Vision and hearing problems and psychosocial outcomes: longitudinal evidence from the German Ageing Survey

PURPOSE

To examine whether changes in vision and hearing problems are associated with changes in psychosocial outcomes (in terms of depressive symptoms, loneliness, and perceived social isolation).

METHODS

We used longitudinal data from the nationally representative German Ageing Survey, which covers individuals aged 43 years and over (wave 6 and wave 7, with 7108 observations and mean age of 67.5 years, SD 10.2 years). The 6-item De Jong Gierveld tool was used to quantify loneliness, the Bude and Lantermann tool was used to quantify perceived social isolation, and the Center for Epidemiologic Studies Depression Scale (15-item version) was used to quantify depressive symptoms. Self-rated problems reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used to quantify vision problems. In addition, self-rated hearing problems on the telephone and self-rated hearing problems in groups of more than four people were used to quantify hearing problems.

RESULTS

Adjusting for various confounders, longitudinal regressions showed that the onset of major vision problems referring to difficulties recognizing people one knows on the street was associated with increases in loneliness (β = 0.17, p < .01) and depressive symptoms (β = 1.90, p < 0.05). Moreover, the onset of some vision problems referring to difficulties reading the newspaper was associated with increases in perceived social isolation (β = 0.06, p < 0.01). Additionally, the onset of some hearing problems in groups of more than four people was associated with increases in depressive symptoms (β = 0.43, p < 0.05).

CONCLUSION

Our longitudinal study showed that vision and hearing problems can contribute differently to psychosocial factors. Delaying sensory impairment may result in favorable psychosocial factors in later life.

Prevalence and determinants of loneliness among the oldest old living in institutionalized settings : Study findings from a representative survey

BACKGROUND

There is very limited knowledge regarding the prevalence and determinants of loneliness in oldest old residents of nursing or old age homes.

OBJECTIVE

To examine the prevalence and determinants of loneliness among the oldest old living in institutionalized settings in Germany.

MATERIAL AND METHODS

Data were taken from the representative survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+) including individuals ≥ 80 years living in North Rhine-Westphalia. The study focused on individuals living in institutionalized settings. Sociodemographic, lifestyle-related, and health-related determinants were included in multiple linear regression models.

RESULTS

Approximately 56.6% of the individuals were not lonely, 25.7% and 17.8% of the individuals were moderately and severely lonely, respectively. Regression analyses showed that higher loneliness was associated with being married (β = 0.48, p < 0.05), high education (compared to low education, β = 0.46, p < 0.05), having a small social network size (β = -0.02, p < 0.05), having poor self-rated health (β = -0.25, p < 0.05), and more depressive symptoms (β = 0.25, p < 0.001).

CONCLUSION

A significant proportion of the institutionalized oldest old individuals reported moderate or severe loneliness, which underpins the relevance of this topic. Understanding the determinants of loneliness may help to address institutionalized adults aged 80 years and over at risk of loneliness.

Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations

BACKGROUND

Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists.

METHODS

We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist.

RESULTS

We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons.

CONCLUSIONS

High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia"

OBJECTIVES

There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany.

METHODS/DESIGN

Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted.

RESULTS

Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes.

CONCLUSIONS

This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

Fear of war in Germany: An observational study

Background

Given the very limited knowledge, the purpose of this study was to identify the current prevalence and correlates of fear of conventional and of nuclear war in the general adult population (Germany).

Methods

Data were taken from a representative survey (n = 3091 participants; mid-March 2022). Established items were used to quantify fear of conventional war and fear of nuclear war. Linear regressions were used to examine the correlates of fear of conventional war and fear of nuclear war, adjusting for several covariates.

Results

While 5.3 % of the respondents were not at all worried about a conventional war, 44.2 % of the respondents reported some fear and 50.5 % of the respondents reported severe fear of a conventional war. Similarly, 7.7 % of the respondents were not at all worried about a nuclear war, whereas 45.7 % of the respondents reported some fear and 46.6 % of the respondents reported severe fear of a nuclear war. The prevalence rates mainly slightly differed between sociodemographic groups (with the exception of gender and having children) and were thus consistently high. Regressions showed that both higher fear of a conventional war and higher fear of a nuclear war were associated with being female, having children in own household, being married and living together with spouse, having at least one chronic illness and poor self-rated health.

Conclusion

Our study showed high prevalence rates for fear of war (both, conventional war and nuclear war). Knowledge about the correlates may assist in tackling individuals at risk for severe fear. Against the background of the current events in Eastern Europe, future research in this area is urgently required.

Neighbourhood cohesion, loneliness and perceived social isolation prior and during the COVID-19 pandemic. Longitudinal evidence from the German Ageing Survey

PURPOSE

To investigate the longitudinal association between neighbourhood cohesion and loneliness as well as perceived social isolation prior and during the COVID-19 pandemic (stratified by sex).

METHODS

Longitudinal data were taken from a nationally representative sample (German Ageing Survey) of inhabitants aged 40 years and over in Germany prior (wave 6: year 2017) and during the COVID-19 pandemic (wave 8: November 2020 until February 2021; n = 6688 observations, mean age was 67.4 years). The De Jong Gierveld tool was used to measure loneliness and the Bude and Lantermann tool was used to measure perceived social isolation. Neighbourhood cohesion was assessed based on different items.

RESULTS

FE regressions showed that decreases in closeness of contact with neighbours were associated with increases in loneliness and perceived social isolation levels among men, but not women. In contrast, decreases in different indicators of involvement in neighbourhood activities were associated with increases in loneliness and perceived social isolation levels among women, but not men.

