucher zu motivieren, mit dem Rauchen aufzuhören. Ziel unserer Studie war, die Wahrnehmung der Kampagne und ihre Effekte auf Rauchstoppmotivation und Rauchstoppversuche zu untersuchen. Methodik: Im Rahmen der repräsentativen Deutschen Befragung zum Rauchverhalten (DEBRA) wurden 1550 Raucher_innen im Zeitraum vor der Kampagne (18.02. bis 30.05.2021) und 2330 während der Kampagne (31.05. bis 14.11.2021) befragt. Spezifische Fragen bezogen sich auf die Wahrnehmung der Kampagne und davon ausgehende Impulse zur Änderung des Rauchverhaltens. Mögliche Effekte wurden anhand der Motivation zum Rauchstopp Skala sowie dem Anteil der Raucher_innen mit mindestens einem Rauchstoppversuch gemessen. Ergebnisse: 14.6 % (95%KI=13.2-16.1) der Raucher_innen nahm die Kampagne wahr. Hinsichtlich der Altersgruppen wurde die Kampagne am häufigsten von 14-24-Jährigen wahrgenommen (19.1 %, 95%KI=14.9-24.0). Raucher_innen mit niedriger Schulbildung nahmen die Kampagne seltener wahr als Raucher_innen mit hoher Schulbildung (OR=0.65, 95%KI=0.46-0.93). Unter den Raucher_innen, welche die Kampagne wahrgenommen hatten, informierten sich 6.4 % (95%KI=3.0-11.9) über die Kampagne, und 13.6 % (95%KI=9.1-19.0) wurden angeregt, über einen Rauchstopp nachzudenken. Im Vergleich zum Zeitraum vor der Kampagne gab es bei den Raucher_innen während der Kampagne keinen Unterschied in der Rauchstoppmotivation (OR=0.96, 95%KI=0.85-1.08) oder in durchgeführten Rauchstoppversuchen (OR=0.96, 95%KI=0.69-1.35). Schlussfolgerungen: Die Medienkampagne „Deine Chance“ hatte vermutlich keine nennenswerten Effekte auf die Rauchstoppmotivation und Rauchstoppversuche der Raucher_innen in Deutschland. Effektivere tabakkontrollpolitische Maßnahmen sind dringend notwendig, um das langfristige Ziel einer rauchfreien Gesellschaft zu erreichen.

Abstract: Aims: Nationwide restrictions were implemented in Germany in March 2020 to reduce the spread of the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2). It is not yet precisely known how these restrictions affected peoples’ health behaviours in Germany. Objectives were to 1) retrospectively examine changes in self-reported health behaviours (tobacco smoking, alcohol consumption, and physical activity) in response to these restrictions; and 2) to explore associations among health behaviour changes as well as links to socioeconomic and sociodemographic characteristics. Methodology: We used data from two waves (June-August 2020) of the German Study on Tobacco Use (DEBRA): a cross-sectional, representative survey with people aged ≥14 years (n=4078). Associations between socioeconomic and sociodemographic characteristics and health behaviour changes were analysed using multinomial logistic regression analyses. Results: Changes in health behaviours were as follows: smoking increase=24.0 % (95 % confidence interval (CI)=21.5–26.7), decrease=12.2 % (95 %CI=10.4–14.4); alcohol consumption increase=12.9 % (95 %CI=11.7–14.1), decrease=19.9 % (95 %CI=18.4–21.3); physical activity increase=18.5 % (95 %CI=17.3–19.7); decrease=29.4 % (95 %CI=28.0–31.0). Younger people with a lower level of education were more likely to report a harmful health behaviour change. Conclusions: The majority of people did not change their health behaviours. Among those who did, comparatively more increased their smoking and decreased their alcohol consumption and physical activity. Public health interventions in this context should particularly target younger people and those with a lower level of education.

Zusammenfassung. Zielsetzung: Die Motivation to Stop Scale (MTSS) ist eine englischsprachige Single-Item Skala zur Vorhersage von Rauchstoppversuchen. Ziel dieser Arbeit war die externe Validierung der deutschsprachigen Version der MTSS (Motivation zum Rauchstopp Skala, MRS) an einer Stichprobe von aktuell Tabakrauchenden in Deutschland. Methodik: Datenbasis war die Deutsche Befragung zum Rauchverhalten (DEBRA), eine deutschlandweite, persönlich-mündliche Haushaltsbefragung von Personen ab 14 Jahren mit telefonischer Nachbefragung nach 6 Monaten. Analysiert wurden Daten aus den ersten 18 Wellen (Juni 2016–Mai 2019) von 767 aktuell Tabakrauchenden. Die MRS (Stufe 1–7 = keine bis höchste Motivation) wurde bei der Erstbefragung eingesetzt. Bei der Nachbefragung wurde die Anzahl der Rauchstoppversuche seit Erstbefragung erfasst. Logistische Regression wurde durchgeführt und die diskriminative Genauigkeit der MRS mittels Area Under the Receiver Operating Characteristic Curve (ROC-AUC) berechnet. Ergebnisse: Bei Erstbefragung waren 61,1 % ( n = 469; 95 % Konfidenzintervall (KI) = 57.7–64.6) der 767 Rauchenden nicht zum Rauchstopp motiviert (MRS-Stufe 1–2). Insgesamt unternahmen 185 der 767 Rauchenden (24,1 %; 95 % KI = 21.1–27.1) zwischen der Erst- und Nachbefragung mindestens einen Rauchstoppversuch. Mit steigender Motivationsstufe auf der MRS nahm die Wahrscheinlichkeit für einen Rauchstoppversuch zu: Odds Ratio = 1.37, 95 % KI = 1.25–1.51, bei einer diskriminativen Genauigkeit von ROC-AUC = 0.64. Schlussfolgerung: Die MRS ist ein kurzes und valides Messinstrument zur Erfassung der Rauchstoppmotivation im deutschen Sprachraum.

