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Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell 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 Lernen und Lernstörungen is the property of Hogrefe AG 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 Die Urologie 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: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased costs for the family, the health care system and the society. Previous cost-of-illness studies in Germany usually focused on prevalent ADHD. This study addressed the research gap on health care resource utilisation and costs of children and adolescents with incident ADHD diagnosis using nationwide claims data from the statutory health insurance DAK-Gesundheit. Methods: A matched-control design (propensity score matching, 1:3 ratio) was used to examine the health care costs of incident ADHD patients compared with a non-ADHD control group, considering an observation period of four quarters. Besides bivariate statistics, multivariate analyses of total costs were used to consider relevant covariates. Results: Total health care costs for children and adolescents with ADHD in the first year after diagnosis exceeded those of the control group by € 1,505.3. According to the multivariate analysis, the group with incident ADHD had significantly higher (2.86-fold) health care costs when compared with non-ADHD peers. Sensitivity analyses proved these findings. In addition, the analyses identified children’s age and comorbidity index to be significantly associated with increased costs. Conclusions: ADHD in children and adolescents is associated with a significant economic burden. The results emphasise the need for social awareness, prevention, appropriate treatment and research efforts.

Copyright of HNO 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 Rheumatologie 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.)

Objective: There have been reports of neuromyelitis optica spectrum disorder (NMOSD) coexisting with connective tissue disorders. The objective of this study was to describe the characteristics of NMOSD coexisting with autoimmune diseases (AID). Methods: This retrospective study evaluated NMOSD patients with and without AID. The enrolled patients had at least one attack, with duration of more than 1 year. Data on the demographics, clinical features, and laboratory findings were assessed. The Poisson model was used to investigate the risk factors associated with the annualized relapse rate (ARR), whereas the Cox model was used to evaluate the risk factors for the first relapse. Results: A total of 180 patients (154 women and 26 men) with NMOSD were identified: 45 had AID and 135 did not. Female patients had a higher prevalence of concomitant AID (p = 0.006) and a greater relapse rate within the first year. There were no statistically significant differences in the characteristics of patients. Kaplan–Meier analysis revealed that NMOSD patients with seropositive aquaporin 4 antibodies (AQP4-Ab; log-rank: p = 0.044), had a shorter time to relapse. Patients seropositive for AQP4-Ab (HR = 2.402, 95%CI = 1.092–5.283, p = 0.029) had a higher risk of suffering a first relapse, according to the Cox model. Patients with and without AID showed a similar declining tendency in terms of change in ARR throughout the first 5 years of the disease. The ARR was greater in the first year [incidence rate ratio (IRR) = 1.534, 95%CI = 1.111–2.118] and the first 2 years (IRR = 1.474, 95%CI = 1.056–2.058) in patients with coexisting AID diagnosis prior to the NMOSD onset. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is often the last resort for escalation of treatment in patients with severe acute respiratory distress syndrome (ARDS). The success of treatment is mainly determined by patient-specific factors, such as age, comorbidities, duration and invasiveness of the pre-existing ventilation treatment as well as the expertise of the treating ECMO center. In particular, the adjustment of mechanical ventilation during ongoing ECMO treatment remains controversial. Although a reduction of invasiveness of mechanical ventilation seems to be reasonable due to physiological considerations, no improvement in outcome has been demonstrated so far for the use of ultraprotective ventilation regimens. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie 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 European Surgery: ACA Acta Chirurgica Austriaca 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.)

Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important to carefully monitor the graft function in the perioperative period with respect to the occurrence of a possible rejection reaction. On the other hand, the ongoing immunosuppression may have to be adapted to the perioperative requirements in terms of the active substance and the route of administration, the resulting increased risk of infection and possible side effects (e.g., myelosuppression, nephrotoxicity and impairment of wound healing) must be included in the perioperative treatment concept. Furthermore, possible persistent comorbidities of the underlying disease and physiological peculiarities as a result of the organ transplantation must be taken into account. Support can be obtained from the expertise of the respective transplantation center. [ABSTRACT FROM AUTHOR]

The present article presents the basic concepts of OA pain management. Due to the multiple different causes for OA and the fact that OA patients suffer from multiple co-morbidities and take multiple co-medications, the treatment of OA never be unidimensional. There need to be, however, an individual multimodal and interdisciplinary concept for every patient. [ABSTRACT FROM AUTHOR]

Pain appears to be a leading symptom of many diseases. Patients suffering from chronic pain are of high risk to develop comorbidities coming along with profound personal- and social disadvantages. Knowledge and awareness about pathomechanisms leading to chronic pain, the individual and social consequences of neuropathic pain as result of chronification as well as its high prevalence of therapy resistance are still not common amoung medical professionals. In daily practice patients are either subject to medical neglect in years of suffering or over-diagnosed and -treated. Pathophysiologically every pain condition depending on duration und intensity and independent from origin will provoke ongoing structural and functional changes in pain-conducting, -processing and -controlling parts of the nervous system. The resulting pain syndromes, which acquire neuropathic features along the chronification process, exhibit increasing resistance to conventional therapies. To recognize neuropathic pain components, in order to initiate correct diagnostics appears to be the first challenge. The second challenge includes the timely initiation of the correct therapy, in order to prevent further chronification. Only a third of the patients suffering from chronic neuropathic pain can be treated sufficiently using conservative strategies as medicated therapy, psycho-, physio- or occupational therapy in the long run. Different interventional treatment strategies have proven to be effective on short-, middle- or long-term outcome. Modern, minimally invasive methods of neuromodulation as spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG) represent additional and effective options for pain management regarding individual improvement of pain and quality of life as well as the entailing costs. [ABSTRACT FROM AUTHOR]

Copyright of Die Urologie 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 Die Urologie 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.)

The demographic change with an increase in the number of geriatric patients presents major challenges for perioperative medicine. Frailty is a multimorbidity complex that incorporates a combination of various factors, such as physical weakness, slower walking speed and unwanted weight loss. It is of great importance that these patients receive an individually adapted perioperative care. This includes, among others, a preoperative examination for frailty, a structured prehabilitation according to the concept of better in, better out, the compliance with the guidelines on prevention and timely treatment of postoperative delirium as well as the continuous maintenance of the body's homeostasis. By means of these measures the risk of complications in this patient group can be reduced and the best possible postoperative results can be achieved. [ABSTRACT FROM AUTHOR]

