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Background: Living wills regulate medical decisions in emergency situations. Those who create a living will can have it registered voluntarily in the Central Register of Lasting Powers of Attorney. Little is known about the general prevalence of living wills. Methods: The German Ageing Survey is an ongoing, population-representative study. 4,185 people aged 50 and older were surveyed about living wills in 2020/2021. Results: 44.8 % of people aged 50 and older have a living will, women more often than men (50.1 % vs. 39.2 %), older people more often than middle-aged people. Educational differences do not exist. Conclusions: Living wills increase the autonomy in medical emergency situations because the patient’s wishes are specified in written form. People of all age groups should inform themselves about the significance of living wills and should seek advice about the contents, for example from the general practitioner or one’s own health insurance.

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Gerontologie und Geriatrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In old age, taking medications in the desired dosage contributes to health and wellbeing and is therefore an essential component of the effectiveness of treatments and ultimately the desired impact on public health and reduction of health care budgets. However, it is known that medication compliance among older persons is frequently not at the desired level. Therefore, this study aimed to determine the medication compliance after patient education was applied among 60 years of age and over individuals in two healthcare facilities in Ankara, Turkey. Methods: This study was conducted in two public hospitals between March and July 2019. 315 people aged 60 and over participated in the study. One hundred and sixty-one participants who received regular health services (without medication compliance education) were in Group 1, and 154 participants who received medication compliance education were in Group 2. The education tool was the "teach-back" method. SPSS 23.0 program was used for data entry and analysis. P values less than 0.05 were indicated for statistical significance. Results: Participants who received education showed a statistically significant improvement in their capacity to understand the long-term benefits of drugs, their side effects, and storage conditions, as well as their knowledge of when the drugs should not be taken and their ability to repeat information about the drugs used (p<0,05). Conclusion: This study has revealed that medication compliance among older individuals can be increased with appropriate communication and training method like the "teach-back" method in healthcare settings. Time allocated by health workers in this regard has the potential to respond to compliance-related needs. It is recommended that such techniques be integrated into routine health service models. [ABSTRACT FROM AUTHOR]

Some drugs prolong the QT interval, which can be fatal in the presence of other risk factors. In the 3040 forensic autopsy cases that underwent toxicological analysis over the past five years, in which no certain cause of death could be identified, at least one drug with QT interval prolonging potential was detected in 188 individuals (6%). Risk factors for cardiac events, incl. a history of drug and/or alcohol abuse (45%), pathological cardiovascular changes (66%), and more than one QT-prolonging drug (64%) pointed toward fatal arrhythmic events resulting from the drug, of which antipsychotics were the most prevalent in our cohort., (© 2024. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The impairment of mental health among veterinary professionals has raised public awareness in recent years. The driving forces include a serious gap in veterinary services - with less available veterinary colleagues, especially in rural areas - and a general lack of veterinary graduates. This article presents the results of our first Swiss survey on psychological well-being in the veterinary profession. Our results are viewed both in the current context and in the context of developments that have already taken place in other medical disciplines. Results indicate higher levels of stress in veterinarians working as clinicians, in female colleagues, in veterinarians of younger age and veterinarians under employment. In the meantime, larger surveys such as the Vétos Entraide (https://vetos-entraide.com) were established in France and projects such as the Happy Vet project (https://happyvetproject.org) were launched in Switzerland for eg. the burnout prevention in the profession. However, the topic of «mental health» remains highly relevant in veterinary medicine and requires further research and measures, which should consider the identified predisposing factors, such as age and gender.