IntroductionWe explored past-year quit attempts, cessation methods used, and associations with person characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany.MethodsCross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with spirometry-confirmed COPD from 19 pulmonary primary care practices were used. Associations were explored between sociodemographic characteristics, lung function, urges to smoke, psychological distress, and ≥1 past-year quit attempt (yes/no)/use of ≥1 evidence-based cessation method (yes/no). ResultsOf all patients, 48.5% (n=247) reported ≥1 past-year quit attempt. Male gender was positively and time spent with urges to smoke was negatively associated with such attempt. One third used ≥1 evidence-based cessation method. Strength of urges to smoke was positively associated with such use. Combined behavioural-pharmacological therapy was used by 4.0%. Electronic cigarettes were used most frequently (21.5%). ConclusionsQuit attempt prevalence among smoking COPD patients in Germany pulmonary primary care is high, but only a small proportion of them support their attempt with treatments as recommended in clinical guidelines.

ObjectivesWe aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the validated German version of the Motivation To Stop Scale (MTSS) are associated with sociodemographics, nicotine dependence, past quit attempts, and use of e-cigarettes and tobacco product alternatives.MethodsWe used data from the German Study on Tobacco Use: an ongoing repeated cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We analysed data from 18 969 adult current smokers with multivariable ordinal regression and described MTSS scores between 2016 and 2021 (scores 1–7=lowest to highest level of motivation).ResultsThe mean MTSS score was 2.04 (SD=1.37) and showed a slight downward trend over time. Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, no previous waterpipe use and current or past e-cigarette use were associated with higher MTSS scores. The largest effect estimates were observed for at least one quit attempt 0–6 months ago versus no attempt in the past year (OR=7.54; 95% CI 6.78 to 8.40), at least one quit attempt 7–12 months ago versus no attempt in the past year (OR=4.00; 95% CI 3.59 to 4.45) and for current versus never use of e-cigarettes (OR=1.71; 95% CI 1.48 to 1.99).ConclusionsRecent quit attempts and current use of e-cigarettes were associated with higher motivation to stop smoking in the German population. Actions to boost the general motivation to stop smoking are required.

BACKGROUND: Our primary aim was to assess—in the German population—the effectiveness of e-cigarettes (ECs; with or without nicotine), nicotine replacement therapy (NRT), and no use of evidence-based aids in smoking cessation. METHODS: Analysis of cross-sectional data from a representative survey of the population (age 14–96 years) conducted in 2016–2021. All current smokers and recent ex-smokers (< 12 months since quitting) who had made ≥ 1 attempt to quit in the past 12 months (n = 2740) were included. They were asked about use of cessation aids in their most recent quit attempt and their current smoking status. RESULTS: Two hundred thirty-nine respondents had used ECs, 168 NRT, and 2333 no aid. After adjustment for potential confounders, the odds of abstinence were 1.78 times higher for smokers who had used ECs in their quit attempt than in the group that had used no aids (95% confidence interval [1.09; 2.92]; p = 0.02) and 1.46 times higher than in the NRT group ([0.68; 3.13]; p = 0.34, Bayes factor = 1.26). Compared with the unaided group, the odds of abstinence were 2.34 times higher ([1.21; 4.53]; p = 0.01) in the subgroup using ECs with nicotine and 1.48 times higher ([0.68; 3.26]; p = 0.33) in the subgroup using ECs without nicotine. The unadjusted abstinence rates in people who had started their quit attempt > 6 months earlier were 15.6% [9.4; 23.8] in the ECs group and 13.8% [7.3; 22.9] in the NRT group. CONCLUSION: In Germany, use of ECs in an attempt to quit smoking is associated with a higher rate of abstinence than attempting to quit unaided.

This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice – ABC versus 5As – on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34–4.51). Recommendation/prescription rates of evidence-based treatments were low (, A brief, single training session is effective in changing GP behaviour for providing stop-smoking advice and evidence-based cessation treatment. Training according to the very brief ABC method may lead to higher rates of such GP-delivered advice. https://bit.ly/2TciPSO

Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14–99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality.

Introduction: This study aimed to estimate prevalence rates of mental health symptoms (anxiety, depression, and overall psychological distress) by tobacco smoking status, and associations between such symptoms and the level of dependence, motivation, and attempts to quit smoking in the German population. Methods: Cross-sectional analysis of data from six waves of a nationally representative household survey collected in 2018/19 (N = 11,937 respondents aged ≥18). Mental health symptoms were assessed with the Patient Health Questionnaire-4. Associations with smoking status, dependence, motivation to quit, and ≥1 past-year quit attempt (yes/no) were analysed with adjusted regression models among the total group, and among subgroups of current (n = 3,248) and past-year smokers (quit ≤12 months ago, n = 3,357). Results: Weighted prevalence rates of mental health symptoms among current, former, and never smokers were: 4.1%, 2.4%, 2.5% (anxiety), 5.4%, 4.7%, 4.0% (depression), and 3.1%, 2.5%, 2.4% (psychological distress). Current versus never smokers were more likely to report symptoms of anxiety and depression. Smokers with higher versus lower levels of dependence were more likely to report higher levels of all three mental health symptoms. Higher versus lower levels of overall psychological distress were associated with a higher motivation to quit smoking and, among past-year smokers, with higher odds of reporting a past-year quit attempt. Conclusions: We found various relevant associations between mental health symptoms and smoking behaviour. Healthcare professionals need to be informed about these associations and trained to effectively support this vulnerable group in translating their motivation into abstinence.