CONCLUSION

Changes in neighbourhood factors are differently associated with loneliness and perceived social isolation among middle-aged and older women and men. Gender-specific efforts to avoid loneliness and social isolation are, therefore, needed.

Religious affiliation and oral health-related quality of life: a cross-sectional study based on a nationally representative survey in Germany

BACKGROUND

Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL.

METHODS

A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses.

RESULTS

Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (β = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (β = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (β = 1.89, p < 0.01).

CONCLUSION

Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL.

Parkinson's Disease and Subjective Prospects for the Future in Different Life Domains. Findings of a Nationally Representative Sample

Purpose

To analyze the link between Parkinson's disease and perceived prospects for the future.

Patients and Methods

Data were taken from the German Ageing Survey (year 2021; n=4296 individuals, thereof 33 individuals with Parkinson's disease) were used. This is a nationally representative sample of community-dwelling individuals ≥ 40 years in Germany. Perceived prospects for the future in different life domains (ie, living standard, health and general optimism) were used as outcomes. Physician-diagnosed Parkinson's disease served as key independent variable . It was adjusted for several covariates.

Results

Individuals with Parkinson's disease had a markedly worse (Cohen's d=0.65) general optimism compared to individuals without Parkinson's disease. After adjusting for various factors, these differences disappeared in multiple linear regressions (β=-0.04, p=0.72). Moreover, multiple ordered logistic regressions showed that individuals with Parkinson's disease had a worse future self-rated health (OR: 4.10, 95% CI: 1.99-8.47, p<0.001) compared to individuals without Parkinson's disease.

Conclusion

Our study first showed that general optimism may be lower among individuals with Parkinson's disease (bivariate analysis). However, this association disappeared when it was adjusted for health-related factors in regression analysis. In sum, our findings indicate that more general future-related factors did not significantly differ between individuals with and without Parkinson's disease. However, there were significant differences in future self-rated health.

[Reasons of Individuals 60 Years and Older in Germany for not Getting Vaccinated against Covid-19]

PURPOSE

To identify the reasons of individuals aged 60 years and older in Germany for not getting vaccinated against Covid-19.

METHODS

Data for this study were collected in July/August 2021 from "Kommunikation der Corona-Schutzimpfung in Deutschland" (CoSiD)", a representative survey of the general adult population in Germany. The focus was on individuals aged 60 years and older in our current study (n=1,281 individuals).

RESULTS

Approximately 92% of individuals 60 years and older were already vaccinated against Covid-19. Among the older unvaccinated, nearly 60% were opposed to vaccination. Major reasons among older (and also younger) unvaccinated persons for "rather not getting vaccinated"/"definitely not" wanting to be vaccinated against Covid-19 were: (1) too little research on the vaccines or too short a time of research (roughly half of the individuals) and (2 and 3) no confidence/general skepticism or because of side effects (in each case, just over a quarter of the group surveyed).

CONCLUSION

To increase the vaccination rate, these three arguments must be countered, for instance, during conversations in the context of medical care.

Utilization of internet for religious purposes and psychosocial outcomes during the COVID-19 pandemic

BACKGROUND

Prior to the COVID-19 pandemic, research findings pointed towards an alleviating effect of religion on depressive symptoms and loneliness. However, it is not clear whether such a relationship persisted when worships were mostly held as online events. Consequently, this study investigates the link between religion-related internet utilization, particularly for online worships, depressive symptoms, and loneliness during the lockdown period.

METHODS

Data were derived from a representative sample of German individuals aged 40 years and above, which was conducted in June and July 2020. Utilization of internet for religious purposes was treated as a dichotomous variable.

RESULTS

Regarding bivariate analysis, individuals that used the internet for religious purposes were significantly older, and more likely to be female or to live in an urban setting. Furthermore, they had significantly more severe depressive symptoms. According to multiple linear regression, internet usage for religious purposes was both associated with more depressive symptoms, R² = .30, F(11, 3367) = 113.01, ß = 0.39, p = .050, and higher loneliness levels, R² = .09, F(11, 3367) = 25.75, ß = 2.24, p = .025.

CONCLUSIONS

It seems possible that the alleviating effect of religion on depressive symptoms and loneliness did not hold during the COVID-19 pandemic, which may imply that online worships are not perfect replacements for traditional worships in terms of their social and health benefits.

Long-term care need, loneliness, and perceived social isolation during the COVID-19 pandemic: evidence from the German Ageing Survey

BACKGROUND

There is a complete lack of studies focusing on the association between care degree (reflecting the long-term care need) and loneliness or social isolation in Germany.

AIMS

To investigate the association between care degree and loneliness as well as perceived social isolation during the COVID-19 pandemic.

METHODS

We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. We used wave 8 of the German Ageing Survey (analytical sample: n = 4334 individuals, mean age was 68.9 years, SD: 10.2 years; range 46-100 years). To assess loneliness, the De Jong Gierveld instrument was used. To assess perceived social isolation, the Bude and Lantermann instrument was used. Moreover, the level of care was used as a key independent variable (absence of care degree (0); care degree 1-5).

RESULTS

After adjusting for various covariates, regressions showed that there were no significant differences between individuals without a care degree and individuals with a care degree of 1 or 2 in terms of loneliness and perceived social isolation. In contrast, individuals with a care degree of 3 or 4 had higher loneliness (β = 0.23, p = 0.034) and higher perceived social isolation scores (β = 0.38, p < 0.01) compared to individuals without a care degree.

DISCUSSION/CONCLUSIONS

Care degrees of 3 or 4 are associated with higher levels of both loneliness and perceived social isolation. Longitudinal studies are required to confirm this association.