Aim of the Study: Diabetes mellitus is associated with an increased likelihood of mental disorders, especially depression. Despite a frequently postulated underprovision, the actual need for psychotherapeutic treatment in this patient group has hardly been investigated. The aim of this study is to analyze the care situation of diabetes patients with mental comorbidities in Germany., Methods: 240 consecutively treated patients with type 1 or type 2 diabetes were examined cross-sectionally and longitudinally in a tertiary diabetological center. After a screening and diagnostic examination, 94 patients with comorbid mental disorders were included in the study. Patients then decided on the treatment of their mental disorder according to a standardized shared decision-making process. At the 6-month follow-up, 77 of the 94 patients (81.9%) provided information about the realization of their treatment decision and the obstacles they encountered., Results: 39.2% of patients with diabetes had a mental disorder. Of these, 44.2% were already receiving psychotherapy or medication. After six months, 46.8% were able to implement their treatment decision. Only 7.1% did not receive any treatment despite their efforts. The 6-month follow-up showed a significant reduction in diabetes-related distress (PAID; p<0.05) and an increase in psychological well-being in all subgroups, regardless of treatment initiation (WHO-5; p<0.05)., Discussion: Contrary to the widespread notion of a lack of access to psychotherapy for people with diabetes and mental disorders in Germany, this assumption could not be confirmed in this study., Conclusion: Equating the frequency of mental disorders with the need for psychotherapeutic and/or psychopharmacological treatment without considering the specific treatment needs and preferences of patients may lead to an overestimation of the need for care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Respiratory syncytial virus (RSV) is a frequent cause of respiratory infections in all age groups. Infections in infants and older adults frequently result in severe disease and complications. There is no specific antiviral treatment against RSV. The characterization of the structure of the fusion (F) protein in its immunogenic prefusion conformation has enabled the development of novel vaccines directed against the prefusion protein as the antigen. These include an adjuvanted monovalent vaccine (Arexvy) and a nonadjuvanted bivalent vaccine (Abrysvo). Both are approved and indicated for use in older adults, in whom they have been shown to be over 80% effective in the protection against symptomatic RSV infections and associated lower respiratory tract diseases. Abrysvo is approved for use in pregnancy to protect the newborn through the transplacental transfer of high-titer maternal antibodies. The vaccine has been shown to have an efficacy of over 80% in the first 3 months of life to protect the infant from severe RSV-associated lower respiratory disease but slightly deceases after an age of 6 months. The clinical studies demonstrated the safety of the vaccines in both adults and pregnant women. The rate of undesired side effects was low in all studies and severe side effects were very rare. The new vaccines are efficacious new tools to prevent RSV-associated disease and complications in high-risk groups. For infants, an alternative strategy can be passive immunization with monoclonal antibodies, including the recently developed nirsevimab, which has also shown high efficacy., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Rsv (respiratory Syncytial Virus): RSV is a common cause of respiratory tract infections, posing a risk of severe disease, particularly for newborns and infants, as well as in older individuals with pre-existing conditions. Two safe and effective RSV vaccines were approved in 2023. These vaccines elicit protective antibodies and offer robust protection with no additional benefit from annual boosters. Both vaccines have been approved for individuals aged 60 years and older, while one of the vaccines has also been approved in pregnant women to elicit maternal immunity for passive protection of the unborn child. In Germany, RSV vaccination is currently recommended for all individuals aged 75 years and older, as well as people aged 60-74 years of age with severe underlying conditions. PNEUMOCOCCAL INFECTION: Streptococcus pneumoniae is a primary cause of community-acquired pneumonia (CAP). Since early 2022, a 20-valent conjugate vaccine (PCV20) is approved and recommended for people over 60 years of age and individuals over 18 years of age with risk factors. PCV20 replaces the 23-valent polysaccharide vaccine (PPV23) previously recommended for those over 60 years of age., Pertussis: Although viewed primarily as a childhood disease, the majority of infections affect adults. Patients with chronic respiratory diseases are at a higher risk for severe clinical course of pertussis infection. It has therefore been recommended that all adults should get a pertussis booster with their next scheduled tetanus vaccination, given as a combination vaccine (Tdap). For risk groups (healthcare personnel, community facilities) a booster vaccination every 10 years is recommended., Herpes Zoster: Herpes Zoster (shingles) is caused by the varicella-zoster virus, and reactivations can lead to painful skin lesions and potential complications such as herpes zoster oticus, meningitis, or postherpetic neuralgia. People with chronic lung diseases such as COPD or asthma are at increased risk of herpes zoster-related complications. A recombinant adjuvanted inactivated vaccine was approved in 2018 and offers robust protection against herpes zoster and its complications. The vaccine is recommended for all people over 60 years of age and for certain risk groups over 50 years of age., Competing Interests: Leif Erik Sander gibt Beratertätigkeiten für OM-Pharma SA an., (Thieme. All rights reserved.)

Cardiovascular risk factors (high blood pressure, smoking, overweight, type 2 diabetes, dyslipidemia, physical inactivity) substantially rise with increasing age, particularly after middle age, whereby women are affected to a much greater extent. In the population of Saxony-Anhalt the prevalence of cardiovascular risk factors is clearly increased and the population structure in Saxony-Anhalt is particularly characterized by a high average age as well as high morbidity and mortality rates due to cardiovascular diseases. Saxony-Anhalt therefore provides a model character for the demographic development in Europe. This review article discusses strategies for the implementation of target group-specific cardiovascular preventive strategies in the Federal State of Saxony-Anhalt with special consideration of age and sex. When preventive medicine facilities are established and innovative treatment possibilities for patients with cardiovascular risks are created, prevention should also become available in rural areas., (© 2024. The Author(s).)

