Ralph Brinks

Background: Epidemiological evidence on the incidence and remission of anxiety and depressive disorders is limited. We estimated age- and sex-specific incidence and remission rates of moderate-to-severe anxiety and depressive symptoms using the illness-death model. Methods: The German National Cohort (NAKO) is a cohort of over 200,000 participants aged 19–74 at baseline. Prevalence of probable cases, estimated with the Generalized Anxiety Disorder Scale and the Patient Health Questionnaire data 2014–2019 across five regions, was related to general mortality rates and disorder-specific mortality rate ratios in the illness-death model. The partial derivative of prevalence was modeled as a function of incidence and remission, with parameters estimated via least-squares optimization through 2,000 bootstrap resamples. Results: The highest incidence rates (per 1,000 person-years) occurred at ages 19–21 for anxiety symptoms: 4.07 (95% CI: 0.00–7.57) in women and 2.55 (0.00–4.94) in men; and at ages 28–34 for depressive symptoms: 4.41 (0.00–9.81) in women and 3.30 (0.00–7.34) in men, all in Hamburg. Remission rates (per 100 person-years) were highest at older ages. For anxiety symptoms, rates peaked at 71.8 years in women (4.10 [0.00–11.94]) and 64.2 years in men (3.00 [0.00–9.23]) in Freiburg. For depressive symptoms, the highest observed was at 74.0 years, both among women (6.61 [0.00–15.50] in Münster) and men (3.58 [0.00–11.51] in Berlin). Conclusions: Incidence and remission rates of anxiety and depressive symptoms can be estimated from prevalence and mortality data, revealing regional, sex-, and age-related variation. Validation with longitudinal data is warranted.

Objective: In view of increasing work-related burdens resulting from staff shortages, demographic changes, and high physical and psychological demands, there is a growing need for an understanding of the health status of nursing staff in Germany. The aim of this review is to consolidate existing knowledge on nurses’ health, health behaviors, and subjective stress perceptions to highlight existing research gaps, and to provide impetus for the development of future health-promoting interventions. Methods: To analyze the research field, a scoping review was conducted following the JBI methodology. The systematic literature search was carried out using CINAHL, PubMed, and CareLit- databases and was supplemented by searches of the preprint servers OpenGrey and MedRxiv. In addition, a targeted supplementary search for relevant publications was also conducted on selected pertinent websites. Results: A total of 11,006 titles and abstracts were screened, of which 150 full texts were reviewed, resulting in the inclusion of 90 studies. The literature predominantly focused on nurses’ mental health. Physical health and health-related behaviors were examined less frequently. Results consistently indicate a high burden of morbidity and substantial work-related stress, which have significant implications for individual well-being, professional performance, and long-term retention in the nursing profession. These challenges have been further intensified by the COVID-19 pandemic. Protective factors such as team cohesion and recognition have emerged repeatedly, highlighting the importance of supportive work environments. Although some interventions have demonstrated short-term improvements in mental health outcomes, robust evidence of long-term effects and physical health promotion remains limited. Conclusions: Nursing staff are exposed to a wide range of health risks and high work-related burdens. Despite a broad body of research, substantial gaps remain - particularly regarding health behaviors and physical health. Future research requires longitudinal, comparative studies, and a structured, nursing-specific health monitoring system. In practice, comprehensive strategies that combine individual-level interventions with structural improvements in the work environment are needed. Review registration: Open Science Framework https://doi.org/10.17605/OSF.IO/HX9ZM . Clinical trial number: Not applicable.

Objective: Belimumab has well-established efficacy in improving overall SLE disease activity and preventing flares and organ damage. Belimumab effects have been demonstrated across organ domains but have not been reported in detail for haematological manifestations. We investigated the efficacy of belimumab in thrombocytopenia and leucopenia in patients with SLE. Methods: Anonymised data on haematological parameters from five phase III randomised controlled clinical trials of belimumab were provided by GSK. These datasets included 1769 patients treated with belimumab and 1144 patients who received placebo, on top of standard therapy. We selected patients with active thrombocytopenia or leucopenia at baseline and compared sustained resolution of symptoms from the time of resolution through week 52 by means of log-rank tests. Results: At baseline, thrombocytopenia and leucopenia were present in 39 and 346 belimumab-treated patients and 25 and 203 placebo recipients, respectively. Thrombocytopenia resolved earlier with belimumab versus placebo, starting from week 2 on therapy and in a higher proportion of belimumab-treated patients (p=0.0267). One-third (13/39) of belimumab-treated and 8% (2/25) of placebo-receiving patients reached persistent resolution. In contrast to thrombocytopenia, observed improvements in leucopenia were slower, with no apparent difference between belimumab and placebo. Conclusion: This post hoc analysis of data from five large phase III RCTs suggests a benefit from belimumab compared with placebo in the haematological domain. A benefit from belimumab was seen in improving thrombocytopenia, but not leucopenia. While mild leucopenia is rarely clinically relevant, the data on thrombocytopenia will inform differential therapeutic decisions in patients with active SLE.

