All treatment methods under study were appropriate for achieving comparable clinical and functional outcome. The internal fixator is superior in restoration of the spinal alignment. Best radiological outcome is achieved by combined stabilization. Merely by direct reconstruction of the anterior column the postoperative re-kyphosing is prevented and a gain in segmental angle is achieved.

Background Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. Objective This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. Methods We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. Results The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines. Conclusions These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects.

Background Lipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT. Methods/design LIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema (n=405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0–10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction. The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher’s exact test in a hierarchical test strategy. Discussion LIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema. Trial registration ClinicalTrials.gov NCT04272827. Registered on February 14, 2020. Trial status Protocol version is 02_0, December 17, 2019

No abstract

Background Cancer patients often suffer from psychological distress. Psycho‐oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs). Methods Center‐reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted. Results Model 1 showed that utilization of POS in PCCs is associated with patients’ age (OR = 0.98; 95%‐CI = 0.96‐0.99; P < .001), number of comorbidities (1‐2 vs 0, OR = 1.27; 95%‐CI = 1.00‐1.60; P=.048), disease staging (localized high‐risk vs localized intermediate risk, OR = 1.41; 95%‐CI = 1.14‐1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%‐CI = 0.10‐0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%‐CI = 0.02‐0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%‐CI = 0.03‐0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%‐CI = 0.02‐0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high‐risk vs localized intermediate risk, OR = 1.31; 95%‐CI = 1.05‐1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%‐CI = 0.01‐0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics. Conclusions Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects – for example, less need following radiotherapy – or because access to POS is more difficult for those receiving radiotherapy.

The Blue Whale Challenge (BWC) is an online viral "game" that allegedly encourages youth and young adults towards self-harming behaviors that could eventually lead to suicide. The BWC can be situated within a larger phenomenon of viral online self-harm challenges, which may be propagated through both social media and news sources. Research has established that suicide is a global public health issue that is known to be influenced by media reporting. Violation of safe messaging guidelines has been shown to increase imitative suicides, particularly in youth and young adults. Given the confirmed effects of news media reporting, we analyzed 150 digital newspaper articles reporting on the BWC to assess whether they adhered to suicide prevention safe messaging guidelines. Overall, 81% of the articles violated at least one contagion-related guideline, most commonly normalizing suicide, discussing means of suicide, and sensationalizing. Even though the majority (91%) of the articles adhered to at least one health-promotion guideline, such as emphasizing prevention, the articles did not follow these guidelines on a deep and comprehensive level. Through thematic analysis, we also found evidence of potential misinformation in reporting, where the articles unequivocally attributed many suicides to the BWC with little or no evidence. Additionally, articles often stated an individual's reason for participating in the challenge without interviewing the individual or those close to the individual, another aspect of potential misinformation due to lack of evidence. A contribution of the current study is the synthesis of safe messaging guidelines that can be used in future research. This study contributes to the understanding of news reporting practices regarding suicide and self-harm in regard to the BWC and similar online challenges. We discuss how sensationalized news media reports on the BWC could unintentionally propagate suicide contagion effects that normalize self-harming behaviors among youth. We then examine implications for practice and policy, such using automated approaches to aid reporters in adhering to safe messaging guidelines.

Purpose: To give an overview of the multicenter Prostate Cancer Outcomes (PCO) study, involving paper-based and web-based collection of patient-reported outcome measures (PROM) in patients undergoing local treatment for prostate cancer in certified centers in Germany. The PCO study is part of the larger Movember-funded TrueNTH Global Registry. The article reports on the study's design and provides a brief progress report after the first 2 years of data collection. Methods: Prostate cancer centers (PCCs) certified according to German Cancer Society requirements were invited to participate in collecting patient-reported information on symptoms and function before and at least once (at 12 months) after treatment. The data were matched with disease and treatment information. This report describes progress in patient inclusion, response rate, and variations between centers relative to online/paper use, and also data quality, including recruitment variations relative to treatment in the first participating PCCs. Results: PCC participation increased over time; 44 centers had transferred data for 3094 patients at the time of this report. Patient recruitment varied widely across centers. Recruitment was highest among patients undergoing radical prostatectomy. The completeness of the data was good, except for comorbidity information. Conclusions: The PCO study benefits from a quality improvement system first established over 10 years ago, requiring collection and harmonization of a predefined clinical dataset across centers. Nevertheless, establishing a PROM routine requires substantial effort on the part of providers and constant monitoring in order to achieve highquality data. The findings reported here may be useful for guiding implementation in similar initiatives.