Equine Gastric Ulcer Syndrome (EGUS) is of ongoing importance in sport and pleasure horses and is a frequently diagnosed disease in equine practice. A distinction is made between lesions of the cutaneous mucosa ("Equine Squamous Gastric Disease" – ESGD), which are classically treated with omeprazole. In Germany, there are approved oral preparations for horses in paste or granular form however, there is no-approved drug for the treatment of lesions of the glandular mucosa ("Equine Glandular Gastric Disease" – EGGD). Rendle et al. recommend in their consensus statement for EGGD firstly a combination therapy of oral omeprazole and sucralfate (GGS), secondly a monotherapy with misoprostol (MP) or thirdly a therapy with intramuscularly administered "long acting injectable omeprazole" (LAIOMEP), all as first-line treatment options for EGGD. The first treatment recommendation (omeprazole + sucralfate) is widely used as a standard in EGGD patients in Germany at the Equine Veterinaey Center in Kirchheim. LAIOMEP is not available in Germany, but shows good treatment results in EGGD. Misoprostol has to be used following the prescribing cascade in horses and is not always available in Germany. Due to super-bioavailability of omeprazole in granular form (Equizol®) it is licensed for use in EGUS at a dose of 2mg/kg. The aim of the study was to assess whether doubling this dose could possibly improve the therapeutic success in EGGD, as prolonged high serum levels of omeprazole from intramuscular administration of a long-acting formula appear to improve outcome when treating EGGD. Overall, there is commonly a high number of "non-responders" in the treatment of EGGD, presumably because sufficient acid suppression is often not achieved. Based on the patient population of a private equine veterinary hospital, two medication protocols were retrospectively investigated. Included in the study were 31 patients diagnosed with only EGGD or both EGGD and ESGD in gastroscopy and which returned for control gastroscopy after four weeks. 48% of the patients underwent gastroscopy due to previous colic, and 29% of the horses had a concomitant chronic disease that could potentially cause ongoing stress and pain for the horse (e.g., EOTRH, osteoarthritis, etc.). 21 horses received 4mg/kg omeprazole in paste form (Gastrogard®) in combination with 12mg/kg bw sucralfate (Sucrabest®) twice daily for treatment. The other group of 10 horses was treated with a monotherapy of 3,5–4mg/kg omeprazole in granule form (Equizol®). This is about twice the Equizol® recommended dose for the Therapy of EGUS as mentioned above. ESGD and EGGD findings were separately evaluated according to a scoring system with grades 0 to 4 adopted from the work of Vondran (2016). All owners also received similar recommendations for husbandry and feeding. In the Gastrogard®/Sucrabest® group (GGS), the healing rate after four weeks was 44% for ESGD and 19% for EGGD. The healing rates in the Equizol® group (EQ) were 71% for ESGD and 20% for EGGD. Overall, gastric findings improved by an average of 1.3 grades under GGS therapy for ESGD in 83% of patients, and 57% of EGGD findings improved by an average of 1 grade. Under EQ therapy, there was an improvement in scoring of ESGD by an average of 1.8 grades in 86% of the patients. EGGD improved by an average of 1.4 grades in 50% of the horses. High-dose Equizol® therapy did not show a significantly better therapeutic outcome compared to the Gastrogard®/Sucrabest® medication commonly used in practice. Colic preceding the therapy as well as the presence of a concomitant disease did not show a significant influence on the therapy success. However, based on the results of this study, there is also no good reason to recommend a combination therapy with omeprazole paste and sucralfate, which on the one hand is much more difficult for horse owners to apply and quite similar in terms of costs. On the other hand sucralfate as a human drug must be redesignated for the combination therapy following the prescription cascade, which in Germany is only permitted in the case of a so-called therapeutic emergency based on the veterinary drug law. Thus, a need for more effective treatment options for lesions of the glandular gastric mucosa still remains. LAIOMEP therapy, which is currently not available in Germany, seems to be promising in treatment of EGGD. Further investigations on the causes of glandular lesions are also very important. With a better understanding, the development of EGGD could possibly be prevented by prophylactic measures or at least healing could be supported by an appropriately adapted husbandry, feeding and training design. [ABSTRACT FROM AUTHOR]

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie 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 Gynäkologische Endokrinologie 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 Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. 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 Monatsschrift Kinderheilkunde 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.)

The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases. [ABSTRACT FROM AUTHOR]

Medical guidelines summarize evidence based knowledge and give helpful recommendations for diagnostics and therapy in daily practice. Most Swiss medical societies therefore adapt international guidelines for the Swiss setting. In primary care this adaption must not only take into account the specific Swiss healthcare system, but also the specific setting of primary care, which is characterized by a low prevalence of most diseases as well as by chronic conditions and multimorbidity. Exactly these multimorbid patients are underrepresented in the studies, which underline the current guidelines of medical societies. The institute of primary care at the university of Zurich, IHAMZ, therefore creates evidence based guidelines according to international established quality criteria for the Swiss primary care setting. [ABSTRACT FROM AUTHOR]

Muscle weakness is a common symptom in the general practice. The diagnostic work-up starts with distinguishing true muscle weakness from fatigue. The localization, time course and severity of muscle weakness as well as associated symptoms, concomitant diseases, medication and family history can help classify the weakness into certain main categories. These are genetic, inflammatory, infectious, neoplastic, toxic and metabolic/endocrine causes. Further laboratory investigations, ENMG, MRI, muscle biopsy and genetic testing can help to further narrow the differential diagnosis. Due to recent advances, particularly in the field of genetics and targeted immunomodulatory therapies, a growing number of diseases which present with muscular weakness can be treated successfully. [ABSTRACT FROM AUTHOR]

Copyright of Praxis der Kinderpsychologie und Kinderpsychiatrie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG 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 Die Nephrologie 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.)