Considering the growing popularity and rapid evolution of e-cigarettes, we examined e-cigarette use and tobacco smoking trends, and e-cigarette consumption patterns (i.e., device type, nicotine level) among adolescents and young adults in Germany.Data from 26 waves of the German Study on Tobacco Use (DEBRA), a repeated cross-sectional nationwide household survey, were used to explore trends in the prevalence of ever e-cigarette use and tobacco smoking in a sample of adolescents (aged 14-17 years, N = 1,396) and young adults (aged 18-24 years, N = 4,685) between June/July 2016 and Aug/Sept 2020. Among current e-cigarette users (N = 208), consumption patterns were examined. Associations with e-cigarette use were analysed using multivariable regression.Adolescent e-cigarette use increased from 9.2% in 2016 to 16.5% in 2017, decreased in 2018 to 8.3% and then gradually increased to 13.4% by 2020. Adolescent tobacco smoking followed a similar trend. Young adult e-cigarette use rates remained relatively stable at 19.1% on average, while tobacco smoking slowly declined (2016: 44.7%, 2020: 38.5%). More than half of current e-cigarette users used refillable-style e-cigarettes (59.4% adolescents; 68.4% young adults) and also smoked tobacco (62.5% adolescents; 79.4% young adults). About 41.6% of adolescents and 56.0% of young adults vaped with nicotine. Among young adults, men (OR = 1.5; 95%CI: 1.3-1.8) and former (OR = 9.6; 95%CI: 1.1-13.1) and current (OR = 10.7; 95%CI: 8.7-13.2) tobacco smokers were more likely to have vaped.E-cigarette use continues to rise in German adolescents and young adults requiring targeted health interventions and campaigns aimed at preventing and/or reducing use in this population.

We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients – independently of the receipt of GP advice – recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients’ loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs’ advice into patients’ behaviour change., GP-delivered brief stop-smoking advice increases smoking patients’ quit attempts and abstinence rates. 3.5 h GP training in providing such advice according to the ABC versus 5As method increases advice rates. https://bit.ly/2SM3on4

IntroductionMost cigarettes are smoked with filters made of synthetic plastic, which are not fully biodegradable. Littering used cigarette filters (butts) represents a substantial environmental hazard. It is unclear if people, in particular smokers, know that filters consist of synthetic plastic.MethodsWe used data collected in August/September 2019 from a representative household survey of the German population aged 14 years and over (wave 20 of the German Study on Tobacco Use; DEBRA). Respondents were asked: ‘The majority of smokers use cigarettes with a filter. What do you think these filters are composed of? (1) Mainly of natural material; (2) Mainly of synthetic material; (3) I don’t know what cigarette filters are composed of.’ Response option 2 indicated correct knowledge.ResultsA total of 2066 people were interviewed, including 625 current smokers. The weighted response rate to option 2 (‘mainly of synthetic material’) was 34.8% (95%CI 32.7 to 36.9) in the total sample and 42.7% (95%CI=38.7 to 46.8) in the subgroup of current smokers. In the latter subgroup, smokers with low compared with those with high educational level were less likely to know that filters are mainly composed of synthetic material (OR=0.62, 95%CI=0.39 to 0.99).ConclusionsThe majority of smokers in Germany does not know that cigarette filters are mainly composed of synthetic material. Our findings suggest a need for promoting awareness as well as knowledge of environmental health hazards of cigarette filters to the general population, and specifically to current smokers.Trial registration numberDRKS00011322 and DRKS00017157.

Im deutschen Bundestag wird aktuell uber ein umfassendes Tabakwerbeverbot diskutiert und daruber, ob dieses Verbot alternative Nikotinabgabesysteme (ANDS) wie E‑Zigaretten und Tabakerhitzer einschliesen sollte. Es ware wichtig zu wissen, welches Ergebnis sich die Allgemeinbevolkerung und speziell Nutzer/innen von Tabak/ANDS wunschen. Erhebung der Akzeptanz fur ein vollstandiges Werbeverbot von ANDS in der Allgemeinbevolkerung Deutschlands, speziell unter Tabak- und ANDS-Konsument/innen. Die Studie „Deutsche Befragung zum Rauchverhalten“ (DEBRA) ist eine fortlaufende, reprasentative Haushaltsbefragung von Personen ab 14 Jahren. Daten der Welle Juni/Juli 2019 (n = 2019) wurden analysiert. Teilnehmende wurden zu ihrem Tabak- und ANDS-Konsum, Soziodemografie sowie zu ihrer Zustimmung zu einem ANDS-Werbeverbot befragt. Berichtet werden Pravalenzen und Zusammenhange (Odds Ratio, OR) zwischen Zustimmung und Soziodemografie bzw. Tabak‑/ANDS-Konsum. Insgesamt 57,0 % (95 %-Konfidenzintervall (95 %-KI) = 54,7–59,1 %) der Bevolkerung befurworten ein ANDS-Werbeverbot; 11,1 % (95 %-KI = 9,8–12,6 %) lehnen es ab. Unter aktuellen Tabakraucher/innen betragt die Zustimmung 46,0 % (95 %-KI = 42,2–49,9 %), unter Jemalsnutzer/innen von ANDS 42,7 % (95 %-KI = 35,9–49,6 %). Die hochste Zustimmung besteht unter Ex-Raucher/innen (64,8 %, 95 %-KI = 58,9–70,3 %). Die Zustimmung unter Nie- und Ex-Raucher/innen ist hoher als unter aktuellen Raucher/innen (adjustiertes OR 2,06, 95 %-KI = 1,64–2,59 bzw. OR 1,65, 95 %-KI = 1,23–2,21). Die Mehrheit der Bevolkerung unterstutzt ein Werbeverbot fur ANDS. Auch Konsument/innen von Tabak und ANDS sprechen sich eher dafur als dagegen aus. Einer Aufnahme von E‑Zigaretten und Tabakerhitzer in die vom Bundestag geplante Erweiterung des Tabakwerbeverbots steht also kaum Widerstand in der Bevolkerung gegenuber.