Introduction: Currently, only little data is available on the impact of the COVID-19 pandemic on inpatient dermatosurgical care in German dermatological clinics., Methods: A retrospective analysis of all dermatosurgical cases that were treated in inpatient setting in nine German dermatological clinics in four federal states in 2019, 2020 and 2021 was performed. The diagnoses were recorded using the ICD-10 codes. In addition, demographic data such as age, gender and the length of inpatient stay were analysed., Results: In 2019, 2020 and 2021, a total of 10,739, 9185 and 9828 dermatosurgical inpatients were treated respectively. Thus, the reduction of inpatient dermatosurgical cases was 14.5% in 2020 and 8.5% in 2021 compared to 2019. Inpatient surgical treatment of melanoma decreased by 10.1% of cases in 2020. This decrease was only 1.4% in 2021 compared to 2019. The number of inpatient surgeries performed for benign lesions such as melanocytic nevi or viral warts reduced sharply in both pandemic years., Conclusion: Our data show for the first time how inpatient care for the entire spectrum of dermatosurgical diseases developed during the COVID-19 pandemic in Germany. After the initial marked decline in inpatient dermatosurgical cases in 2020, there was less difference in 2021 compared to 2019. This trend can be interpreted as an indication that there is still a strong need for inpatient dermatosurgical care that cannot yet be met on an outpatient basis., (© 2024. The Author(s).)

Background: In surgery for sepsis it is a well-established principle that no internal osteosynthetic material should be implanted in cases of chronic osteomyelitis. Therefore, the surgical treatment with intramedullary nails is so far used only rarely in cases of chronic osteomyelitis., Objective: This study analyzed whether the implantation of tibial intramedullary nails is an effective treatment for chronic osteomyelitis and how high is the rate of reinfection., Material and Methods: A retrospective analysis of patients with an infected pseudarthrosis of the tibia in whom a gentamycin-coated nail (ETN) or an uncoated tibial intramedullary nail (UCN) was implanted between December 2011 and December 2019 was carried out. The preoperative, perioperative and postoperative results were evaluated., Results: During the study period 29 patients received a UCN and 27 patients received an ETN. Of the patients 95% (n = 53) had been previously unsuccessfully treated with external fixation. Postoperative complications occurred in 45% of the patients and more often in the ETN group (48% vs. 41%). Reexacerbation of the infection occurred in 20 patients and more frequently in the UCN group (38% vs. 33%). The nonunion already showed a bony consolidation at the time of the exacerbation in 10 patients (50%). At the end of the follow-up a consolidation was present in 48 patients (86%), more frequently in the UCN group (90% vs. 78%). Of the patients 50 (89%) reached full weight bearing without any differences between the groups., Conclusion: Despite a relatively high a rate of postoperative complications the risk of reinfection was acceptable with good functional and radiological results. The main general advantages of nailing are without doubt the high primary stability, the implantation with preservation of the soft tissue and the improved wearing comfort for patients., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This study presents first descriptive statistics on the usage behavior relating to discounted tickets for public transportation as part of an initiative of the German Federal Government in 2022. During a three-month period, 103 psychiatric outpatients of the University Clinic - Charité Berlin provided self-reported data by completing a survey. In general results suggested a high usage rate of the so-called "9-Euro-ticket" of 89,3%. Due to its purchase, 37,9% (N=39) of the participants felt motivated to explore unknown places. Furthermore, approximately one third of the sample (34,9%; n=36) reported an increase of social contacts as a result of their ticket usage. A higher influence of costs on participants' activity levels was associated with an increase in main symptoms. Higher age was correlated with a decrease of patients' core symptoms due to their activity. Results indicate a high usage of reduced-price tickets for subsidized public transport by the patients concerned., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The increasing interruptions of nocturnal sleep with aging must be distinguished from actual sleep disorders. Morbidity and medication have an impact on sleep. The relationship between sleep and morbidity is mutual. Disturbed sleep modifies many clinical symptoms and diseases affect sleep and the ability to sleep. Geriatric syndromes such as falls, depression and dementia are modified by sleep disorders. Geriatric syndromes can be favorably influenced by the treatment of sleep disorders. Adequate diagnostics are important prerequisites. Coincidences of different sleep disorders are frequent. The medical history of patients and a sleep diary form the basis of the diagnostics. Sleep medicine provides further technical examination procedures. Older people should be examined in a sleep laboratory if the results have consequences that are accepted by the patient. This should be clarified in advance., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The article demonstrates the contributions of the innovation program "D-Care Lab Baden-Württemberg 2023" to the development of innovative solutions for neighborhood care. The effects of the program are reconstructed on the basis of initial research findings pertaining to the innovation program. A distinctive aspect of the laboratory is its cross-sectoral collaborative structure. The levels of impact can be defined