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References
PMC10844074
Key Points
PMC10245194
Question
multiple cardiovascular disease, CVD
CVD
Is a home visit from a peer health coach effective at improving systolic blood pressure (SBP) and other clinical outcomes for veterans with multiple cardiovascular disease (CVD) risks?
PMC10245194
Findings
In this randomized clinical trial of 264 US veterans, there was no significant improvement in SBP in participants who received the peer health coaching intervention. However, a significant improvement in the mental health–related quality of life was reported in the intervention group compared with the control group.
PMC10245194
Meaning
Findings from this trial indicate that a peer health coaching intervention can create opportunities for well-being improvements beyond blood pressure control.
PMC10245194
Importance
death, CVD
CVD, CARDIOVASCULAR DISEASE
Although cardiovascular disease (CVD) is the leading cause of death in the US, CVD risk factors remain suboptimally controlled.
PMC10245194
Objective
CVD
To test the effectiveness of a home-visit, peer health coaching intervention to improve health outcomes for veterans with multiple CVD risks.
PMC10245194
Design, Setting, and Participants
obesity, hypertension, overweight
OBESITY, HYPERLIPIDEMIA, CVD, MAY, HYPERTENSION
This 2-group, unblinded randomized clinical trial, called Vet-COACH (Veteran Peer Coaches Optimizing and Advancing Cardiac Health), used a novel geographic-based method to recruit a racially diverse population of veterans with low income. These veterans were enrolled at the Seattle or American Lake Veterans Health Affa...
PMC10245194
Intervention
Participants in the intervention group received peer health coaching for 12 months with mandatory and optional educational materials, an automatic blood pressure monitor, a scale, a pill organizer, and healthy nutrition tools. Participants in the control group received usual care plus educational materials.
PMC10245194
Main Outcomes and Measures
CVD
The primary outcome was a change in systolic blood pressure (SBP) from baseline to 12-month follow-up. Secondary outcomes included change in health-related quality of life (HRQOL; measured using the 12-item Short Form survey’s Mental Component Summary and Physical Component Summary scores), Framingham Risk Score, and o...
PMC10245194
Results
The 264 participants who were randomized (mean [SD] age of 60.6 [9.7] years) were predominantly male (229 [87%]) and 73 (28%) were Black individuals and 103 (44%) reported low annual income (<$40 000 per year). Seven peer health coaches were recruited. No difference was found in change in SBP between the intervention a...
PMC10245194
Conclusions and Relevance
This trial found that, although the peer health coaching program did not significantly decrease SBP, participants who received the intervention reported better mental HRQOL compared with the control group. The results suggest that a peer-support model that is integrated into primary care can create opportunities for we...
PMC10245194
Trial Registration
ClinicalTrials.gov Identifier:
PMC10245194
Introduction
death, CVD
CVD, RECRUITMENT, CARDIOVASCULAR DISEASE
Cardiovascular disease (CVD) is the leading cause of death in the US, and non-Hispanic Black Americans have a higher burden of CVD than other groups.Successful management of cardiovascular risks is a complex process that requires self-monitoring, using medications, adjusting diet and physical activity, and working effe...
PMC10245194
Methods
PMC10245194
Study Design, Setting, and Participants
hypertension
HYPERTENSION, RECRUITMENT
A description of the trial design, intervention components, and peer health coach training has been previously published.Veterans were eligible to participate if they had a diagnosis of hypertension (with an We sent recruitment letters to 2921 potentially eligible veterans. Of the 1419 veterans we were able to contact,...
PMC10245194
Participant Flow Diagram
CPRS indicates Computerized Patient Record System; HV, home visit; TV, telephone visit.After completing baseline data collection, participants were randomized to receive either a home-based peer-support intervention for 12 months or usual care. Block randomization with varying blocks of 4 or 6 was used to ensure the tr...
PMC10245194
Vet-COACH Intervention
ELEVATED BLOOD PRESSURE
Of the 7 peer health coaches, 1 was assigned to a participant in each intervention arm and made 5 home visits and 5 telephone visits over 12 months. Telephone visits were used between in-home visits as check-ins on goal setting and progress. The protocol was modified to telephone-only visits after the start of the COVI...