Attention deficit hyperactivity disorder (ADHD) is the most frequent developmental disorder in childhood, adolescence and adulthood. Substance use disorders are a frequent comorbidity in ADHD. The many different forms and severities of these comorbidities necessitate individual strategies in the diagnostics and treatment. Principally, ADHD and addictive disorders should be treated together whenever possible. The more acute or severe the dependence disorder is, the less priority can be given to the topic of ADHD and the lower are the chances of carrying out valid diagnostics and simultaneous treatment at the beginning of the treatment of the addictive disorder. The less severe and acute the addictive disorder is, the quicker the diagnostics and, if necessary, treatment of ADHD can be initiated. In this continuing education article, the customary means for diagnostics and pharmacotherapy as well as the special features that must be considered with respect to comorbidities of both disorders are presented. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapie im Alter is the property of Psychosozial-Verlag 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 Rheumatologie 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.)

Abstract: Objective: Internet use disorders have been recognized as a relevant health-related issue. It is known that this condition is related to increased rates of further comorbid mental disorders. Yet, less is known on clinical features of patients meeting both diagnoses, internet related disorders and gambling disorder. The current paper presents a first clinical characterization of patients being diagnosed with both behavioural addiction disorders (dual diagnosis). Methods: For data analyses a consecutive clinical sample (N =1813) of treatment-seekers presenting for either internet use disorders or gambling disorders was used. Data were derived from clinical intake interviews and psychometric scales assessing depression, distress, anxiety and level of functioning. These data were compared between patients with dual diagnoses, patients with gaming disorder, and patients with gambling disorder. Results: A total of n=46 patients met criteria for internet use disorders and gambling disorder. This patient group was significantly more often affected by further mental disorders. In each symptom cluster assessed, every patient group revealed high symptom burden without differing from each other substantially. Conclusion: A small proportion of treatment-seekers meets diagnostic criteria for internet use disorders and gambling disorder. While there are only few differences regarding clinical characteristics compared to the other patients, a dual diagnosis might be related to a more complex treatment strategy. [ABSTRACT FROM AUTHOR]

The following featured study deals with the concrete manifestation of the comorbid occurrence of linguistic and emotional-social abnormalities. While the relationship between the areas of development and possible disorders is considered confirmed, there are still gaps in research with regard to the manifestations of comorbid abnormalities, the age groups examined and school aspects. This is where the following work comes in and uses two special needs students to investigate similarities and differences within comorbid linguistic and emotional-social abnormalities. For this purpose, a comparative case study was carried out with two special needs students. The evaluation of the results shows that both students show abnormalities in the external behavioral area, the social problems and the attention problems. Furthermore, abnormalities in both speech production and language comprehension were detected in both subjects. In the concrete form, the abnormalities of the test persons differ. However, it was possible to establish consistent concrete connections with regard to specific sub-components of linguistic and emotional-social development. [ABSTRACT FROM AUTHOR]

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.)

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.)

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).)