as follows: the acquisition of skills by the participants, the connection between skills acquisition and learning arrangement, the changes observed as a result of participation and the innovative solutions developed for care in the neighborhood. The initial results are presented in accordance with the theoretical research design and research methods previously outlined. The results demonstrate alterations in the competence profiles of the participants and the impact of the cooperative laboratory setting on the development of solutions. Based on these findings, the function of innovation programs becomes evident, thereby highlighting the necessity for mid-term to long-term impact analysis., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Fatigue is an unspecific symptom complex characterized by tiredness, lack of energy, and lack of concentration and is of considerable public health relevance, due to its links with incapacity for work, risk of accidents, and increased need for healthcare., Methods: The analyses are based on data from 9766 adults of the telephone survey "Gesundheit in Deutschland aktuell (GEDA)" 2023. Fatigue was recorded using the Fatigue Assessment Scale (FAS), a validated instrument with 10 questions for self-assessment of fatigue. The scale was dichotomized into yes (at least mild to moderate fatigue) versus no (no fatigue). Population-weighted prevalences of fatigue and associated sociodemographic and health-related factors were calculated in descriptive analyses and multivariable Poisson regression., Results: The overall prevalence of fatigue in adults in Germany is 29.7% (95% CI 28.1-31.2), is highest in 18- to 29-year-olds (39.6% (95% CI 35.0-44.4)), and decreases in the age groups up to 65-79 years (20.6% (95% CI 18.2-23.3)). It is higher again in the very old age group (33.2% (95% CI 28.9-37.7)). Women have a higher risk of fatigue than men (aRR 1.19 (95% CI 1.08-1.32)). Fatigue is significantly associated with age, lower education, chronic illness, depression, and long COVID, regardless of covariates., Discussion: GEDA 2023 is one of the few population-based studies to have collected data on fatigue. The results allow estimates to be made for Germany on the frequency of fatigue and the significance of physical, psychological, and social influencing factors. They can be used as a reference or as a basis for trends over time as part of continuous health monitoring in Germany., (© 2024. The Author(s).)

Background: Fatigue is one of the most frequent symptoms in post-COVID syndrome (PCS) patients and describes a long-term feeling of tiredness and exhaustion. Frequently, it follows an infection or is a component of depressive symptoms. But fatigue itself is also a risk to mental health like other chronic conditions. The objective of this paper was to analyse the relationship between fatigue and depression/anxiety and the differences between PCS patients and fully recovered COVID-19 cases., Methods: In a longitudinal study with three measurement points, insured members of the Statutory Accident Insurance and Prevention in the Health and Welfare Service with a SARS-CoV‑2 infection in 2020 were asked about fatigue, depression/anxiety and persisting COVID-19 symptoms. To analyse the longitudinal effects of the two variables, a cross-lagged panel model was applied., Results: In the present sample (n = 860), a proportion of 68.7% to 75.1% of people was suffering from PCS. The results showed a model fit of R 2  = 61.49% and all effects were significant, but the cross-lagged effects were not significantly different from each other. If stratified according to whether PCS symptoms were present, the cross-lagged effects weakened in both groups, while the effects of fatigue on depression and anxiety only remained in the group of those affected by PCS., Discussion: The results show a relationship in both directions between fatigue and depression/anxiety. PCS patients can benefit from psychotherapeutic treatment to tackle fatigue and prevent depression and anxiety., (© 2024. The Author(s).)

Background: In the second half of 2023 the Senate for Science, Health and Nursing of Berlin commissioned an explicit gerontological expert report from the team of authors, which was intended to provide suggestions for the modernization and concretization of § 71 of the German Social Code Act (SGB) XII, i.e., the central social law basis for so-called care of older people. It was completed by the end of 2023. The objective of the report was to provide suggestions for a Berlin Assistance for Old People Structural Law that considers the differentiation and diversity of the life phase of old age by identifying, analyzing and describing the necessary individual services., Aim of the Article: The approach and the central results of the report are presented and discussed., Material and Methods: In a multistep procedure, combined with a multimodal research approach, various methods were combined in order to generate a comprehensive understanding of the current situation of so-called assistance for older people and gerontological justifications for its services. Critical and selective literature reviews, document analysis and qualitative guideline-based expert interviews were used., Results and Discussion: The expert report contains concrete recommendations for an age phase and life situation-orientated development of individual services according to § 71 SGB XII. This relates to approaches, forms and topics of counselling that enable and support successful ageing for all older people. The report also explicitly identifies objects of necessary cash and non-cash benefits, which, even in precarious situations in old age, aim to strengthen the ability for self-help and provide the opportunity to participate independently in community life., (© 2024. The Author(s).)