PMC10245194
Outcomes and Measures
CVD, BLOOD, SECONDARY
The primary outcome was a change in systolic blood pressure (SBP) from baseline to the 12-month follow-up. Blood pressure readings were obtained using standard procedures with a blood pressure monitor (UA-767F Multi-User Blood Pressure Monitor; A&D Medical). The mean of 3 blood pressure measurements was used. If a part...
PMC10245194
Statistical Analysis
We projected a sample size of 400 veterans to detect a clinically significant difference between intervention and control groups in SBP change of 5 mm Hg between baseline and 12-month follow-up.We examined distributions of demographic and clinical variables of participants in the intervention and control arms and repor...
PMC10245194
Results
PMC10245194
Trial Participants
HIGH BLOOD PRESSURE
Of the 264 randomized participants (130 to control group; 134 to intervention group), 225 completed the 12-month follow-up (85% completion rate). Eighty participants (60%) in the intervention group received at least 8 of the 10 total number of required visits. From the optional modules, weight management was selected b...
PMC10245194
Baseline Characteristics of Vet-COACH Trial Participants
CVD
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); DBP, diastolic blood pressure; ED, emergency department; FRS, Framingham Risk Score (10-year estimate of CVD risk, ranging from 0% to >30%); HRQOL, health-related quality of life; LDL-C, low-density lipoprotein ...
PMC10245194
Outcomes
We found no significant difference in change in SBP between the intervention and control groups (−3.32 [95% CI, −6.88 to 0.23] mm Hg vs −0.40 [95% CI, −4.20 to 3.39] mm Hg; adjusted difference in differences, −2.05 [95% CI, −7.00 to 2.55] mm Hg;
PMC10245194
Differences in Primary and Secondary Outcomes Between Intervention and Control Groups
CVD, REGRESSION
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); BP, blood pressure; DBP, diastolic blood pressure; FRS, Framingham Risk Score (10-year estimate of CVD risk, ranging from 0% to >30%); HRQOL, health-related quality of life; LDL-C, low-density lipoprotein choles...
PMC10245194
Previous Year Health Care Use at Baseline and 12 Months Between Intervention and Control Groups
Abbreviation: ED, emergency department.
PMC10245194
Discussion
calmness, depression, pain
CVD, HYPERTENSION
The goal of the Vet-COACH trial was to test a peer-support intervention aimed at improving cardiovascular health and quality of life among veterans who resided in areas with a high prevalence of hypertension. We used a novel neighborhood-based strategy and recruited a racially diverse population with low annual income....
PMC10245194
Strengths and Limitations
The Vet-COACH trial has several strengths. First, intervention protocols were designed to be practical and feasible, thus allowing replication in other clinic settings. Second, we accounted for clustering by peer health coach. Largely ignored in peer health coaching studies is the peer health coach’s contribution to th...
PMC10245194
Conclusions
The Vet-COACH randomized clinical trial adds to the literature on the effectiveness of peer support, which has shown mixed results,
PMC10245194
Introduction
sleep disordered breathing complaints
BACTERIAL DISEASES, CHRONIC ADENOIDITIS, MIDDLE EAR INFECTION, RHINOSINUSITIS, INFLAMMATIONS, MIDDLE EAR
Chronic adenoiditis (CA) is a common condition in pediatric otorhinolaryngological clinical practice, frequently associated with chronic or recurrent middle ear infections, rhinosinusitis, and sleep disordered breathing complaints; these situations often require specialist consultations, antibiotic prescriptions and, i...
PMC10857951
Materials and methods
PMC10857951
Study design and setting
This prospective, double-blind, randomized controlled study was carried out at the University of Milan’s Department of Clinical Sciences and Community Health between January 2019 and January 2021. The protocol was approved BY the Ethics Committee “Milano Area 2” (protocol number AC-TAR-2018, September 10
PMC10857951
Study subjects
choanal atresia, adenoidal hypertrophy, acute febrile illness, upper respiratory tract infection
ACUTE ADENOIDITIS, ADENOIDAL HYPERTROPHY, SYSTEMIC DISEASE, UPPER RESPIRATORY TRACT INFECTIONS
The study involved children aged 2–18 years with CA defined as adenoidal hypertrophy detected by means of nasopharyngeal flexible video-endoscopy and recurrent infectious exacerbations (i.e., ≥ 3 episodes of acute adenoiditis requiring antibiotic treatment in the former 6 months or ≥ 4 episodes in the former 12 months)...