Aim: Periprosthetic joint infection (PJI) is one of the main causes of revision surgeries after total knee arthroplasty (TKA) and unicondylar knee replacement. Patient- and hospital-related risk factors must be evaluated to prevent PJI. This study identifies influencing factors and differences in infection rates between various types of implant., Methods: The basis for the data is the German Arthroplasty Register (EPRD). Septic revisions were calculated with the aid of Kaplan-Meier estimates, with septic revision surgery defined as the primary endpoint. Patients with constrained and unconstrained TKA or UKA were analysed using the Holm multiple log-rank test and the Cox proportional hazard model. The 300,998 cases of knee arthroplasty analysed included 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA, with a maximum follow-up of 7 years., Results: After 1 year, the PJI rate was 0.5% for UKA and 2.8% for TKA, whereas after 7 years it was 4.5% for UKA and 0.9% for TKA (p < 0.0001). In constrained TKA, the PJI rate was significantly increased compared with unconstrained TKA (p < 0.0001). After 1 year, the PJI rate was 2.0% for constrained TKA and 0.8% for unconstrained TKA, as well as 3.1% and 1.4% respectively after 7 years. Implantation of a constrained TKA (HR = 2.55), male sex (HR = 1.84), an increased Elixhauser Comorbidity Index score (HR = 1.18-1.56) and an implantation volume of less than 25 UKA per year (HR = 2.15) were identified as risk factors for revision surgeries; an Elixhauser Comorbidity Index score of 0 (HR = 0.80) was identified as a preventive factor., Conclusions: A reduced implantation volume and constrained knee arthroplasty are linked to a higher risk of PJI. Comorbidities (increased Elixhauser Comorbidity Index score), male sex and a low UKA-implantation volume were identified as risk factors for PJI. Patients who fulfil these criteria need specific infection prevention measures. Further analyses are required to investigate the potential influence of prevention and risk factor modification., Level of Evidence: III., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The coincidence of an inflammatory rheumatic and a malignant disease causes a physical, cognitive and psychological reduction in performance. The prescription of physical therapy is therefore essential to address safety issues associated with both diseases, as well as side effects associated with antirheumatic and antineoplastic therapy that can impact the treatment. It is important to perform a risk assessment prior to physical therapy to identify potential safety issues and to determine baseline physical and functional status. In this review article descriptive information and the current literature on the safety of physical therapy interventions for people with rheumatic and malignant disease are highlighted, taking the disease process, treatment side effects and associated precautions and contraindications into account., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Numerous reports in recent years have focused on the influence of environmental factors on rheumatoid arthritis. This article provides an overview of the current study situation on the influence of modifiable environmental factors on the development and course of rheumatoid arthritis. Lifestyle factors, such as cigarette smoking, diet, exercise and body weight can be individually influenced. Factors such as air pollution and socioeconomic status can be influenced by environmental and sociopolitical measures at a public level. Epidemiological studies have identified nicotine abuse, an unhealthy diet and obesity as well as a low level of education and social status as risk factors for the development of rheumatoid arthritis. Numerous factors are also associated with a poorer response to treatment and a worse prognosis. As randomized interventional studies on most environmental factors are hardly feasible, the causal relationship of the individual factors to the incidence and progression of rheumatoid arthritis is difficult to quantify. Nevertheless, the current evidence already enables the provision of appropriate counselling to patients with rheumatoid arthritis with respect to a healthy lifestyle including abstaining from cigarette smoking, maintaining a healthy diet, physical activity and avoiding obesity., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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).)

The enormous potential of cardiovascular prevention in terms of expanding the life span and health span is presently nowhere near being realized. The five classical cardiovascular risk factors body mass index (BMI), systolic blood pressure, non-high-density lipoprotein (non-HDL) cholesterol, tobacco smoking, and diabetes mellitus account for more than half of the cases of incident cardiovascular diseases. Cardiovascular prevention is also effective and adequate in seemingly healthy individuals aged 70 years or above, although the association of several cardiovascular risk factors with cardiovascular diseases is less pronounced in old age. The cardiovascular risk of seemingly healthy persons aged 70 years or above can validly be determined using the Systematic COronary Risk Evaluation-Older Persons (SCORE2-OP), leading to risk-adjusted clear treatment recommendations. National and international guidelines advocate individualized cardiovascular prevention in several domains including diet, physical activity and risk factor management through to old age., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Population-based studies on the relationship between social isolation and obesity, which also include younger adults, are still lacking in Germany. The aim of this study is to investigate the prevalence of social isolation in people with and without obesity. In addition, socially isolated people with and without obesity are examined with regard to socio-demographic and socio-economic factors as well as with regard to depressive symptoms., Methods: This study was based on baseline data from the LIFE Adult Study (18-79 years) from the 2011-2014 study period. The sample comprised n = 8350 participants. In addition to socio-demographic characteristics and socio-economic status (SES), data on social isolation (LSNS-6), depression (ADS), and body mass index (BMI) were collected. Evaluations were carried out using inferential statistical analyses., Results: Overall, 13.1% of the total sample were affected by social isolation. Participants with obesity (20.4%) had a significantly (p < 0.001) higher prevalence compared to those without obesity (11.4%). A better social integration was significantly associated with younger age (p < 0.001), female sex (p < 0.001), being married (and cohabiting) (p < 0.001), higher socioeconomic status (p < 0.001), and lower depressive symptoms (p < 0.001)., Discussion: A higher BMI was not associated per se with poorer social integration. However, the present study showed that socially isolated people with obesity represent a special risk group for impaired mental health and had twice the prevalence of social isolation compared to those without obesity., (© 2024. The Author(s).)