Oral health, anxiety symptoms and depressive symptoms: findings from the survey of health, ageing and retirement in Europe

BACKGROUND

There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge.

METHODS

Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis.

RESULTS

Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (β = 0.11, P < 0.001) and higher depressive symptoms (β = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (β = 0.02, P < 0.001) and higher depressive symptoms (β = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (β = -0.35, P < 0.001) and lower depressive symptoms (β = -0.36, P < 0.001).

CONCLUSION

Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required.

Perceived Norms and Vaccination against COVID-19 among the General Adult Population in Germany: Results of a Nationally Representative Survey

OBJECTIVE

to examine whether perceived norms are associated with vaccination against COVID-19 (also stratified by age group).

STUDY DESIGN

nationally representative survey.

METHODS

Data were taken from a sample of the general adult population (n = 3829, 16 to 94 years). Data collection took place from early July to early August 2021, and 3 different groups (1: not yet vaccinated and no intention to vaccinate against COVID-19; 2: not yet, but intended to vaccinate against COVID-19; 3: yes, at least one vaccination against COVID-19) were distinguished in the analyses. Data were adjusted for several sociodemographic and health-related factors. Perceived norms served as key independent variables (1: number of important friends and relatives who would like me to get vaccinated; 2: number of important friends and relatives who already have been vaccinated or still want to do so; 3: how your general practitioner (GP) thinks about Corona vaccination).

RESULTS

Multiple logistic regression showed that, in particular, the number of important friends/relatives who would like an individual to get vaccinated is associated with the actual COVID-19 vaccination status among individuals aged 16 to 59 years. Interestingly, all 3 indicators for perceived norms are associated with the likelihood of COVID-19 vaccination status among individuals aged 60 years and over.

CONCLUSIONS

Our study adds to the understanding of the association between perceived norms and COVID-19 vaccination status. This highlights potential pathways to increase vaccination rates to further combat the later stages of the pandemic.

Community centers for older adults and psychosocial factors: Evidence from the German Ageing Survey

INTRODUCTION

There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)-which is important for successful aging.

METHODS/DESIGN

Data were taken from a nationally representative sample-the German Ageing Survey-including older community-dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations.

RESULTS

In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65-97 years). After adjusting for various socioeconomic, lifestyle-related, and health-related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (β = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender.

CONCLUSIONS

The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings.

[Use of and Attitudes toward Tests for the Detection of SARS-CoV-2 and Corresponding Antibodies: Results of a Nationally Representative Survey in Late Summer 2021]

OBJECTIVE

There is a lack of knowledge regarding utilization of and attitudes towards tests for the detection of SARS-CoV-2 in Germany. Our work aimed to reduce this gap.

METHODS

Data were taken from a nationally representative online survey (August 24th to 3rd September 2021, n=3,075; mean age: 44.5 years). Utilization of and attitudes toward Covid-19-tests were quantified in detail.

RESULTS

In sum, 79.1% of respondents had already undergone an appropriate test to detect SARS-CoV-2 test (mainly rapid antigen testing at rapid testing centers and self-testing) or an antibody test. With the exception of a PCR test, Covid-19 tests were rarely perceived as uncomfortable. Respondents were most likely to prefer a rapid antigen test in a rapid testing center. The main reasons for using self-testing as well as rapid antigen testing at rapid testing centers were (i) protection of others, (ii) for their own health precautions, and (iii) traveling. The main reasons for not using self-testing/rapid antigen testing at the workplace/training center were: (i) already vaccinated against Covid-19/recovered from Covid-19, followed by (ii) the home office workplace, and (iii) a lack of perceived benefit. Nearly 80% were somewhat or very satisfied, with access to testing at the workplace/training center and rapid testing centers.

CONCLUSION

Our work described the use of and aspects of attitudes toward tests for the detection of SARS-CoV-2 in Germany in late summer 2021. At that time, such test offers were already used quite often and were predominantly perceived as not being very unpleasant. The protection of other individuals was one of the main reasons for the use of such tests. Future research in this area is desirable (e. g., among the oldest old and in times when free-of-charge testing is no longer offered).

Frequency and correlates of mild cognitive impairment and dementia among the oldest old - Evidence from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)"

OBJECTIVES

Since there is limited knowledge with regard to the frequency and correlates of mild cognitive impairment and dementia among the oldest old based on large representative data (including institutionalized individuals), our objective was to fill this research gap.

METHODS

For our study, data came from the representative "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)". This study included community-dwelling and institutionalized individuals aged 80 years and over (n = 1,173, mean age: 86 years) residing in the most populous state of Germany (North Rhine-Westphalia). The DemTect was used to quantify cognitive impairment (i.e., probable mild cognitive impairment and probable dementia).

RESULTS

Overall, 73.1% of the individuals were not cognitively impaired, 17.0% of the individuals had probable mild cognitive impairment and 9.9% of the individuals had probable dementia. Compared to individuals without cognitive impairment, individuals with probable mild cognitive impairment were more likely to be male, live in an institutionalized setting, have a lower educational level, have a smaller network size, and have lower functional abilities. Moreover, compared to individuals without cognitive impairment, individuals with probable dementia were more likely to be older, live in an institutionalized setting, have a lower educational level, have a smaller network size, not be multimorbid, and have lower functional abilities.

CONCLUSIONS

Our study identified several sociodemographic and health-related factors which are associated with probable mild cognitive impairment and probable dementia among the oldest old. This knowledge may help to address individuals at risk for mild cognitive impairment and dementia.