PMC10857951
Interventions
DMD, acute adenoidal infections, hypertrophic adenoids, choanal space occlusion
RECRUITMENT
Upon enrolment (T0), a complete clinical history (including the number of documented acute adenoidal infections occurring in the previous 3 months) was taken, and the child’s gender and age were recorded; all the children underwent a detailed otorhinolaryngological clinical examination including nasopharyngeal flexible...
PMC10857951
Statistical analysis
acute adenoidal infections
The sample size was determined on the basis of the primary endpoint, which was to evaluate the impact of the topical administration of Rinogermina nasal spray on the reduction of the number of acute adenoidal infections, and was computed using published data reporting a 15% reduction of acute exacerbation in children r...
PMC10857951
Acknowledgements
Publication was granted by The Italian Ministry of Health-Ricerca Corrente 2023.
PMC10857951
Authors' contributions
ST designed the study and drafted the manuscript; DDP, FF: data collection and helping in drafting the manuscript: SB, LG, LB: data collection; LP, PM, and PC reviewed the paper for important intellectual considerations.
PMC10857951
Funding
Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement. This study was sponsored by DMG ITALIA S.r.l.
PMC10857951
Data availability
Data available on request due to privacy/ethical restrictions.
PMC10857951
Declarations
PMC10857951
Ethical approval
The protocol was approved by the Ethics Committee “Milano Area 2” (protocol number AC-TAR-2018) on September 10, 2018, and the research was carried out in line with standard directives from the Ethics Committee “Milano Area 2.”
PMC10857951
Competing interests
ST: advisor for Sanofi and GSK. All other authors declare no competing interests.
PMC10857951
References
PMC10857951
Key Points
PMC10238946
Question
NASOPHARYNGEAL CANCER
Can bevacizumab be safely combined with chemoradiation in the treatment of nasopharyngeal cancer?
PMC10238946
Findings
NASOPHARYNGEAL CANCER
In this nonrandomized controlled trial of 44 patients with locoregionally advanced nasopharyngeal cancer, the addition of bevacizumab to standard chemoradiation was not associated with excessive or unwarranted toxic effects.
PMC10238946
Meaning
nasopharyngeal cancer
NASOPHARYNGEAL CANCER
These findings suggest that the addition of bevacizumab to chemoradiation for nasopharyngeal cancer may be safe and tolerable.
PMC10238946
Importance
NPC
NASOPHARYNGEAL CARCINOMA
The long-term outcomes associated with adding bevacizumab, a vascular endothelial growth factor inhibitor, to standard chemoradiation have continued to be favorable for a group of patients with locoregionally advanced nasopharyngeal carcinoma (NPC).
PMC10238946
Objective
To assess long-term toxic effects and clinical outcomes associated with chemotherapy, radiation therapy (RT), and bevacizumab for NPC.
PMC10238946
Design, Setting, and Participants
cancer, Cancer
ONCOLOGY, CANCER, CANCER
This single-arm phase II nonrandomized controlled trial was conducted by the National Cancer Trials Network group and NRG Oncology (formerly Radiation Therapy Oncology Group), with accrual from December 13, 2006, to February 5, 2009, and data analysis from June 26 to July 1, 2019. The study was conducted at 19 cancer c...
PMC10238946
Interventions
Patients received 3 cycles of bevacizumab (15 mg/kg) concurrently with standard cisplatin (100 mg/m
PMC10238946
Main Outcomes and Measures
hemorrhage
ADVERSE EVENTS, HEMORRHAGE, METASTASIS
The primary end point was grade 4 hemorrhage or grade 5 adverse events in the first year. Secondary end points were locoregional progression–free (LRPF) interval, distant metastasis–free (DMF) interval, progression-free survival (PFS), overall survival (OS), and other adverse events. Long-term toxic effects and clinica...
PMC10238946
Results
dysphagia, death, hearing impairment, hemorrhage, dry mouth
DYSPHAGIA, DISEASE PROGRESSION, DISEASE, HEARING IMPAIRMENT, HEMORRHAGE, DRY MOUTH
Among 46 patients with NPC who were enrolled, 44 patients were analyzed (29 males [65.9%]; 23 Asian [52.3%], 2 Black [4.5%], and 16 White [36.4%]; 38 not Hispanic [86.4%]; median [IQR] age, 48.5 [39.0-56.0] years). There were 33 patients with a Zubrod performance status of 0, indicating that they were fully functional ...