Background: AURIGA is the largest prospective real-world study to evaluate intravitreal aflibercept (IVT-AFL) treatment of diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion. This article presents 24-month data from the German cohort of treatment-naïve patients with DME., Methods: Treatment-naïve patients (≥ 18 years) with DME were treated with IVT-AFL at the discretion of the physician in clinical practice. The primary endpoint was mean change in visual acuity (early treatment diabetic retinopathy, ETDRS, letters) at month 12 compared to baseline. Statistical analyses were descriptive., Results: The analysis included data from 150 DME patients (54.7% male). At months 6, 12 and 24, mean (95% confidence interval) visual acuity gains of 4.6 (2.6; 6.5), 4.0 (2.1; 6.5) and 5.0 (3.0; 6.9) letters from baseline (mean ±SD: 65.0 ± 15.3 letters) and reductions in retinal thickness of 86µm (109; 64µm), 70µm (94; 43µm) and 75µm (103; 47µm) from baseline (mean ±SD: 391 ± 132 µm), respectively, were achieved. At month 24, 54% of patients gained ≥ 5 letters and 22% ≥ 15 letters. Patients received a mean number of 5.0 ± 1.6 injections until month 6, 7.1 ± 3.2 until month 12 and 9.0 ± 5.3 until month 24, 68% of patients received ≥ 5 injections until month 6 and 56% ≥ 7 injections within the first year. The safety profile was consistent with previous studies., Discussion: In the German AURIGA cohort, treatment-naïve DME patients achieved a clinically relevant gain in visual acuity as well as reduction in central retinal thickness following IVT-AFL treatment in clinical practice. From month 6 onwards, improvements were maintained despite a low injection frequency over 24 months. In comparison with previous real-world studies, care of DME patients in clinical practice seems to have improved; however, there is still room for further improvement., (© 2024. The Author(s).)

Background: Low back pain is a very common condition that affects most people at some point in their lives. It represents a burden on those affected, reducing their ability to participate in activities of normal life; at the same time, dealing with it increases the economic costs of healthcare., Aim:  The aim of this guideline was to contribute to WHO activities for reducing the impact of low back pain in adults and to support the WHO approach to integrated care for older people in primary care., Methods: In December 2023, the World Health Organization (WHO) published the "WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings". It was developed following the process according to the WHO handbook for guideline development. The team at the WHO Collaborating Centre for Evidence-Based Medicine at the University for Continuing Education Krems (Austria) translated the summary of this guideline for its application in German-speaking countries., Results/conclusion: The guideline addresses 37 interventions for the treatment of chronic primary low back pain in primary care and provides 24 recommendations and one good practice statement. No recommendations were made regarding twelve interventions due to equivocation or lack of sufficient evidence. The recommended interventions are intended to provide a range of options to support and personalize care for adults with chronic primary low back pain., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Thrombosis of the superior ophthalmic vein (SOV) is rare. It can present with heterogeneous symptoms and requires a careful diagnostic work-up., Methods: This article reports on a case series of three female patients with thrombosis of the SOV and performed an extensive review of the existing literature in PubMed., Results: All three patients showed different leading symptoms but all had a triad of restricted eye motility, exophthalmos and a difference in intraocular pressure with the higher pressure on the side of the protruded eyeball. The pathophysiological background differed in all cases: in the two first cases a pre-existing anticoagulation treatment had been paused shortly before the event. Cofactors were an intraorbital venous outflow obstruction due to an unclear mass in the orbital apex in one case and hypercoagulability due to a malignant disease in the other case. In the third case, there was a cavernous sinus fistula., Conclusion: The diagnosis should be considered not only in patients with dilated vessels of the anterior segment but also in unclear cases of exophthalmos or unilateral elevated intraocular pressure (IOP)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Life situation dimensions, such as financial resources, housing, health and social relationships, have a significant influence on the scope available to older people for coping with everyday life and participation and thus for a good life in old age., Method: As a basis for identifying current and future challenges posed by precarious living conditions in old age, current publicly available data and study results on the income situation, housing, health and care are reported as central dimensions of the living conditions of people aged 65 years and over in Germany., Results: The study results presented provide indications as to which groups of older people live in particularly precarious living situations, which provide starting points for municipal action. Inequalities exist in the availability of income, affordable and accessible housing, social networks, health opportunities and care support services. Particular importance is attached to the risk of poverty, which goes hand in hand with the risk of disadvantages in the other dimensions analyzed., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Empathy as a central element