Zusammenfassung. Zielsetzung: Klinische Leitlinien empfehlen ärztliche Kurzberatung zur Tabakentwöhnung routinemäßig anzubieten. Repräsentative Daten zur Umsetzung in Deutschland und zu Assoziationen mit Soziodemographie und Rauchverhalten von Raucher/innen sollen erhoben werden. Methoden: Die Deutsche Befragung zum Rauchverhalten (DEBRA) erhebt zweimonatlich Daten in repräsentativen Bevölkerungsstichproben (je ~2.000 Personen, ≥14 Jahre) zu Tabak- und E-Zigarettenkonsum. In den ersten fünf Wellen seit Juni 2016 (10.225 Befragte) wurden Raucher/innen zu dem Erhalt von Rauchstoppberatung während des letzten Besuchs bei einer Hausärztin/einem Hausarzt (A) oder einer Ärztin/einem Arzt anderer Fachrichtung (B) befragt. Assoziationen mit Soziodemographie und Rauchverhalten wurden analysiert. Ergebnisse: Nach eigener Aussage von 2.910 Raucher/innen, hatten 72,8 % (95 %KI=71–74 %) eine Ärztin/einen Arzt des Fachgebiets A und/oder B konsultiert. Davon hatten 80,7 % (95 %KI=79–82 %) keine Rauchstoppempfehlung erhalten. 3,6 % (95 %KI=3–5 %) hatten ein evidenzbasiertes Therapieangebot bekommen. Starker Zigarettenkonsum und steigendes Alter waren mit dem Erhalt der Kurzberatung assoziiert (P

BACKGROUND: During cardiosurgical procedures that use extracorporeal circulation (ECC), a variety of neurological complications can occur, and postoperative cognitive deficits remain an unsolved problem. Among the sources of these complications are intraoperatively detectable cerebral microemboli, which mainly consist of air. This study’s purpose was to assess neuroprotective effects of reducing these gaseous microemboli using a dynamic bubble trap (DBT) in patients undergoing pulmonary endarterectomy (PEA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Patients undergoing PEA were randomly assigned to receive either a DBT (n=47) or no additional device (controls, n=46) during ECC. Neuropsychological testing was performed before and 3 months after PEA. The primary endpoint was cognitive improvement in the DBT group (n=29) compared with the control group (n=42). As secondary endpoint, ischemic brain micro-lesions were analyzed on postoperative days 6 through 10 using diffusion-weighted magnetic resonance imaging (MRI). RESULTS: Analysis of interaction effects revealed improved performance in visual long-term memory (P=0.008, η(2)=0.099), verbal long-term memory (P=0.030, η(2)=0.067), verbal short-term memory (P=0.014, η(2)=0.083), and attention and processing speed (P=0.043, η(2)=0.056) from pre- to post-testing in the DBT group compared to control group. In MRI, postoperative ischemic micro-lesions could only be detected in one patient; another patient suffered a severe bihemispheric embolic stroke. CONCLUSIONS: DBT positively influences memory function after PEA. This effect is most likely caused by the reduction of gaseous microemboli. TRIAL REGISTRATION: This study is registered in the German Clinical Trials Register, ID: DRKS00021499.

Background Broad nationwide restrictions of social life and contacts were implemented in Germany on March 22nd, 2020, to reduce the spread of the severe acute respiratory syndrome coronavirus type 2 (SARS‑CoV‑2). It is unclear how these restrictions affected peoples’ health behaviour. Objective To: i) examine changes in self-reported health behaviour of the German population regarding tobacco smoking, alcohol consumption, and physical activity during the restrictions compared with the time prior to these restrictions; ii) explore associations between potential changes and socioeconomic and sociodemographic characteristics. Methods We used data from two waves (June-August 2020) of the German Study on Tobacco Use (DEBRA): a cross-sectional, representative, face-to‐face household survey in people aged ≥ 14 years (N = 4078). Associations between socioeconomic and sociodemographic characteristics and changes in each health behaviour were analysed using multinomial logistic regression analyses (categories of the dependent variable: increase, no change, decrease). Results People reported changes in their health behaviour: smoking increase = 24.0% (95% confidence interval (CI) = 21.5–26.7), decrease = 12.2% (95%CI = 10.4–14.4); alcohol consumption increase = 12.9% (95%CI = 11.7–14.1), decrease = 19.9% (95%CI = 18.4–21.3); physical activity increase = 18.5% (95%CI = 17.3–19.7); decrease = 29.4% (95%CI = 28.0–31.0). People with a lower level of education and younger age were more likely to report a harmful change in health behaviour. Conclusion The majority of people in Germany did not change their health behaviour during the 2020 corona restrictions. Among those who changed, relatively more increased their smoking and decreased their alcohol consumption and physical activity. Public health interventions in this context should particularly target people with lower socioeconomic status and younger age e.g., by offering more online courses.