Does Oral Health-Related Quality of Life Differ by Income Group? Findings from a Nationally Representative Survey

OBJECTIVES

Clarify the association between income group and oral health-related quality of life.

METHODS

Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values.

RESULTS

Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen's d = -0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen's d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen's d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (β = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (β = -0.28, p < 0.10).

CONCLUSIONS

The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.

Association between migration and oral health-related quality of life: results from a nationally representative online survey

Purpose

To analyze the link between individuals with and without migration background and oral health-related quality of life (also stratified by sex).

Methods

Data in this cross-sectional study were taken from a nationally representative survey (n = 3075, August/September 2021). The Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. Two-part models were calculated, adjusting for various covariates.

Results

Individuals with migration background had lower oral health-related quality of life (total sample, Cohen’s d = − 0.30; in men, d =− 0.44; in women, d =− 0.22). Two-part models also revealed that the migration background was associated with a higher likelihood of OHIP-G5 scores of one or higher (total sample and in both sexes). Moreover, migration background was positively associated with the extent of oral health-related quality of life (conditional on OHIP-G5 scores of one or higher; total sample and in men). Furthermore, regressions showed that migration background was associated with lower oral health-related quality of life (total sample and in both sexes).

Conclusions

Our study emphasized the link between having a migration background and lower oral health-related quality of life among both women and men. Maintaining oral health among individuals with a migration background is a key challenge. Culturally and socially sensitive actions should provide easy accessible oral health information and preventive measures in order to lower access barriers in dental care for individuals with migration background.

Prevalence and correlates of obesity among the oldest old. A systematic review, meta-analysis and meta-regression

Thus far, the prevalence and correlates of obesity among the oldest have been identified in several studies. Nevertheless, there is a lack of a systematic review, meta-analysis and meta-regression synthesizing the existing observational studies. Consequently, our aim was to fill this knowledge gap. Three electronic databases were searched (Medline, PsycINFO, CINAHL) and an additional hand search was performed. Observational studies (both, cross-sectional and longitudinal) determining the prevalence and (preferably) the correlates of obesity in the oldest old (≥80 years) were included. Data extraction covered study design, measurement of obesity, analytical approach, sample characteristics and main results. In total, 19 studies were included. Reported prevalence of obesity in the community varied greatly (range 0.7%-71.5%). The pooled prevalence of obesity was 17.8% (95% CI: 13.3%-22.2%), with significant heterogeneity between studies (I²  = 99.7%, P < 0.001). There is evidence of a publication bias. Meta-regressions showed that some of the heterogeneity was explained by the types of measures of obesity and country of the respective sample. In conclusion, obesity remains a key challenge among the oldest old. Future research in this age bracket is urgently required in regions mostly neglected thus far (e.g., South America, Africa or Asia). Moreover, studies based on longitudinal data are required to clarify the determinants of obesity among the oldest old. Furthermore, studies based on objectively recorded obesity (e.g., waist circumference) are also required. Geriatr Gerontol Int 2022; 22: 373-383.

Prevalence of Prefrailty and Frailty Among Older Adults in Germany: A Systematic Review, Meta-Analysis and Meta-Regression

Background

Various studies have identified the prevalence of prefrailty and frailty among older adults in Germany. Nevertheless, there is no review systematically synthesizing these studies. Thus, our aim was to close this gap in knowledge. Moreover, another aim was to perform a meta-analysis to synthesize the pooled prevalence of prefrailty and frailty. A further aim was to explore potential sources of heterogeneity based on a meta-regression.

Methods

A number of three electronic databases (PubMed, PsycINFO, and CINAHL) were searched (plus an additional hand search). The observational studies that determine the prevalence of frailty among older adults aged 65 years and above in Germany were included, whereas disease-specific samples were excluded. Data extraction included the description of the sample, operationalization of frailty, statistical analysis, sample characteristics and main findings. The established Joanna Briggs Institute (JBI) standardized critical appraisal instrument for prevalence studies was used for evaluating the quality of the studies. Important steps were performed by two reviewers.

Results

In sum, a number of 12 studies were included. The prevalence of frailty varied from about 2.4 to 25.6%. The pooled prevalence of frailty was 13.7% (95% CI: 9.0 to 18.5%). There was a significant heterogeneity among the studies (I² = 98.9%, p < 0.001). The pooled prevalence of prefrailty was 40.2% (95% CI: 28.3 to 52.1%; I² = 99.6%, p < 0.001). Some evidence of a publication bias exists. Meta-regressions showed that some of the heterogeneity was explained by the tool to quantify frailty and the average age of the respective sample.

Conclusion

Particularly, the high prevalence of prefrailty should be highlighted since it is important to prevent individuals in old age from developing to frail status. This knowledge is important for the German society as a whole and for relevant stakeholders.

Systematic Review Registration

PROSPERO, identifier: CRD42021293648.

Economic evaluations of musculoskeletal physiotherapy: protocol of a systematic review

INTRODUCTION

Several economic evaluations of musculoskeletal physiotherapy have been published in the literature. We aim to provide an overview of these existing economic evaluations. This overview will be useful for healthcare funders in identifying studies matching their context. In addition, research gaps as well as literature extensive enough to be combined in a meta-analysis will be identified. This will support researchers in planning relevant research projects.