of social cognition plays a decisive role in various psychosocial areas and interpersonal dynamics, especially within the context of psychotherapy. Despite the controversy surrounding a standardized definition, empathy is generally regarded as a multidimensional concept that encompasses both cognitive and affective dimensions. This differentiation between cognitive and affective facets is addressed by a widely used and internationally well-established self-report measure of empathy, the Questionnaire of Cognitive and Affective Empathy (QCAE). This study focuses on evaluating the psychometric properties of the German version of the QCAE. In a convenience sample (N=1300), the postulated confirmatory five-factor model showed an adequate fit to the underlying structure. The subscales of the QCAE exhibited satisfactory internal consistency and convergent validity with other instruments measuring empathy. Despite certain methodological limitations, our findings suggest that the German version of the QCAE is suitable as a reliable and valid instrument for measuring empathy. Further studies in population-representative samples and clinical populations are required before a clear recommendation regarding its utilization can be provided., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The aim of this study was to measure the acceptance of a telemedical, inpatient-outpatient care concept by physicians, patients and the relatives of patients. Based on a quantitative survey of acceptance, both the potential and success factors influencing the use of telemedicine were to be highlighted., Methods: The TELnet@NRW study is a national, multicenter, cluster-randomized study in stepped-wedge design conducted from February 2017 to January 2020 for the purpose of documenting changes in the quality of care through telemedicine in an inpatient-outpatient network. Consultations were focused on intensive care medicine and infectious diseases. This current study used questionnaires for specific groups of patients to determine acceptance of the telemedical care concept practiced in the main study. The survey was anonymously conducted once in either digital or paper-based form during the reporting period., Results: The answers of 126 questionnaires from physicians and 1686 questionnaires from patients and their relatives were evaluated. The physicians of both sectors attributed high potential (up to 88.4%) for telemedicine to improve guideline-adherent treatment. A trustworthy and appreciative communication during the telemedical consultation represented a positively reinforcing success factor. The additional workload generated by telemedicine inhibited acceptance, especially in the inpatient sector. A continuation of telemedicine beyond the end of the project was supported by the majority of surveyed physicians (inpatient 60.6%, outpatient 82.1%) as well as in patients and their relatives (inpatient 79.7%, outpatient 57.4%) in both sectors., Conclusion: There is widespread acceptance of telemedical, inpatient-outpatient care concepts among physicians, patients and their relatives. Low-effort processes and user-centered technology are crucial to increase the rate of use. Telemedicine has the potential to improve the quality of care and can serve as a robust component of sustainable healthcare in Germany., Competing Interests: Sandra Dohmen: Vorstandsmitglied der Deutschen Gesellschaft für Telemedizin; Gernot Marx: Koordinator der S1-Leitlinie Telemedizin in der Intensivmedizin, Vorsitzender der Deutschen Gesellschaft für Telemedizin (DGTelemed) und Vizepräsident der Deutschen Interdisziplinären Vereinigung für Intensivmedizin (DIVI e.V.), in der Vergangenheit Vortragstätigkeiten für Philips, Mitbegründer der Clinomic GmbH für Co-Autor Rainer Beckers:Die ZTG GmbH wurde von der RWTH Aachen für Beratungsleistungen beauftragt. Geschäftsführer der ZTG GmbH und Vorstandsmitglied der DGTelemed., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: With the continuous increase in the average age, the temporal perspective for the phase of old age is also significantly expanding. This results in an individual need for reorientation for the aging person with respect to a meaningful shaping of this long period of time, which as a progressive process leads to the end of life. In the context of the status passages to the third, fourth and fifth ages, there is a special relevance for this; however, the so-called care for older people (§ 71 Social Security Code, SGB XII) has so far largely ignored these important aspects. Rethinking in a needs-oriented way, the facilitation of the necessary reorientation of life in old age through learning and education must therefore be given greater consideration., Aim of the Article: The article gives a necessary update of the existing care for older persons, which takes greater account of a needs-oriented design of a society of long life. Furthermore, the role and significance of the necessary educational processes in the sense of geragogy are outlined and also how they can contribute to successful aging., Material and Methods: With reference to current research work and publications on the topic, the possibilities of geragogic support as a challenge and opportunity for new care for older persons are worked out., Results and Discussion: The learning and educational processes of the aging person can be aimed at various concerns, if nothing else differentiated according to the challenges associated with the social age categories, i.e., the third, fourth or fifth age; however, learning and educational processes also address very different dimensions, each focusing on the question of how older people can