We developed a 3.5-h-training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice. In this follow-up analysis we examined the effect of ABC and 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12, and 26 following GP consultation.Follow-up data were collected by questionnaires delivered to 1,937 smoking patients recruited before or after the training in which 69 GPs participated. At week 26, ∼70% of the patients were lost to follow-up. All 1,937 smoking patients were included in an intention-to-treat analysis. Multiple imputation was used to impute missing outcome data of each follow-up and few missing data of potential confounders.While the receipt of brief GP advice compared to no advice was associated with a two-fold increase in patients’ attempts to quit at each follow-up and abstinence at week 26, quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group.We previously reported that our training increases patient-reported rates of GP-delivered stop-smoking advice. The present follow-up analysis did not show that patients more often attempted or achieved to quit when they received advice from a trained vs. untrained GP. Future training studies should take contextual factors into account – such as access to free evidence-based cessation treatment – which might hamper the transfer of GPs’ effective advice into patients’ behaviour change.TRIAL REGISTRATIONGerman Clinical Trials Register, prior to the first patient in (DRKS00012786, www.drks.de/drks_web/setLocale_EN.do).

OBJECTIVETo assess the effectiveness of a 3.5h-training for general practitioners (GPs) in two different methods (ABC, 5As) of giving brief stop-smoking advice during routine consultations.DESIGNPragmatic two-arm cluster randomised controlled trial with pre-post-design for the primary outcome and cluster randomisation for secondary outcomes.SETTINGGeneral practices, North Rhine-Westphalia (German federal state), recruited 2017-2019.PARTICIPANTSPractices were randomised (1:1) to an ABC or 5As training. Tobacco smoking, adult patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training were eligible to participate. Ineligible were: non-smokers, patients who did not meet the GP in person, or could not provide informed consent.INTERVENTIONSTwo different standardised 3.5h-trainings (ABC or 5As) for GPs in delivering brief stop-smoking advice were carried out per study cycle (six cycles in total). Trainings were moderated by a senior researcher and an experienced GP, and included role-plays with professional actors.MAIN OUTCOME MEASURESPrimary outcome: patient-reported rates of GP-delivered stop-smoking advice prior and following the training, irrespective of the training method. Secondary outcomes: patient-reported receipt of recommendation/prescription of evidence-based smoking cessation treatment: including behavioural support, any pharmacotherapy (nicotine replacement therapy (NRT), varenicline, or bupropion), or a combination therapy; and the effectiveness of ABC versus 5As regarding all outcomes.RANDOMISATION AND MASKINGComputer-generated block randomisation or, if not feasible, randomisation based on the GPs’ temporal availability at training dates. GPs were not fully blinded. Patients were blinded to the nature of the study until data collection ended.RESULTS52 GP practices (27 ABC, 25 5As) with 69 GPs were included. Of 5,406 patients who provided informed consent, 1,937 (35.9%) were current smokers, of whom 1,039 were interviewed prior to and 898 following the training. GP-delivered stop-smoking advice increased from 13.1% (n=136/1,039) to 33.1% (n=297/898) following the training (adjusted odds ratio (aOR)=3.25, 95%CI=2.34 to 4.51). Recommendation/prescription rates of treatment were low (CONCLUSIONSIn GPs in Germany, a single session of training in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered stop-smoking advice during routine consultations. Approaches to further increase the delivery of such advice, and upscaling implementation strategies for the training in general practice, should be evaluated.TRIAL REGISTRATIONGerman Clinical Trials Register: DRKS00012786.WHAT IS ALREADY KNOWN ON THIS TOPICThe implementation of clinical guideline recommendations stating that general practitioners (GPs) should routinely deliver brief stop-smoking advice and offer evidence-based smoking cessation treatment is low in Germany, a country with a smoking prevalence of ∼28%.A strategy is needed to overcome barriers (e.g., lack in knowledge and skills) preventing GPs from routinely delivering stop-smoking advice. No experimental study has evaluated such a strategy in German general practice so far.Two different methods of delivering such advice are recommended in the national guidelines – ABC and 5As – but it is unclear which method can be more effectively implemented by trained GPs.WHAT THIS STUDY ADDSThis cluster randomised controlled trial evaluated the effectiveness of a 3.5h-training for GPs in delivering brief stop-smoking advice and compared two different methods (ABC vs. 5As) regarding the rates of delivery of such advice and recommendations of evidence-based cessation treatment in 1,937 smoking patients from 52 GP practices in Germany.The training, irrespective of the method, was associated with a three-fold increase in rates of advice giving and a seven-fold increase in the offer of support.The data indicate that training according to ABC may be more effective than 5As in increasing the rates of GP-delivered stop-smoking advice.

Introduction Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success. Methods We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) – a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders. Results Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77–0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73–0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08–1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success. Conclusions In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.

Background: In Germany, cannabis is the most widely used illicit drug, and inhalation together with tobacco is most popular. However, it has been described that electronic cigarettes (ECs) are bein...