METHODS AND ANALYSES

We will search in PubMed, EconLit and NHS-EED for relevant literature. Full economic evaluations of musculoskeletal physiotherapy interventions will be included, regardless of type, and economic evaluation perspective. Initial searches were performed on 7th October 2021. Study selection, data extraction and the quality evaluation will be conducted initially by two independent researchers. If their agreement is sufficient, one reviewer will proceed with the respected process. From the included studies, we will extract information on the publication year, the country of origin, the type of economical evaluation analyses and the specific musculoskeletal condition. An overview will be provided, concerning the distributions of the included studies regarding the extracted information. Furthermore, an evaluation of the individual study quality will be offered.

ETHICS AND DISSEMINATION

No ethical approval will be required for this systematic review, since no human participants are involved. We aim to distribute the findings of this review in a peer-reviewed journal, on national and international conferences, as well as via social media.

Religious Denomination, Religiosity, Religious Attendance, and Cancer Prevention. A Systematic Review

Recent research highlighted the influence of religion among health outcomes. To the best of our knowledge, there is no systematic review that summarizes the evidence on the relationship between religious factors and the utilization of cancer screenings. Therefore, this article aims to list the findings about the influence of religious denominations, the importance of religion in one’s life, and religious practices, such as church attendance on the utilization of cancer screenings. PubMed, PsycInfo and CINAHL were searched using a predefined algorithm in June 2020. We included observational studies that examined the association between religion and cancer screening use and employed appropriate items to quantify these key variables. Study selection, data extraction and quality assessment were performed independently by two reviewers. We detected n=27 studies that fulfilled the inclusion criteria. Hereby, n=16 used data from the United States. Most of the studies that were included in our review found a positive association between religious attendance and cancer screening utilization. There was mixed evidence concerning religious denomination as well as religiosity and use of cancer screenings. The studies suggest that religious factors are related to the utilization of cancer screenings. The findings of this systematic review may be helpful to resolve the underuse of cancer screenings by revealing at-risk-groups.

Oral Health, Loneliness and Social Isolation. A Systematic Review and Meta-Analysis

OBJECTIVES

Thus far, some empirical studies have investigated the association between oral health and loneliness as well as social isolation. However, a systematic review and meta-analysis is lacking synthesizing this evidence. Hence, our purpose was to close this knowledge gap.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Observational studies examining the association between oral health and loneliness or social isolation were included. Disease-specific samples were excluded.

METHODS

We searched three electronic databases (PubMed, PsycINFO, CINAHL), and did an additional hand search. Data extraction covered methods, sample characteristics and main findings. To evaluate study quality/risk of bias, the NIH tool was used. Study selection, data extraction and assessment of study quality were each conducted by two reviewers.

RESULTS

Seven studies were included in our current work. Several cross-sectional studies and one longitudinal study reported an association between poorer oral health and higher loneliness as well as higher social isolation. The quality of the studies was mostly fair, with two studies of high quality. The pooled OR was 1.47 (95% CI: 1.24-1.75) among the studies with adult samples.

CONCLUSION

Most of the included studies demonstrated an association between oral health and loneliness or social isolation. There is a lack of high quality studies on these associations; in particular, future studies should use longitudinal data to clarify the directionality between oral health and loneliness or social isolation. Prospero registration number: CRD42021268116.

Religion and cancer prevention: study protocol for a systematic review

INTRODUCTION

Several studies explored a relationship between religiousness and the utilisation of cancer screenings, as religious people may obtain an increased social network or could have certain personality traits that enhance screening use. To the best of our knowledge, there is no systematic review that sums up the evidence gained from research on that relationship. Thus, our review aims to appraise the findings of observational studies regarding that relationship. Its findings may be useful in addressing specific target groups to increase ineffectively the low cancer screening rates.

METHODS AND ANALYSIS

Employing a predefined search algorithm, three online databases (CINAHL, PsycInfo and PubMed) will be searched. In addition, the bibliographies of the studies included in our review will be searched through manually and independently by two reviewers. We are looking for observational studies (both cross-sectional and longitudinal) which examine the association between religion and cancer screening utilisation. However, studies regarding specific samples (as ethnic minorities or religious sects) will be excluded. We expect that the studies examine various dimensions of religion, such as religious attendance or religious intensity. We will extract data that describe methodology, sample characteristics and the findings concerning our object of investigation. Moreover, a quality assessment will be performed. Two reviewers will independently select the studies, extract the data and assess the studies' quality. Disagreements will be dissolved by discussion or by inclusion of a third party. The findings will be presented narratively in text and tables. If possible, a meta-analysis will be carried out.

ETHICS AND DISSEMINATION

As no primary data are collected, the approval from an ethics committee is not required. Our review will be published in a peer-reviewed, scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42021229222.

Willingness to bear economic costs of measures against SARS-CoV-2 in Germany

Background

The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2.

Methods

Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21–22 April 2020, N = 976; wave 16: 7–8 July 2020, N = 977; wave 38: 9–10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19.

Results

65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves.

Conclusions

The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11734-4.

Relationship between personality factors and frailty. A systematic review

PURPOSE

To date, some empirical studies showed a link between personality factors and frailty. Nevertheless, a systematic review is lacking synthesizing the current evidence. Consequently, the purpose of this review was to fill this gap in knowledge based on observational studies.

MATERIALS AND METHODS

Three electronic databases (PubMed, PsycINFO, CINAHL) were searched. Moreover, a hand search was conducted. Observational studies focusing on the association between personality and frailty were included, whereas disease-specific studies were excluded. Data referring to methods, characteristics of the sample and key findings were extracted. The NIH tool was used to assess study quality/risk of bias. Two reviewers performed study selection, extracted the data and conducted the quality assessment.

RESULT

In sum, five (mostly longitudinal) studies were included in the final synthesis. Mainly based on large, nationally representative cohorts, these studies point to an association between personality and frailty. More precisely, they mainly point to a link between low conscientiousness as well as high neuroticism and increased frailty levels. The quality of the studies included was quite high.