tackle and cope with such necessary adaptation and change processes., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Internet and print media are frequently used by laypersons to learn about health issues. The objective of this study was to find out whether people with mental disorders showed a special pattern of usage. Where and why do they seek for information about their disorder? How do they experience their search? In semi-standardized interviews, we surveyed 200 psychiatric inpatients. Only patients of the following diagnostic groups were included: 1. Schizophrenia, schizotypal and delusional disorders (F20-F29), 2. Affective disorders (F30-F39) and 3. Disorders of adult personality and behavior (F60-F69). We focused on the sources the patients had used and the experiences they had in the course of their internet search. The vast majority had already searched for information about psychiatry, psychology or medication via internet or in print media. Most participants described positive emotions while reading. More than two-thirds rated the information as useful. Only 10 participants discontinued or rejected therapeutic measures due to information they had gained. Patients with personality disorders were significantly more likely than other patients to attribute their symptoms to a wrong diagnosis after seeking for information. Overall, psychiatric patients mostly experience helpful effects of reading medical information. In rare cases there are negative effects, e. g. negative emotions, discontinuation of therapy or an incorrect assessment of one's own illness. Further research is required in order to find out how the use of internet by people with mental disorders, which is already successful in many cases, can be improved even further., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: The bejective was to determine health literacy (HL) and care aspects of those affected by Long-COVID., Method: 407 patients with Long-COVID and long-term neuropsychiatric symptoms were interviewed in the LIFE study center. In addition to descriptive analyses, regression models were calculated to examine the relationships between health literacy (HLS-EU-Q16) and various aspects of care (RehaQ-N1)., Results: The results show that 35.8% had problematic and 17.9% had inadequate HL. The majority of subjective needs were unmet and 47.7% of those affected were dissatisfied with the therapy they received., Discussion: Among those affected by Long-COVID, subjective HL is rather reduced. The healthcare system appears to be unprepared for these patients, which is reflected in unmet needs and low treatment satisfaction. This was even more pronounced among those exhibiting lower HL., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme. All rights reserved.)

Background: Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease that is associated with great suffering for those affected, as well as high socioeconomic costs. Early diagnosis and adequate medical care are essential for a mild course of the disease. However, there is a lack of current figures and data on the care situation of patients in the area., Methodology: A total of 1546 general practitioners, rheumatologists, neurologists, nephrologists and dermatologists in Rhineland-Palatinate and Saarland were interviewed by fax or mail using a questionnaire regarding epidemiology, symptoms, therapy and therapy success. In addition, there was the possibility of making suggestions for improvement., Results: Five out of six of the 635 reported SLE patients were female. The most common main symptoms were arthralgia, fatigue, myalgia, and skin changes. Of the patients, 68% received antimalarials (AMs), whereas 46% were treated with glucocorticoids (GCs) and 50% with an immunosuppressant (IS), mainly methotrexate. In terms of comorbidities, patients suffered mainly from cardiovascular disease, fibromyalgia syndrome and depression. Rheumatologists also frequently described anaemia, diabetes mellitus and osteoporosis., Discussion: Compared with guideline recommendations, the low rate of AMs in therapy was particularly striking in patients not treated by rheumatologists (35% on average compared with 81% for rheumatologists). Additionally, (sustained) high doses of GCs are not in line with literature recommendations. In the free text field, the main requests were for more rheumatologists in private practice and faster appointment scheduling, as well as better communication and networking. In addition, the desire for more training and education was frequently expressed.., (© 2024. The Author(s).)

Introduction: Based on the cases in which assisted suicide (AS) has taken place in Switzerland in the context of a mental disorder or dementia, we discuss whether the slippery slope argument often brought up by opponents of assisted dying is justified. Long-term data from the Swiss Federal Statistical Office shows that while the number of cases with these «indications» is increasing (1999-2017: on average 21 cases/year vs. 2018-2022: n = 73 cases/year), the percentage share of these diseases in the total number of all AS cases has remained unchanged at around 5 %. Opponents of assisted dying believe that the slippery slope argument is already fulfilled by the fact that these cases occur at all. However, the still limited prevalence of these specific indications which still represent only a minority of assisted suicide cases over time, may be used by advocates of assisted dying to weaken the opposing viewpoint., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht. Keiner der Autoren ist Mitglied in einer der Schweizer Sterbe­hilfeorganisationen., (© 2024 Aerzteverlag medinfo AG.)