BACKGROUND: Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a representative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS: Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (

Highlights • Prevalence of hazardous drinking was 19.4% among adults in Germany between 2018 and 2019. • Heavier levels of alcohol consumption were associated with being younger and male. • Heavier levels of alcohol consumption were associated with having anxiety. • Lower levels of alcohol consumption were associated with depression. • Certain groups may benefit from targeted alcohol reduction policies and support., Background To assess the prevalence of ever-drinking and hazardous drinking among adults in Germany, and investigate the factors associated with level of alcohol consumption. Methods Cross-sectional population survey of a representative sample of 11,331 adults in Germany (2018 to 2019). The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to define ever-drinking (AUDIT-C>=1), hazardous drinking (AUDIT-C>=5) and an overall AUDIT-C (alcohol consumption) score (from 0 to 12). Regression models were used to examine sociodemographic and health-related characteristics associated with AUDIT-C score. Results The prevalence of ever-drinking and hazardous drinking was 84.7% (95% CI = 84.1–85.4) and 19.4% (95% CI = 18.6–20.1), respectively. The mean AUDIT-C score was 2.8 (SD = 2.16). AUDIT-C scores were independently positively associated with having medium (Badj = 0.12, 95% CI = 0.02–0.21) and high (Badj = 0.11, 95% CI = 0.01–0.21) educational qualifications (compared with low), monthly income (Badj = 0.31 per €1,000, 95% CI = 0.26–0.36), being a current smoker (Badj = 0.94, 95% CI = 0.86–1.02), anxiety (Badj = 0.26, 95% CI = 0.02–0.50), and living in North East (Badj = 0.43, 95% CI = 0.29–0.58), North West (Badj = 0.47, 95% CI = 0.39–0.55) and South East (Badj = 0.79, 95% CI = 0.64–0.93) Germany (compared with South West), and negatively associated with age (Badj = -0.17, 95% CI = -0.21- −0.13), being female (Badj = -1.21, 95% CI = -1.28- −1.14) and depression (Badj = -0.22, 95% CI = -0.43- −0.02). Conclusion In a large, representative sample of adults in Germany, the majority were ever-drinkers and one fifth were hazardous drinkers. Higher alcohol consumption scores were associated with being younger, male, current smoker, of high socioeconomic position, anxiety, and not living in South West Germany, and lower scores were associated with depression. These groups may benefit from targeted alcohol reduction policies and support.

E-Zigaretten und Tabakerhitzer sind neue Produkte, die alternativ oder komplementar zum herkommlichen Tabakrauchen verwendet werden. Aktuelle Daten der Deutschen Befragung zum Rauchverhalten (DEBRA-Studie) zur Nutzung von E‑Zigaretten und Tabakerhitzern sollen in Abhangigkeit von Tabakrauchstatus und soziookonomischen Merkmalen ausgewertet werden. Grunde fur die E‑Zigarettennutzung und die Risikoeinschatzung von Tabakerhitzern sollen dargestellt werden. DEBRA ist eine fortlaufende, reprasentative, personlich-mundliche Haushaltsbefragung von Personen uber 14 Jahren. In der vorliegenden Arbeit wurden Daten der ersten neun Befragungswellen analysiert (Juni/Juli 2016 bis Oktober/November 2017; n = 18.415). Im Beobachtungszeitraum konsumierten 1,9 % (95 %-Konfidenzintervall (KI) = 1,7–2,2 %) der Bevolkerung E‑Zigaretten (2,8 % der 14- bis 17-Jahrigen). 74,5 % (95 %-KI = 69,4–79,2 %) der aktuellen E‑Zigarettennutzer rauchten gleichzeitig Tabak. Drei Viertel der Jugendlichen nutzten E‑Zigaretten uberwiegend „aus Spas“, Erwachsene eher aus Grunden, die mit dem Tabakrauchen zusammenhangen (u. a. weniger schadlich, Rauchstoppmethode). 0,3 % (95 %-KI = 0,09–0,64 %) der aktuellen Tabakraucher und neuen Ex-Tabakraucher (

The German federal parliament is discussing the implementation of a comprehensive tobacco advertising ban and whether that ban should include alternative nicotine delivery systems (ANDSs), such as e‑cigarettes and tobacco heaters. It would be important to know which outcome the general population, and in particular the users of tobacco/ANDSs, would prefer.Assessing public support for a comprehensive advertising ban on ANDSs in the German population, and particularly in tobacco and ANDSs users.The German Study on Tobacco Use ("Deutsche Befragung zum Rauchverhalten", DEBRA) is an ongoing, representative household survey of persons aged 14 years and older. Data from the June/July 2019 survey wave (n = 2019) were analysed. Participants were interviewed regarding their tobacco smoking status and ANDS use, sociodemographic factors, and their support of an advertising ban on ANDSs. Prevalence rates and associations (odds ratio, OR) between support and sociodemographic factors or use of tobacco/ANDSs are reported.Of the population, 57.0% (95% confidence interval (95%CI) = 54.7-59.1%) support a ban on ANDS advertising; 11.1% (95%CI = 9.8-12.6%) reject it. There is support for the ban from 46.0% (95%CI = 42.2-49.9%) of current tobacco smokers and 42.7% (95%CI = 35.9-49.6%) of ANDS users. Ex-smokers show the highest rates of support (64.8%, 95%CI = 58.9-70.3%). Acceptance among never- and ex-smokers is higher than among current smokers (adjusted OR 2.06, 95%CI = 1.64-2.59 and OR 1.65, 95%CI = 1.23-2.21).The majority of the German population supports a comprehensive advertising ban on ANDSs. Tobacco smokers and ANDS users are also more in favour of than against such a ban. Thus, only little resistance will be expected within the population if a comprehensive tobacco advertising ban, as currently discussed in parliament, includes e‑cigarettes and heated tobacco products.

Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in. Open-Access-Publikationsfonds 2019

Great advances have been made in our understanding of Takotsubo syndrome in the past decade, but the aetiology of the condition remains incompletely understood. The most established theory, that catecholamine-mediated myocardial stunning is provoked by emotional or physiological stress, is supported by the presence of supraphysiological levels of plasma catecholamines in patients with Takotsubo syndrome. For this reason, the hyperexcitability of the autonomic nervous system under conditions of physical and emotional stress is often assessed in these patients. Observational studies have indicated that a predisposing influence of chronic or traumatic stress, anxiodepressive disorders, and maladaptive personality traits are linked to the pathogenesis of Takotsubo syndrome. Chronic stress can influence autonomic function through dysregulation of the hypothalamic-pituitary-adrenal axis and contribute to the development of cardiovascular disorders. In this Perspectives article, we discuss the current knowledge of the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.

BACKGROUND: Waterpipes (WP) have a long tradition in certain regions of the world, and their use has been increasing worldwide. Current data on the use of WP in different subgroups of the German population are missing.; OBJECTIVE: To estimate the current prevalence of WP use and associated socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour in the German population aged ≥14years; to describe the frequency of use and starting age in current WP users.; METHODS: We analysed data from waves 13-18 (June/July 2018-April/May 2019; N=12,220) of the German Study on Tobacco Use (DEBRA) - a representative, computer-assisted national household survey. Associations of socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour were assessed with multivariable logistic regression models.; RESULTS: A total of 1.8% (n=217) (95% confidence interval (CI)=1.5%-2.0%) of the population were current WP users, 13% (n=1618) (95% CI=12.3%-13.5%) were ever users. Adjusted multivariable logistic models showed that people with migration background, male sex, younger age, and those who were smokers or used e-cigarettes, were more likely to use a WP. Among current WP users, 15.2% (n=33) (95% CI=10.7%-20.7%) had started to use WP at the age of 26 or older, and 23.0% (n=50) (95%CI=17.6%-29.2%) had used WP at least once a week or almost daily in the last month.; CONCLUSIONS: In Germany, the use of WP is popular and most strongly associated with migration background and use of tobacco and e-cigarettes. These aspects should be considered when designing future target group-specific prevention strategies. Copyright © 2020 Elsevier Ltd. All rights reserved.

Electronic cigarettes (ECs) and heat-not-burn (HNB) devices are relatively new products that are increasingly used alternatively or complementary to ordinary tobacco products.To analyse current data from the German Study on Tobacco Use (DEBRA) regarding the prevalence of EC and HNB device use and associated socioeconomic factors and smoking behaviour; compare reasons for EC use between adolescents and adults; describe the self-perceived risk of HNB devices.DEBRA is an ongoing, representative, face-to-face household survey of the population aged 14 years and older. We analysed data from the first nine waves (June/July 2016 to October/November 2017; n = 18,415) for the current study.During the observation period, 1.9% (95% confidence interval (CI) = 1.7-2.2%) of the German population used ECs (2.8% of the 14- to17-year-olds) and 74.5% (95% CI = 69.4-79.2%) of current EC users also smoked tobacco ("dual use"). Three-quarters of adolescents used ECs mainly "for fun", whereas reasons for use among adults related more to smoking tobacco (e. g., less harmful, to quit smoking). Among current smokers and recent ex-smokers (12 months smoke-free), 0.3% (95% CI = 0.09-0.64%) currently used HNB devices, and 6.0% (95% CI = 5.0-7.2%) had ever used them. Consumption of HNB products increased with increasing education and income. The majority perceived HNB products as somewhat (41.0%, n = 25) or much (14.8%, n = 9) less harmful, and 37.7% (n = 23) as equally harmful compared with tobacco cigarettes.In Germany, ECs are mainly consumed as "dual use" together with tobacco. Consumption of HNB products currently occurs at a very low rate and is relatively more common among smokers with higher education and income. It remains important to monitor the use of new electronic inhalation products in the total population and in relevant subgroups.

Situation-specific theories provide nurses with a vehicle to interpret situations, guide their decisions or make assumptions about factors influencing a health problem. In this article, we used meta-synthesis techniques to integrate statements of findings pertaining to barriers and facilitators to heart failure self-care that were derived previously through meta-summary techniques leading to a new situation-specific theory. According to our proposed theory, self-care behavior is the result of a patient’s naturalistic decision-making process. This process is influenced by two key concepts: “self-efficacy” and the “patient’s disease concept of heart failure.” Numerous facilitative and inhibitive factors have been identified influencing these two key concepts as well as the decision-making process, thereby either enabling or hampering the execution of effective heart failure self-care. Further research is needed to validate the model through empirical testing. Once fully matured, the model may be useful in developing behavioral interventions aiming at enhancing adherence to self-care recommendations.