Recently, it has been shown that the transition rates of the illness-death model (IDM) for chronic conditions are related to the age-specific prevalence by a partial differential equation (PDE). Given mortality, the PDE could be used to estimate incidence rates from cross-sectional data. The aim of this article is to extend the IDM and introduce a novel method to estimate the age-specific incidence rate together with the two mortality rates from aggregated current status (ACS) data. By ACS data we mean counts of people in the four states of the extended IDM at different points in time. ACS data stem from epidemiological studies where only current disease status and vital status data need to be collected without following-up people (as, for example, in cohort studies). To demonstrate feasibility of the method, we use a simulation study from the context of diabetes in Germany. Two estimation methods are introduced, a least squares estimator and a maximum likelihood estimator. We find a good agreement between the estimates and the input parameters used to set up the simulation.

Zusammenfassung: Hintergrund: Pflegekräfte spielen angesichts des demographischen Wandels und der zunehmend steigenden Pflegebedürftigkeit eine maßgebliche Rolle im Gesundheitswesen. Im Rahmen dieser wichtigen Funktion können Pflegekräfte selbst vor herausfordernden Belastungssituationen stehen, die sich auf ihre eigene Gesundheit auswirken können. Um das Wohlbefinden und die Arbeitsfähigkeit von Pflegekräften zu erhalten und somit eine qualitative hochwertige Versorgung zu gewährleisten, ist ein fundiertes Verständnis über den aktuellen Ist-Zustand der Gesundheit, des Gesundheitsverhaltens und der Einflüsse täglicher Belastungssituationen auf die Gesundheit unerlässlich. Ziel: Das A‑priori-Protokoll beschreibt die methodische Vorgehensweise eines geplanten Scoping Reviews zu Gesundheitszustand, Gesundheitsverhaltens und Einflüsse täglicher Belastungsfaktoren von Pflegekräften. Methoden: In dieser Übersicht werden alle Studien zu Pflegekräften in Deutschland, die seit 2015 publiziert wurden, berücksichtigt. Es werden sowohl empirische Studien als auch graue Literatur, unabhängig von deren Qualität, eingeschlossen. Der geplante Scoping Review wird gemäß der vom Joanna Briggs Institute entwickelten Methodologie für Scoping Reviews durchgeführt (Review-Registrierung: Open Science Framework https://osf.io/hx9zm ). Schlussfolgerung: Das vorliegende Protokoll bietet einen strukturierten Ansatz, um den Gesundheitszustand, das Gesundheitsverhalten und die Einflüsse täglicher Belastungsfaktoren von Pflegekräften zu untersuchen. Der geplante Review wird eine systematische und transparente Bündelung vorhandener Evidenz gewährleisten und somit eine adäquate Grundlage für zukünftige Interventionen und Forschung bieten.

Recently, it has been shown that the transition rates of the illness-death model (IDM) for chronic conditions are related to the percentages of people in the states by a three-dimensional system of differential equations [Bri24]. The aim of this article is to introduce a method to estimate the age-specific incidence rate together with the mortality rate ratio from aggregated current status (ACS) data. By ACS data we mean counts of (non-necessarily different) people in the three states of the IDM at different points in time. ACS data stem from epidemiological studies where only current disease status and vital status data need to be collected without following-up people (as, for example, in cohort studies). As an application, we use the theory in a simulation study about diabetes in Germany with 600 study subjects at eleven repeated cross-sections each of which with 50% participation quote. Special focus is given to stochastic dependency of the sampled participants. We find a good agreement between the estimates and the input parameters used for the simulation.

Quantifying the effect of non-pharmaceutical interventions (NPIs) is essential for formulating lessons from the COVID-19 pandemic. To enable a more reliable and rigorous evaluation of NPIs based on time series data, we reanalyse the official evaluation of NPIs in Germany. As the first part of a multi-step validation and verification project, we focus on properly analysing statistical uncertainties for time series data. Using a set of 9 competitive statistical methods for estimating the effects of NPIs and other determinants of disease spread on the effective reproduction number ℛ( t ), we find significantly wider confidence intervals than the official evaluation. In addition to vaccination and seasonality, only few NPIs – such as restrictions in public spaces – can be confidently associated with variations in ℛ( t ), but even then effect sizes have large uncertainties. Furthermore, due to multicollinearity in NPI activation patterns, it is difficult to distinguish potential effects of NPIs in public spaces from other interventions that came into force early, such as physical distancing. In future, NPIs should be more carefully designed and accompanied by plans for data collections to allow for a timely evaluation of benefits and harms as a basis for an effective and proportionate response.