PMC10238946
Conclusions and Relevance
hemorrhage
HEMORRHAGE, DISEASE, METASTASIS
In this nonrandomized controlled trial, no grade 4 hemorrhage or grade 5 AEs were reported in the first year or thereafter among patients with NPC receiving bevacizumab combined with chemoradiation. The rate of distant metastasis was low although 89% of patients had stage III to IVB disease, suggesting that further inv...
PMC10238946
Trial Registration
ClinicalTrials.gov Identifier:
PMC10238946
Introduction
NASOPHARYNGEAL CANCER
There are currently 2 standard treatment options for locoregionally advanced nasopharyngeal cancer (LA-NPC). Patients can be treated with induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) or CCRT followed by adjuvant chemotherapy.Overexpression of vascular endothelial growth factor (VEGF) A has bee...
PMC10238946
Methods
Cancer
CANCER
Patients signed written informed consent for this nonrandomized controlled study. The study was approved by the National Cancer Institute and participating centers’ institutional review boards; it is registered at ClinicalTrials.gov (
PMC10238946
Study Objectives and Patient Eligibility
cancer, Anderson Cancer, RTOG, Cancer
CANCER, DISEASE, CANCER
RTOG 0615 is a nonrandomized multicenter phase II trial at 19 cancer centers that included patients with previously untreated stage IIB through IVB NPC (according to the American Joint Committee on Cancer Staging Manual, 6th Edition [AJCC 6]). Participating centers were the Beth Israel Medical Center, Memorial Sloan Ke...
PMC10238946
Radiation, Chemotherapy, and Bevacizumab Guidelines
primary disease, tumor, necrotic
DISEASE, TUMOR, CAVITY, NECROTIC
For radiation planning, fusion of MRI or PET/CT scans with treatment-planning CT images was encouraged to accurately define the gross tumor volume, which consisted of the primary disease in the nasopharynx and nodes greater than 1 cm in diameter or nodes with necrotic centers. Areas at risk for subclinical spread of di...
PMC10238946
Follow-up and End Points
Cancer
ADVERSE EVENT, ADVERSE EVENT, CANCER
Patients underwent weekly examinations during CCRT. Follow-up evaluations occurred every 3 months during the first 2 years, every 6 months during years 3 to 5, and then annually. Adverse events were graded per National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Adverse events scored as...
PMC10238946
Primary End Point and Sample Size Derivation
hemorrhage
ADVERSE EVENTS, HEMORRHAGE
The primary end point was treatment-associated grade 4 hemorrhage or treatment-associated grade 5 adverse events in the first year after the start of treatment. The trial used a Fleming 2-stage design with 14 and 42 patients in the first and second stage (0.14 one-sided α and 83% power; acceptable and unacceptable rate...
PMC10238946
Secondary End Points
hemorrhage, death
ADVERSE EVENTS, HEMORRHAGE
Secondary end points were treatment-associated grade 4 hemorrhage or treatment-associated grade 5 adverse events after the first year, death during treatment or within 30 days of treatment completion (regardless of the cause of death), other grade 3 to 5 adverse events, feeding tube use rates, treatment tolerability (f...
PMC10238946
Statistical Analysis
cancer, tumor, death
TUMOR, METASTASIS, RECURRENCE, CANCER, MINOR
For the concurrent phase, tolerability was measured by the percentage of patients receiving 2 or more cycles of cisplatin and bevacizumab with RT; it was scored by study chairs (N.Y.L., J.K., and D.G.P.) as no variation or minor variation for tumor volume contouring score and organs at risk contouring score. For the ad...
PMC10238946
Results
PMC10238946
Patient Characteristics and Treatment Compliance
Among 46 patients with NPC enrolled in the study from December 13, 2006, to February 5, 2009, 44 patients (29 males [65.9%]; 23 Asian [52.3%], 2 Black [4.5%], and 16 White [36.4%]; 38 not Hispanic [86.4%]; median [IQR] age, 48.5 [39.0-56.0] years) were eligible for analysis (1 patient did not start protocol therapy, an...