Background Current data on tobacco use are a necessary prerequisite for the study of the implementation of tobacco control measures in the general population. The German Study on Tobacco Use (Deutsche Befragung zum Rauchverhalten, DEBRA) provides previously lacking data on key indicators of smoking behavior and on the consumption of new products such as e-cigarettes. The continual acquisition and accumulation of data permits the analysis of trends and precise statistical evaluation. Methods Data were obtained by repeated face-to-face interviews, at 2-month intervals, of representative samples of approximately 2000 persons across Germany aged 14 years and above. For this article, data from 12 273 persons that were acquired in 6 waves of the survey (June/July 2016 to April/May 2017) were aggregated and weighted. Results The one-year prevalence of current tobacco consumption was 28.3% (95% confidence interval: [27.5; 29.1]) in the overall survey population and 11.9% [8.9; 14.9] among persons under age 18. Higher tobacco consumption was correlated with lower educational attainment and lower income. 28.1% of the smokers had tried to quit smoking in the past year; the most commonly used method of quitting was e-cigarettes (9.1%). Brief physician advice or pharmacotherapy for smoking cessation were tried by 6.1% and 7.0%, respectively. 1.9% of the overall survey population but only 0.3% of persons who had never smoked were current consumers of e-cigarettes. Conclusion Tobacco consumption is very high in Germany compared to other countries in Western and Northern Europe, and its distribution across the population is markedly uneven, with a heavy influence of socioeconomic status.

ObjectiveThe aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany.DesignCross-sectional household survey.SettingData were drawn from the German population and collected through computer-assisted, face-to-face interviews.ParticipantsRepresentative random sample of 2087 people (>14 years) from the German population.Outcome measuresPublic acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed.ResultsSupport for all policies was high (50%–68%), even among smokers (48%–66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues.ConclusionsThe majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance.Trial registration numberDRKS00011322.

Postoperative cognitive decline (POCD) is a frequent complication after cardiac surgeries. It remains unclear how relevant this decline in psychometric results is for daily life. The aim of the study was to assess cognitive failures, as seen by patients and close relatives, on a quantitative level.In addition to an extensive neuropsychological test battery, we interviewed 82 patients with a modified version of the self-assessment cognitive failure questionnaire (s-CFQ) and 62 close relatives (mostly spouses) with the CFQ-for-others version (f-CFQ) before and 3 months after aortic valve replacement. The questionnaires evaluate the frequency of failures in daily living related to memory, attention, action and perception.POCD occurred in all tests that had been applied to assess declarative memory functions; the mean performance dropped from baseline in these tests (P-values ranging from 0.033 and0.001). The s-CFQ did not differ between baseline and postoperative assessment [baseline: mean 37.60, standard deviation (SD) 14.38; post: mean 36.22, SD 12.29] (t(0.05, 76) = 1.17; P = 0.246). However, the assessment by others was worse in the f-CFQ after surgery (baseline: mean 8.02, SD 4.51; post: mean 9.58, SD 6.11) (t(0.05, 61) = 2.61; P = 0.012). All changes were observed in questions related to memory and attention failures only. Higher (worse) rates in f-CFQ change scores correlated with neuropsychological change scores, namely in pictorial memory (mistakes) (r = 0.35; P = 0.003) and word fluency (correct answers) (r = -0.29; P = 0.014). Additionally, those patients with worse f-CFQ change scores (1 SD) from baseline had clearly worse outcomes in word fluency (t(0.05, 60) = 2.53; P = 0.007) and non-verbal learning (t(0.05, 60) = 2.66; P = 0.005). The effects remained significant when controlled for depression/anxiety scores.The result demonstrates that cognitive side-effects could have a perceivable impact on daily living functions. However, slight deficits are more realized by others than by the patients themselves. Correlations between ratings by others and psychometric cognitive measures indicate that assessment by others is more reliable than self-assessment.

Over 100,000 heart surgeries are performed in Germany annually. Although severe neurological complications like ischaemic strokes have meanwhile become rare occurrences, subtle neuropsychological changes are still frequently recognized after major heart surgeries. The hitherto unsolved problem of postoperative cognitive decline (POCD) is portrayed in this article. Multifactorial aetiologies including microembolism and preoperative risk factors are supposed to play a significant role in POCD. A variety of neuroprotective strategies such as intraoperative microemboli filtration have been suggested to minimize cerebral risks. The utility of neuroprotective methods has recently been verified in randomized studies.

Objectives Postoperative cognitive decline (POCD) has a perceivable influence on daily living and is noticed more often by close relatives than by patients themselves 3 months after aortic valve replacement. This study aimed to elucidate the longitudinal course of the subjective awareness of POCD. Design Follow-up of a prospective observational study. Setting A single cardiothoracic center in Germany. Participants The study included 108 patients scheduled for elective aortic valve replacement surgery and 85 close relatives of the patients. Interventions In addition to conducting a neuropsychologic examination, the authors previously interviewed 82 patients with a Cognitive Failure Questionnaire for self-assessment (s-CFQ), and 62 relatives with the Cognitive Failure Questionnaire for others (f-CFQ) before and 3 months after surgery. Up until 12 months after surgery, the authors continuously interviewed additional patients (baseline and 3 months after surgery), thereby enlarging the original sample, and included the entire group (108 patients, 85 relatives) for the 12-month follow-up. Results The analysis showed that relatives (p = 0.026) and patients experienced patients’ cognitive decline 3 months after surgery (p = 0.009). All changes still were observed in questions related to memory and attention. After 1 year, the s-CFQ no longer differed between baseline and postoperative assessment. Mean scores in the f-CFQ still were above baseline, barely missing statistical significance (p = 0.051). In patients with “change to worse” in the f-CFQ at 1-year follow-up, declining cognitive results in nonverbal learning (p = 0.021) could be observed 3 months postoperatively. Only a decrease in 3-month f-CFQ correlated with a decline in specific neuropsychologic tests 3 months after surgery. Conclusions Contrary to the authors’ previous results, the impact of POCD on daily living functions also was recognized by the patients themselves. The long-term influence and the associations between subjective deficits and psychometric cognitive measures seemed to be assessed more reliably by close relatives.