Introduction Social media has created opportunities for children to gather social support online (Blackwell et al., 2016; Gonzales, 2017; Jackson, Bailey, & Foucault Welles, 2018; Khasawneh, Rogers, Bertrand, Madathil, & Gramopadhye, 2019; Ponathil, Agnisarman, Khasawneh, Narasimha, & Madathil, 2017). However, social media also has the potential to expose children and adolescents to undesirable behaviors. Research showed that social media can be used to harass, discriminate (Fritz & Gonzales, 2018), dox (Wood, Rose, & Thompson, 2018), and socially disenfranchise children (Page, Wisniewski, Knijnenburg, & Namara, 2018). Other research proposes that social media use might be correlated to the significant increase in suicide rates and depressive symptoms among children and adolescents in the past ten years (Mitchell, Wells, Priebe, & Ybarra, 2014). Evidence based research suggests that suicidal and unwanted behaviors can be promulgated through social contagion effects, which model, normalize, and reinforce self-harming behavior (Hilton, 2017). These harmful behaviors and social contagion effects may occur more frequently through repetitive exposure and modelling via social media, especially when such content goes “viral” (Hilton, 2017). One example of viral self-harming behavior that has generated significant media attention is the Blue Whale Challenge (BWC). The hearsay about this challenge is that individuals at all ages are persuaded to participate in self-harm and eventually kill themselves (Mukhra, Baryah, Krishan, & Kanchan, 2017). Research is needed specifically concerning BWC ethical concerns, the effects the game may have on teenagers, and potential governmental interventions. To address this gap in the literature, the current study uses qualitative and content analysis research techniques to illustrate the risk of self-harm and suicide contagion through the portrayal of BWC on YouTube and Twitter Posts. The purpose of this study is to analyze the portrayal of BWC on YouTube and Twitter in order to identify the themes that are presented on YouTube and Twitter posts that share and discuss BWC. In addition, we want to explore to what extent are YouTube videos compliant with safe and effective suicide messaging guidelines proposed by the Suicide Prevention Resource Center (SPRC). Method Two social media websites were used to gather the data: 60 videos and 1,112 comments from YouTube and 150 posts from Twitter. The common themes of the YouTube videos, comments on those videos, and the Twitter posts were identified using grounded, thematic content analysis on the collected data (Padgett, 2001). Three codebooks were built, one for each type of data. The data for each site were analyzed, and the common themes were identified. A deductive coding analysis was conducted on the YouTube videos based on the nine SPRC safe and effective messaging guidelines (Suicide Prevention Resource Center, 2006). The analysis explored the number of videos that violated these guidelines and which guidelines were violated the most. The inter-rater reliabilities between the coders ranged from 0.61 – 0.81 based on Cohen’s kappa. Then the coders conducted consensus coding. Results & Findings Three common themes were identified among all the posts in the three social media platforms included in this study. The first theme included posts where social media users were trying to raise awareness and warning parents about this dangerous phenomenon in order to reduce the risk of any potential participation in BWC. This was the most common theme in the videos and posts. Additionally, the posts claimed that there are more than 100 people who have played BWC worldwide and provided detailed description of what each individual did while playing the game. These videos also described the tasks and different names of the game. Only few videos provided recommendations to teenagers who might be playing or thinking of playing the game and fewer videos mentioned that the provided statistics were not confirmed by reliable sources. The second theme included posts of people that either criticized the teenagers who participated in BWC or made fun of them for a couple of reasons: they agreed with the purpose of BWC of “cleaning the society of people with mental issues,” or they misunderstood why teenagers participate in these kind of challenges, such as thinking they mainly participate due to peer pressure or to “show off”. The last theme we identified was that most of these users tend to speak in detail about someone who already participated in BWC. These videos and posts provided information about their demographics and interviews with their parents or acquaintances, who also provide more details about the participant’s personal life. The evaluation of the videos based on the SPRC safe messaging guidelines showed that 37% of the YouTube videos met fewer than 3 of the 9 safe messaging guidelines. Around 50% of them met only 4 to 6 of the guidelines, while the remaining 13% met 7 or more of the guidelines. Discussion This study is the first to systematically investigate the quality, portrayal, and reach of BWC on social media. Based on our findings from the emerging themes and the evaluation of the SPRC safe messaging guidelines we suggest that these videos could contribute to the spread of these deadly challenges (or suicide in general since the game might be a hoax) instead of raising awareness. Our suggestion is parallel with similar studies conducted on the portrait of suicide in traditional media (Fekete & Macsai, 1990; Fekete & Schmidtke, 1995). Most posts on social media romanticized people who have died by following this challenge, and younger vulnerable teens may see the victims as role models, leading them to end their lives in the same way (Fekete & Schmidtke, 1995). The videos presented statistics about the number of suicides believed to be related to this challenge in a way that made suicide seem common (Cialdini, 2003). In addition, the videos presented extensive personal information about the people who have died by suicide while playing the BWC. These videos also provided detailed descriptions of the final task, including pictures of self-harm, material that may encourage vulnerable teens to consider ending their lives and provide them with methods on how to do so (Fekete & Macsai, 1990). On the other hand, these videos both failed to emphasize prevention by highlighting effective treatments for mental health problems and failed to encourage teenagers with mental health problems to seek help and providing information on where to find it. YouTube and Twitter are capable of influencing a large number of teenagers (Khasawneh, Ponathil, Firat Ozkan, & Chalil Madathil, 2018; Pater & Mynatt, 2017). We suggest that it is urgent to monitor social media posts related to BWC and similar self-harm challenges (e.g., the Momo Challenge). Additionally, the SPRC should properly educate social media users, particularly those with more influence (e.g., celebrities) on elements that boost negative contagion effects. While the veracity of these challenges is doubted by some, posting about the challenges in unsafe manners can contribute to contagion regardless of the challlenges’ true nature.