Research at the Institute of Public Health

Research at the Institute of Public Health focuses on

  • Epidemiology (renal, cardiovascular, neuro)
  • Health services research
  • Science research.

You are here:

Research in Public Health

In recent decades, scientists have successfully identified many risk factors for diseases and named causes of the spread of diseases. Now the causal relationships are shifting into the spotlight of public and population health research. Factors that affect health usually don't occur in isolation but are causally linked.

One important research topic at the Institute for Public Health is aging, a cross-cutting topic that covers both aspects of health services research, prevention, epidemiology and methodology.

The epidemiologic research at the institute focuses on nephrology, the cardiovascular system and neurology. Health services research concentrates on the systems, structures and patient-oriented outcomes of the health care system.

Key Research Areas of the Institute of Public Health in Berlin

Recent Publications

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Simona Sacco, Gabriele S. Merki-Feld, Karen Lehrmann Ægidius, Johannes Bitzer, Marianne Canonico, Tobias Kurth, Christian Lampl, Øjvind Lidegaard, E. Anne MacGregor, Antoinette MaassenVanDenBrink, Dimos-Dimitrios Mitsikostas, Rossella Elena Nappi, George Ntaios, Per Morten Sandset, Paolo Martelletti, and on behalf of the European Headache Federation (EHF) and the European Society of
Contraception and Reproductive Health (ESC)

Abstract
Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face the issue of migraine and hormonal contraceptive use in clinical practice. In this document, we systematically reviewed data about the association between migraine, ischemic stroke and hormonal contraceptive use. Thereafter a consensus procedure among international experts was done to develop statements to support clinical decision making, in terms of cardiovascular safety, for prescription of hormonal contraceptives to women with migraine. Overall, quality of current evidence regarding the risk of ischemic stroke in migraineurs associated with the use of hormonal contraceptives is low. Available data suggest that combined hormonal contraceptive may further increase the risk of ischemic stroke in those who have migraine, specifically migraine with aura. Thus, our current statements privilege safety and provide several suggestions to try to avoid possible risks. As the quality of available data is poor further research is needed on this topic to increase safe use of hormonal contraceptives in women with migraine

Complete article:

The Journal of Headache and Pain, 2017, DOI 10.1186/s10194-017-0815-1

Effect of a Website That Presents Patients’ Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial

Effect of a Website That Presents Patients’ Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial

Jürgen M Giesler;  Bettina Keller;  Tim Repke;  Rainer Leonhart ;  Joachim Weis ;  Rebecca Muckelbauer;  Nina Rieckmann;  Jacqueline Müller-Nordhorn ;  Gabriele Lucius-Hoene ;  Christine Holmberg

Background: Patients often seek other patients’ experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people’s health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients’ Experiences) aims to provide scientifically based online information on people’s experiences with health and illness to fulfill patients’ needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences.

Objective: The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence.

Methods: In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks

Results: The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline.

Conclusions: The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users’ motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients’ perceived effects of using such a website.

Trial Registration: Clinicaltrials.gov NCT02157454; clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi)

Published: Journal of Medical Internet Research, 13.10.17 in Vol 19, No 10 (2017)

NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project-1 Results: Decision Making in Breast Cancer Risk Reduction

NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project-1 Results: Decision Making in Breast Cancer Risk Reduction

Christine Holmberg, Hanna Bandos, Angela Fagerlin, Therese B. Bevers, Tracy A. Battaglia, D. Lawrence Wickerham and Worta J. McCaskill-Stevens

Selective estrogen receptor modulators (SERMs) reduce breast cancer risk. Adoption of SERMs as prevention medication remains low. This is the first study to quantify social, cultural, and psychologic factors driving decision making regarding SERM use in women counseled on breast cancer prevention options. A survey study was conducted with women counseled by a health care provider (HCP) about SERMs. A statistical comparison of responses was performed between those who decided to use and those who decided not to use SERMs. Independent factors associated with the decision were determined using logistic regression. Of 1,023 participants, 726 made a decision: 324 (44.6%) decided to take a SERM and 402 (55.4%) decided not to. The most important factor for deciding on SERM use was the HCP recommendation. Other characteristics associated with the decision included attitudes and perceptions regarding medication intake, breast cancer worry, trust in HCP, family members with blood clots, and others' experiences with SERMs. The odds of SERM intake when HCP recommended were higher for participants with a positive attitude toward taking medications than for those with a negative attitude (Pinteraction = 0.01). This study highlights the importance of social and cultural aspects for SERM decision making, most importantly personal beliefs and experiences. HCPs' recommendations play a statistically significant role in decision making and are more likely to be followed if in line with patients' attitudes. Results indicate the need for developing interventions for HCPs that not only focus on the presentation of medical information but, equally as important, on addressing patients' beliefs and experiences. Cancer Prev Res; 1–10. 4.10.2017

See complete article in: American Association for Cancer Research Publications

Deciding on breast cancer risk reduction: The role of counseling in individual decisionmaking – A qualitative study

Deciding on breast cancer risk reduction: The role of counseling in individual decisionmaking
– A qualitative study, Patient Educ Couns (2017)

Sarah B. Blakeslee, Worta McCaskill-Stevens, Patricia A. Parkerc, Christine M. Gunn, Hanna Bandos, Therese B. Bevers, Tracy A. Battaglia, Angela Fagerlin, Jacqueline Müller-Nordhorn, Christine Holmberg

Objectives: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women’s decision-making.
Methods: Thirty breast cancer risk counseling sessions were recorded from April 2012–August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis.
Results: Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer.
Conclusion: Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations.
Practice implications: Individuals’ health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients’ experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.