CONCLUSIONS

This knowledge may assist in identifying individuals at risk for increased frailty levels (i.e., particularly individuals with low conscientiousness and high neuroticism). Efforts to increase conscientiousness and reduce neuroticism may assist in postponing frailty. Future studies are required to elucidate the underlying mechanisms. Prospero registration number: CRD42020193100.

[Use of Health Care by Homeless Individuals: Results of the Hamburg Survey of Homeless Individuals]

OBJECTIVE

There is a lack of studies focusing on the use of health care facilities by homeless people. The aim of this study was to survey health care use by the homeless.

METHODS

Data were taken from the Hamburg survey of homeless individuals (n=150, mean age:12,5 years; SD: 12,5 years). Assessment covered details of health insurance status, use of ambulatory and hospital care, medication use, and reasons for not accessing health services.

RESULTS

In total, 61,2% of the homeless individuals had health insurance. About two thirds of homeless individuals (65,9%) had accessed some sort of medical services in the past 12 months. The key reason for not making use of health services was the absence of any need for treatment (74,6%). In sum, 39,8% of homeless individuals had made at least one hospital visit in the past 12 months. About one third (34,2%) had used mobile support services (mainly a mobile doctor's office). In total, 37,7% of homeless individuals took medications regularly, with 'prices too high' (63,6%) being the key reason for difficulties in access to medications. Almost one half of homeless individuals (47,0%) had not made a visit to a physician in the past three months.

CONCLUSION

Additional efforts are required to improve access to health care by homeless individuals. Future research in this area is therefore necessary.

Determinants of Postponed Cancer Screening During the COVID-19 Pandemic: Evidence from the Nationally Representative COVID-19 Snapshot Monitoring in Germany (COSMO)

Purpose

The COVID-19 pandemic is accompanied by various challenges for individual health and the health care system. However, preventive examinations such as cancer screenings should not be postponed during a pandemic. Because nationally representative studies describing postponed cancer screenings and identifying its determinants in Germany are lacking, our aim was to close this gap in knowledge.

Materials and Methods

We used cross-sectional data from the nationally representative online-survey “COVID-19 Snapshot Monitoring in Germany (COSMO)” (wave 17), which was conducted in July 2020. The analytical sample included 974 individuals (mean age was 45.9 years, SD: 16.5 years; 18 to 74 years). The outcome measure was whether cancer screening had been postponed since March 2020 due to the COVID-19 pandemic (no, attended as planned; yes, postponed).

Results

In total, slightly more than 10% of individuals stated to have postponed cancer screenings between March and July 2020 due to the COVID-19 pandemic, particularly women and individuals aged 30 to 49 years. The likelihood of postponed cancer screening was positively associated with higher affect regarding COVID-19 (OR: 1.65, 95% CI: 1.16–2.35), whereas it was negatively associated with younger age (eg, 18 to 29 years, OR: 0.17, 95% CI: 0.05–0.64, compared to individuals 30 to 49 years).

Conclusion

Study findings showed that one out of ten individuals postponed cancer screenings during the COVID-19 pandemic. We determined two correlates of them (age and affect regarding COVID-19). Individuals with an increased likelihood of postponed cancer screenings should be specifically addressed.

Prevalence and Factors Associated with Fear of COVID-19 Among Homeless Individuals During the COVID-19 Pandemic: Evidence from the Hamburg Survey of Homeless Individuals

PURPOSE

To clarify the prevalence and determinants of fear of COVID-19 among homeless individuals during the COVID-19 pandemic.

PATIENTS AND METHODS

Data were taken from the Hamburg survey of homeless individuals (n=150) covering homeless adults in Hamburg, Germany. Multiple linear regressions were used. Beyond sociodemographic and lifestyle-related independent variables, COVID-19-related factors were also used as independent variables.

RESULTS

In sum, 56.2% of homeless individuals reported no fear of COVID-19, 23.8% reported a little fear of COVID-19, 9.2% reported some fear of COVID-19 and 10.8% reported severe fear of COVID-19. Regressions showed that an increased fear of COVID-19 was significantly associated with younger age (β=-.01, p<0.05), absence of chronic alcohol consume (β=-.55, p<0.01), an increased perceived own risk of getting infected with the coronavirus one day (β=0.42, p<0.001) and a higher agreement that a diagnosis of the coronavirus would ruin his/her life (β=0.13, p<0.01).

CONCLUSION

Given the poor hygienic conditions and their increased vulnerability, data surprisingly suggest a quite low fear of COVID-19 among homeless individuals. Efforts may be beneficial which contribute to thinking rationally about COVID-19 among homeless people, since low levels of fear of COVID-19 may contribute to careless behavior and can lead to super-spreading events.

Determinants of healthcare use based on the Andersen model: a study protocol for a systematic review of longitudinal studies

INTRODUCTION

A previous systematic review published in 2012 focused on the use of health services based on the Andersen model. Extending this review, we will exclusively focus on systematically synthesising longitudinal studies examining the determinants of healthcare use based on the Andersen model. Therefore, our aim of this systematic review is to provide an overview of longitudinal observational studies investigating the predictors of healthcare use explicitly using this model.