PMC10238946
Study Flowchart
PMC10238946
Pretreatment Patient Characteristics
Cancer
CANCER
Abbreviations: AJCC, American Joint Committee on Cancer; WHO, World Health Organization.There was an option for more than 1 self-reported race in the patient clinical record.
PMC10238946
Treatment Outcome Data
cancer, deaths, death, failure
EVENTS, METASTASIS, CANCER
Median (IQR) follow-up for surviving patients was 9.0 (7.7-9.3) years compared with 2.5 (2.1-2.9) years for the initial report. After the initial report, 7 additional deaths were reported, for a total of 13 deaths (29.5%). Estimated 5- and 7-year OS rates were 79.5% (95% CI, 67.6%-91.5%) and 69.7% (95% CI, 55.9%-83.5%)...
PMC10238946
Estimates of Survival Rates
Shaded areas indicate pointwise 95% CIs.
PMC10238946
Toxic Effects Data
dysphagia, hearing impairment, hemorrhages, neuralgia, dry mouth
DYSPHAGIA, ADVERSE EVENTS, HEARING IMPAIRMENT, ADVERSE EVENT, HEMORRHAGES, DRY MOUTH
No grade 4 hemorrhages or grade 5 adverse events in the first year were reported in the prior publication,The most frequently reported late adverse event grades were grade 3, occurring in 16 patients (36.4%); grade 2, occurring in 16 patients (36.4%); and grade 1, occurring in 9 patients (20.5%). There were late grade ...
PMC10238946
Grade 3 Treatment-Associated Late Adverse Event Rates by Category and Term
Cancer
ADVERSE EVENT, ADVERSE EVENT, CANCER
Abbreviation: NOS, not otherwise specified.Treatment associated is defined as definitely, probably, or possibly associated with the protocol treatment. The late period is defined as more than 90 days after the end of treatment. Time points were measured from the end of treatment, with a window of 3 months before or aft...
PMC10238946
Discussion
head and neck squamous cell carcinoma, death, tumors, kidney cell cancer, lung cancer
HEPATOCELLULAR CARCINOMA, INFILTRATION, TUMORS, METASTASIS
Findings from our initial reportImmunotherapy (ie, programmed cell death 1 protein [PD1] inhibitors), has shown activity and promise for recurrent and metastatic NPC. Several phase II nonrandomized controlled trialsPhase III randomized clinical trialsCombining anti-VEGF with anti–PD1 and PDL1 therapies may be associate...
PMC10238946
Limitations
tumors
TUMORS
A limitation of this study was the small, nonrandomized sample size of 44 patients with locoregionally advanced NPC. Nonetheless, our findings suggest that VEGF inhibition may be combined safely with standard chemoradiation. We did not observe excessive rates of toxic effects with this combination even when tumors were...
PMC10238946
Conclusions
hemorrhage
HEMORRHAGE, DISEASE, METASTASIS
In this phase II nonrandomized controlled trial, no grade 4 hemorrhage or grade 5 AEs were reported with the addition of bevacizumab to CCRT for locally or regionally advanced NPC. The relatively low rate of distant metastasis despite nearly 90% of patients presenting with stage III to IVB disease is intriguing and may...
PMC10238946
References
Trial Protocol Click here for additional data file. Data Sharing Statement Click here for additional data file.
PMC10238946
Background
There is consistent evidence that the COVID-19 pandemic is associated with an increased psychosocial burden on children and adolescents and their parents. Relatively little is known about its particular impact on high-risk groups with chronic physical health conditions (CCs). Therefore, the primary aim of the study is ...
PMC10031163
Methods
obesity, diabetes
OBESITY, RHEUMATIC DISEASES, DIABETES
We will implement a two-stage approach. In the first step, parents and their underage children from three German patient registries for diabetes, obesity, and rheumatic diseases, are invited to fill out short questionnaires including questions about corona-specific stressors, the health care situation, and psychosocial...
PMC10031163
Discussion
The study will provide insights into the multiple longer-term stressors during the COVID-19 pandemic in families with a child with a CC. The simultaneous consideration of medical and psycho-social endpoints will help to gain a deeper understanding of the complex interactions affecting family functioning, psychological ...