Complete Article in Patient Education and Counseling

Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions

Exploring Explanatory Models of Risk in Breast Cancer Risk Counseling Discussions: NSABP/NRG Oncology Decision-Making Project 1

Gunn CM1, Bokhour B, Parker VA, Parker PA, Blakeslee S, Bandos H, Holmberg C.

Background:
Explanatory models represent patient understanding of etiology, pathophysiology, illness, symptoms, and treatments, but little attention has been paid to how they are used by patients "at risk" for future disease.
Objective:
The aims of this study were to elucidate what constitutes an explanatory model of risk and to describe explanatory models of risk related to developing breast cancer.
Methods:
Thirty qualitative interviews with women identified as at an increased risk for breast cancer were conducted. Interviews were coded to identify domains of explanatory models of risk using a priori codes derived from the explanatory model of illness framework. Within each domain, a grounded thematic analysis described participants' explanatory models related to breast cancer risk.
Results:
The domains of treatment and etiology remained similar in a risk context compared with illness, whereas course of illness, symptoms, and pathophysiology differed. We identified a new, integrative concept relative to other domains within explanatory models of risk: social comparisons, which was dominant in risk perhaps due to the lack of physical experiences associated with being "at risk."
Conclusions:
Developing inclusive understandings of risk and its treatment is key to developing a framework for the care of high-risk patients that is both evidence based and sensitive to patient preferences.
IMPLICATIONS FOR PRACTICE:
The concept of "social comparisons" can assist healthcare providers in understanding women's decision making under conditions of risk. Ensuring that healthcare providers understand patient perceptions of risk is important because it relates to patient decision making, particularly due to an increasing focus on risk assessment in cancer.

Complete Article in Pubmed

The politics of vaccination A global history

 "Politics of Vaccination. A global history"
Christine Holmberg, senior researcher at the Institute of Public Health, together with Paul Greenough from the University of Iowa, and Stuart Blume, University of Amsterdam.

In this book scholars from around the globe analyse vaccination in relation to state power, concepts of national identity and solidarity, and of individuals' obligations to self and others. The essays provide a comparative overview of vaccination policies at different times, in widely different places, and under different types of political regime.  Authors explore relationships between vaccination policies and vaccine-making, and the discourses and debates on citizenship and nationhood that have often accompanied mass campaigns. The analysis unmasks the idea of vaccination as a simple health technology, and makes visible the complexities in which vaccination is embedded.
The book provides a comprehensive overview of global vaccination politics, immunisation is analyzed  and characterized in its political dimension in forming (or weakening ) nation-states. It is a truly global history, including scholars and cases not only from "the West", but also from such countries as Brazil, South Korea, and Mexico. The book suggests immunisation is a novel historical lens through which to view changes in 'society' and 'nation' over time.

Physician cooperation in outpatient cancer care

Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data
J. Engler
, C. Güthlin, A. Dahlhaus, E. Kojima, J. Müller-Nordhorn, L. Weißbach, C. Holmberg

Objectives The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany.
Conclusions
Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone.

Completed projects (selection)

Projectname Category
Krankheitsvorstellungen und Krankheitserfahrungen von Ovarialkarzinompatientinnen Versorgungsforschung
Berufsprofil und Arbeitsfelder der Diätassistentinnen und Diätassistenten in Deutschland Versorgungsforschung
Sozialpolitische Entwicklungen und die Einführung neuer medizinischer Praktiken Wissenschaftssforschung
Medizinische Versorgung von Menschen ohne legalen Aufenthaltsstatus in Berlin. Eine Befragung von Ärzt/innen in Berlin Versorgungsforschung
Evaluation des Projektes "Unsere Kommune ist demenzfreundlich" Versorgungsforschung
Evaluation des Projektes "Menschen mit Demenz in der Kommune - Achtsamkeit und seelsorgerische Begleitung für Menschen mit Demenz" Versorgungsforschung
Gesundheitsförderung durch Empowerment von Frauen im Setting Stadtteil – Evaluation des Projekts Stadtteilmütter in Berlin-Kreuzberg Versorgungsforschung
Biobanks and the communication of risk knowledge: Interventions by researchers, practioners and artists Wissenschaftsforschung

Research database

For more details please use the Charité research database.