METHODS AND ANALYSIS

We will search three electronic databases (Medline, PsycINFO and CINAHL). Furthermore, reference lists will be searched manually. Longitudinal observational studies will be investigating the determinants of healthcare use (in terms of use of outpatient physician services (like general practitioner's visits or specialist visits in total) and hospitalisation). We will exclude disease-specific samples. Data extraction will focus on methods (eg, assessment of healthcare use), sample characteristics and main findings. A suitable tool will be used to assess the study quality. Study selection, data extraction and evaluation of study quality will be conducted by two reviewers. The findings will be presented by means of figures, summary tables, narrative summaries and meta-analysis (if possible).

ETHICS AND DISSEMINATION

No primary data will be collected. Therefore, approval by an ethics committee is not required. Our findings are planned to be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020193198.

Informal caregiving for adults, loneliness and social isolation: a study protocol for a systematic review

INTRODUCTION

Some empirical studies have identified an association between informal caregiving for adults and loneliness or social isolation. However, there is a lack of a review systematically synthesising empirical studies that have examined these associations. Hence, the aim of this systematic review is to provide an overview of evidence from observational studies.

METHODS AND ANALYSIS

Three electronic databases (Medline, PsycINFO, CINAHL) will be searched (presumably in May 2021), and reference lists of included studies will be searched manually. Cross-sectional and longitudinal observational studies examining the association between informal caregiving for adults and loneliness or social isolation will be included. Studies focusing on grandchildren care or private care for chronically ill children will be excluded. Data extraction will include information related to study design, definition and measurement of informal caregiving, loneliness and social isolation, sample characteristics, statistical analysis and main results. The quality of the studies will be evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers will perform the selection of studies, data extraction and assessment of study quality. Figures and tables will be used to summarise and report results. A narrative summary of the findings will be provided. If data permit, a meta-analysis will be conducted.

ETHICS AND DISSEMINATION

No primary data will be collected. Therefore, approval by an ethics committee is not required. We plan to publish our findings in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020193099.

Factors associated with postponed health checkups during the COVID-19 pandemic in Germany

Objectives

The COVID-19 pandemic has serious social, economic and health consequences. Particularly in these times, it is important to maintain individual health. Therefore, it is important to take part in routine health checkups. Consequently, our objective was to describe the frequency and to identify the determinants of postponed routine health checkups.

Study design

Cross-sectional data from the nationally representative online-survey “COVID-19 Snapshot Monitoring in Germany (COSMO)” was used (wave 17; July 2020).

Methods

In sum, 974 individuals were included in our analytical sample (average age was 45.9 years, SD: 16.5, 18–74 years). Postponed routine health checkups (yes or no) since March 2020 due to the COVID-19 pandemic were assessed.

Results

More than 16% of the individuals reported postponed routine health checkups in the past few months due to the COVID-19 pandemic. Particularly, individuals aged 30–49 years had postponed health checkups (21%). The probability of postponed health checkups was positively associated with the presence of chronic diseases (odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.15–2.47), higher affect regarding COVID-19 (OR: 1.44, 95%-CI: 1.16–1.78), and higher presumed severity of COVID-19 (OR: 1.17, 95%-CI: 1.01–1.35), whereas the outcome measure was not associated with socioeconomic factors. Data showed that a sizeable part (about one of six individuals) of the population reported postponed routine health checkups due to the COVID-19 pandemic between March and July 2020.

Conclusions

Postponed checkups should not be neglected during the COVID-19 pandemic. Individuals at risk for postponed health checkups should be appropriately addressed.

Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals

BACKGROUND

To identify the determinants of health care use among homeless individuals.

METHODS

Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates.

RESULTS

Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]).

CONCLUSIONS

Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.

Determinants of Frequent Attendance in Primary Care. A Systematic Review of Longitudinal Studies

Introduction: There is a lack of a systematic review synthesizing longitudinal studies investigating the determinants of frequent attendance in primary care. The goal of our systematic review was to fill this gap in knowledge.

Methods: Three electronic databases (Medline, PsycINFO, and CINAHL) were searched. Longitudinal observational studies analyzing the predictors of frequent attendance in primary care were included. Data extraction covered methods, sample characteristics, and main findings. Selection of the studies, extracting the data and evaluation of study quality was performed by two reviewers. In the results section, the determinants of frequent attendance were presented based on the (extended) Andersen model.

Results: In total, 11 longitudinal studies have been included in our systematic review. The majority of studies showed that frequent attendance was positively associated with the predisposing characteristics lower age, and unemployment. Moreover, it was mainly not associated with enabling resources. Most of the studies showed that need factors, and in particular worse self-rated health, lower physical functioning and physical illnesses were associated with an increased likelihood of frequent attendance. While most studies were of good quality, several of the included studies did not perform sensitivity analysis or described how they dealt with missing data.

Discussion: Our systematic review showed that particularly lower age, unemployment and need factors are associated with the likelihood of becoming a frequent attender. Enabling resources are mainly not associated with the outcome measure. Future research should concentrate on the determinants of persistent frequent attendance due to the high economic burden associated with it.

The Association Between Obesity and Social Isolation as Well as Loneliness in the Adult Population: A Systematic Review

PURPOSE

Obesity is associated with adverse health outcomes and can result in feelings of loneliness or social isolation, for example due to stigmatization. These factors are in turn associated with morbidity and mortality. Thus far, a systematic review is lacking with regard to the association between obesity, social isolation and loneliness. Therefore, our aim was to fill this gap in knowledge.

MATERIALS AND METHODS

Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies examining the link between obesity and loneliness or social isolation were included. Disease-specific samples were excluded.

RESULTS

In sum, six studies have been included. While some studies point to an association between obesity and increased loneliness levels, it should be acknowledged that findings are mixed. Study quality was quite high.