PMC10031163
Trial registration
German Clinical Trials Register (DRKS), no. DRKS00027974. Registered on 27th of January 2022.
PMC10031163
Keywords
Open Access funding enabled and organized by Projekt DEAL.
PMC10031163
Background
obesity, anxiety, rheumatic disease, depression, diabetes
OBESITY, RHEUMATIC DISEASE, DIABETES
In Germany, around 10% of children and adolescents are affected by a chronic physical health condition, such as obesity, diabetes, or rheumatic disease [Also in times without a pandemic, children and youth with CCs as well as their parents are at increased risk of developing mental health problems, such as anxiety, dep...
PMC10031163
Methods
PMC10031163
Objectives
obesity, chronic diseases, COVID-19 infection, diabetes
OBESITY, DISEASE, CHRONIC DISEASES, COVID-19 INFECTION, DIABETES
Based on a comprehensive understanding of the complex interplay between medical condition, health care use, and environmental and specific context factors in CC (see Fig. Conceptual model of the proposal considering the ICF structure (modified according to Cieza and Stucki [Based on the biopsychosocial model, the speci...
PMC10031163
Study design
RECRUITMENT
The ongoing prospective observational study started recruitment in June 2021. A two-step approach (see Fig. Illustration of the study design and recruitment process
PMC10031163
Study participants
Diabetes, diabetes
DIABETES, DIABETES
Parents and their underage children (aged up to 18 years) who are already taking part in any of the three patient registries for diabetes (German Diabetes Prospective Follow-up Registry, DPV [
PMC10031163
Recruitment
RECRUITMENT
Recruitment takes place during the regular check-ups within the participating clinical facilities. Clinicians ask their adolescent patients and their accompanying parents to fill in a two-page short questionnaire during their waiting time; for children younger than 12 years, the questionnaire is only completed by the a...
PMC10031163
Study measures
This survey uses several questionnaires and self-constructed items to fulfil the primary study objectives stated above.
PMC10031163
Basic survey: Common measures for parents and children
Several measures are administered for the data collection. While parents are asked to fill out the questionnaire for their children under the age of 12, they answer an additional separate questionnaire when their afflicted child is older than 12. The following assessments are identical for the parents of these two age ...
PMC10031163
COVID-19 pandemic-specific impact on well-being and everyday life
Based on experience from a previous study [
PMC10031163
Health-related strain
Two self-constructed items [
PMC10031163
Disease-specific health care use
A total of 10 self-constructed items are implemented to assess the corona-specific utilization of health services in the past 12 months. Parents are asked to provide information about the frequency of disease-specific health care visits; medical appointment cancellations and their causes; and the provision and quality ...
PMC10031163
Basic survey: Common measures for children and adolescents
For the questionnaires aiming at the data collection in children under the age of 12 and adolescents aged 12 years or older, the following measures are applied.
PMC10031163
Perceived stress
A self-constructed item aims to assess how stressed the child feels because of the COVID-19 pandemic with an 11-point numerical rating scale ranging from 0 “not stressed at all” to 10 “totally stressed”. As described above, for children under the age of 12, the accompanying parent is asked to rate this item for their c...
PMC10031163
Perceived loneliness
To measure how lonely a child feels due to the COVID-19 pandemic, a self-constructed item on a Likert scale ranging from 0 to 10 is applied. Older children are asked to select a response ranging from “not stressed at all” to “totally stressed”, and the parents answer this item for younger children.
PMC10031163
COVID-19-specific well-being in everyday life
A self-constructed 5-item scale based on Warschburger et al. [
PMC10031163
Basic survey: Measures for adolescents
PMC10031163
School experience
HOLIDAYS
Two items have been constructed for the purpose of assessing the educational experiences of adolescents during the COVID-19 pandemic. One multiple-choice question aims to assess the teaching method that the students encountered during the last 2 weeks, with possible answers comprising home-schooling, classroom teaching...
PMC10031163
Perceived risk
The risk perception of adolescents is measured with three self-constructed items [
PMC10031163
Media usage
A 5-point Likert scale established by another survey [
PMC10031163
Anxiety
Anxiety
Anxiety symptoms (e.g., not being able to stop or control worrying) during the past 2 weeks are measured with the German version of the General Anxiety Disorder-Scale (GAD-7) [
PMC10031163