Competing Interests: Der Autor hat keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Introduction: Colorectal cancer (CRC) is the third most common type of cancer in Switzerland in terms of annual new cases and cancer deaths. Since most cantons have an organized screening program, more people are recorded with a positive family history of CRC. In the majority, the familial form of CRC is present, a hereditary form is much less common. Relatives of patients with CRC are a heterogeneous group whose CRC risk varies. A good assessment of disease risk can optimize the benefit-risk ratio for more intensive prevention. These recommendations («expert opinion statement») are intended to serve as a basis in clinical practice for planning preventative care, monitoring and human genetic counseling in the presence of a family history positive for CRC., Competing Interests: Die Autorschaft keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Background: Eye injuries range from minor to severe and may lead to permanent visual impairment. There is still little in the way of epidemiological data on eye injuries in Germany., Aim: The aim of this study was to obtain an objective record of minor and severe eye injuries in Germany by evaluating hospital quality reports. We also investigated the relevance of injuries from fireworks in relation to the total number of eye injuries and the general population., Methods: This retrospective routine data study entailed analysing hospital quality reports from 2008 to 2022 in XML format. The R programming language was used for data processing and statistical analysis. The number of ICD-coded eye injuries was exported and analysed together with location data. We also included data from a prospective survey study on fireworks-related eye injuries from 2016 to 2023., Results: Eyeball and/or orbital contusions are the most common eye injuries treated in Germany at up to 2,500 cases per year. The most severe injuries comprise traumatic globe rupture with loss of intraocular tissue at up to 990 cases per year. Numbers of eye injuries of any type have been declining since 2020. As a percentage of population, Mecklenburg-Western Pomerania treats the most eye injuries at up to 0.017%; in absolute numbers, North Rhine-Westphalia leads the country at up to 1,600 injuries. Private firework displays are probably responsible for 1.4% of annual globe ruptures and 8.3% of eyeball contusions., Conclusion: Our analysis of hospital quality reports has provided the first comprehensive epidemiological record on eye injuries in Germany. Firework-related injuries account for a relevant proportion of total injuries. These results could serve as a basis for preventive measures and health policy decisions., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht./The authors declare that there is no conflict of interest., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: EndoArt® (Eye Yon Medical, Ness Ziona, Israel) is a novel artificial corneal inner layer transplant and an innovative treatment alternative for patients at high risk for graft failure after posterior lamellar corneal transplantation (EK)., Aim of the Study: We present the initial results of the EndoArt® implantation in patients with glaucoma drainage devices (GDD)., Patients and Surgical Procedure: In this study 12 eyes with GDD were retrospectively evaluated. All had a high risk of transplant rejection in cases of EK (previous other glaucoma surgery in addition to GDD, n = 8, condition following Descemet membrane endothelial keratoplasty, DMEK, n = 9, uveitis, n = 2, or synechiae, n = 2). The EndoArt® was secured with a gas bubble and one to three holding sutures. The preoperative and postoperative best spectacle-corrected visual acuity (BSCVA) and central corneal thickness (CCT) were determined. The need for additional gas injections (rebubbling) was analyzed., Results: Octafluoropropane (C3F8) 12% was used in nine patients and sulfur hexafluoride (SF6) 20% in three patients as anterior chamber tamponade to ensure adhesion of the EndoArt®. At least one rebubbling was necessary in four eyes. The preoperative BSCVA was 1.6 (± 0.5) logMAR and significantly improved to 1.1 (± 0.6) logMAR after 12 weeks (p = 0.028). The preoperative CCT was 719 µm ± 145.7, which significantly decreased to 622.4 µm ± 174.9 after six weeks (p = 0.004) and to 591.7 µm ± 190.8 after 12 weeks (p = 0.096). In one eye, the prosthesis was explanted due to a suspected fibrotic remodelling of the cornea following multiple previous DMEKs., Discussion: EndoArt® led to a significant improvement in BSCVA and reduction in CCT; however, there was a high rebubbling rate in patients with GDD. In high-risk patients, the use of EndoArt® may be advantageous in avoiding graft failure after EK., (© 2024. The Author(s).)

Despite declining numbers - older people in particular - often die from pulmonary embolism. A rapid assessment of the risk in the event of a suspected embolism, the exclusion of comorbidities and the appropriate therapy are the focus of the current guidelines. Early and subsequent outpatient treatment of a patient with acute PE generally requires 3 criteria: low risk of early complications, the absence of serious comorbidities and the highest possible safety at home and, in the event of a complication, rapid access to acute care in the hospital. For patients with a high risk of VTE recurrence, the long-term dosage of secondary drug prophylaxis is not yet clear - studies are currently underway. In patients at moderate risk of VTE recurrence, low-dose secondary prophylaxis can be used to reduce the risk of bleeding. Outpatient pulmonary embolism follow-up care is becoming increasingly important, because studies have shown several times that serious long-term consequences can occur. In pulmonary embolism patients with persistent dyspnea, reduced performance or risk of CTEPH, an outpatient evaluation of the right ventricle using echocardiography, if necessary, in combination with the determination of natriuretic peptides or spiroergometry, is recommended., Competing Interests: Lukas Hobohm berichtet über Vortrags- und Beraterhonorare von MSD, INARI Medical, Boston Scientific und Janssen, außerhalb der eingereichten Arbeit., (Thieme. All rights reserved.)