CONCLUSION

This systematic review showed that the literature is inconclusive and incomplete. Further research is required to shed further light on these associations. Moreover, studies from countries outside Europe, based on longitudinal data and using objective assessments of obesity, are urgently required. Gender differences should be further explored.

Personality and the use of cancer screenings. A systematic review

BACKGROUND

No systematic review exists synthesizing studies examining the association between personality factors and use of cancer screenings. Hence, the aim of this systematic review is to provide an overview of empirical findings from observational studies investigating the link between personality factors (in terms of agreeableness, conscientiousness, extraversion, neuroticism and openness to experience) and use of cancer screenings.

METHODS

Medline, PsycInfo and CINAHL were searched using predefined search terms. Observational studies examining the link between personality factors and use of cancer screenings using validated tools were included. Study selection, data extraction, and quality assessment were performed by two reviewers.

RESULTS

In total, n = 11 studies were included in our systematic review. There is mostly inconclusive evidence regarding the link between agreeableness, neuroticism, openness to experience and the use of cancer screenings. Clearer evidence was identified for an association between increased extraversion and an increased use of cancer screenings. Moreover, the majority of studies identified a link between increased conscientiousness and an increased use of cancer screenings.

DISCUSSION

Studies indicate that personality factors, particularly an increased extraversion and increased conscientiousness, are associated with an increased use of cancer screenings. This knowledge may be beneficial to address individuals at risk for underuse.

PROSPERO REGISTRATION NUMBER

CRD42020176830.

Perceptions of Health Care Use in Germany during the COVID-19 Pandemic

This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found that about 60% of the individuals rather disagreed about having had problems accessing medical care. Furthermore, 73% of the individuals rather disagreed to having experienced health deteriorations due to restrictions on the availability of medical care. Moreover, 85% of the individuals were rather optimistic about future access to healthcare services. Overall, slightly better past and future access to healthcare services has been reported in wave 16. Several determinants were identified in regression analysis. In conclusion, data suggest that perceived past and future access to healthcare services during the COVID-19 pandemic is reasonably good.

Religious Attendance and Cancer Screening Behavior

Background: Cancer is one of the most important health problems worldwide. Preventive examinations proved to be effective in tackling that issue, but their degree of utilization is not adequate. Thus, research is making efforts to reveal its determinants. It has been shown that religion is associated with several health outcomes, so the aim of our study is to analyze the association between religious attendance and participation in cancer prevention.

Methods: Data are derived from the fifth wave of the German Aging Survey (DEAS), a nationally representative, prospective cohort study. Participants are community-dwelling Germans aged 40 years and older. Our main independent variable is the frequency of attendance in religious services, and the dependent variable is participation in cancer screening. As covariates, we include factors from all the dimensions of the Andersen behavioral health services utilization model. Multiple logistic regressions were used. In our sensitivity analysis, logistic regressions were performed stratified by religious group (Roman Catholic church, Protestant church, not belonging to any religious group).

Results: Our model shows that attendance in religious services once a week, one to three times a month, several times a year, or less often is significantly associated with an increased likelihood of participating in preventive cancer screening, more than never participating in religious services. Moreover, the sensitivity analysis reveals that all these associations remain significant for the Catholic subsample, but not for the Protestant or the non-religious group.

Discussion: This study finds a link between a higher frequency of attendance in religious services and an increased likelihood of participating in cancer screenings. This is important to address individuals at risk for underuse of cancer screenings.

Determinants of Dental Service Use Based on the Andersen Model: A Study Protocol for a Systematic Review

Introduction: Drawing on the Andersen model, there is a large body of evidence examining the determinants of health care use, such as doctor visits or hospitalization. However, far less is known about the determinants of dental service use, explicitly using the Andersen model. Consequently, the aim of this systematic review is to summarize and critically analyze evidence from observational studies that examine the determinants of dental service use based on the Andersen model. Methods and analysis: The following electronic databases will be searched: PubMed, PsycInfo, and CINAHL. Our main inclusion criterion is: observational studies (cross-sectional and longitudinal) investigating the determinants of dental service use based on the Andersen model. Disease-specific samples will be excluded. Data extraction will concentrate on methods (such as measurement of dental service use), sample characteristics (such as age and gender) and key results. The study quality will be assessed using an appropriate tool. Three steps (selecting the studies, extracting the data and assessment of study conducted) will be performed by two reviewers. The findings will be displayed using figures, summary tables, narrative summaries and meta-analysis (if studies are deemed similar enough and of appropriate quality).

Personality, Healthcare Use and Costs-A Systematic Review

BACKGROUND

Thus far, there is a lack of a systematic review synthesizing empirical studies that analyze the link between personality factors and healthcare use (HCU) or costs. Consequently, the purpose of our systematic review is to give an overview of empirical findings from observational studies examining the association between personality factors and HCU or costs.

METHODS

PubMed, PsycINFO, and NHS EED (NHS Economic Evaluation Database) were searched. Observational studies examining the association between personality factors and HCU costs by using validated tools were included. Two reviewers performed study selection and data extraction and evaluated the study quality. Findings were synthesized qualitatively.

RESULTS

In total, n = 15 studies (HCU, n = 14; cost studies, n = 1) were included in the final synthesis. A few studies point to an association between conscientiousness and HCU (with mixed evidence). Some more evidence was found for an association between higher agreeableness, higher extraversion, and higher openness to experience and increased HCU. The majority of studies analyzed found a link between higher neuroticism and increased HCU.

CONCLUSION

Personality factors, and particularly neuroticism, are associated with HCU. This knowledge is important to manage healthcare use. However, future research based on longitudinal data and studies investigating the link between personality characteristics and costs are required.