Loneliness is increasingly recognized as a significant health risk. This review provides an overview of current research on the impact of loneliness on mental and physical health. The findings indicate that loneliness is a significant risk factor of both mental and physical health. Previous reviews focusing on mental health effects reveal that loneliness is associated with the onset of depression, social anxiety, and cognitive decline. Furthermore, loneliness can impede recovery from mental disorders in general, which can be partly attributed to the bidirectional interplay between loneliness and mental health. Regarding physical health, consequences of loneliness have been mostly studied in relation to cardiovascular diseases. Loneliness predicts the onset of cardiovascular diseases and impedes recovery from them. Reviews also highlight that loneliness enhances the likelihood of suicidality and mortality. However, this article also points out the shortage of longitudinal studies, complicating the investigation into how loneliness causally affects future health problems. The health implications of loneliness outlined in this review, some of which are irreversible and can induce suffering and impairment, underscore the importance of interventions aimed at alleviating loneliness as a preventive strategy against both mental and physical illnesses., (© 2024. The Author(s).)

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019 there was no available evidence regarding the management of immunosuppressive or immunomodulatory treatment and the potential outcomes of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections in inflammatory rheumatic diseases (IRD). As a result, the Justus Liebig University of Giessen, Germany, in collaboration with the German Society for Rheumatology, established the German COVID-19 register ( www.covid19-rheuma.de ). The COVID-19 register enabled for the first time a systematic documentation and evaluation of viral infections in patients with IRD. The data collection started as early as March 2020. Currently, the register is one of the largest global registers in the field of COVID-19 and IRD. As of 18 December 2023 the register has recorded more than 7100 cases. The first scientific findings on SARS-CoV‑2 infections in IRD patients were generated from the register in 2020, showing an association between disease activity of IRD, certain comorbidities, such as cardiovascular diseases and treatment with rituximab, with an unfavorable course. The contents and construction of the database of the register were designed at the conception to allow collaboration and data exchange with other national and international registers (e.g., EULAR COVID-19 register, COVID-19 global rheumatology alliance and the Lean European open survey on SARS-CoV‑2 infected patients). In addition, other registers and surveys were initiated. A vaccination register documents the tolerability and possible adverse reactions to COVID-19 vaccination in IRD patients. The data resulted in numerous publications and formed the basis for national and international recommendations for action in the care and vaccination of IRD patients during the COVID-19 pandemic. In summary, the German COVID-19 register has made a significant contribution to the understanding of the course of COVID-19 in IRD patients and has facilitated international collaboration for a better understanding of COVID-19 and IRD., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Coronavirus disease 2019 (COVID-19) has influenced the world over the last 3 years. Although the risk of a severe course is low in children, it can be influenced by chronic rheumatic diseases or treatment with immunosuppressive drugs or immunomodulatory medication. The German register for biologics in pediatric rheumatology (BIKER) documented systematic data from 68 centers on the occurrence, presentation and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in children with rheumatic diseases. Between March 2020 and December 2022, a total of 927 SARS-CoV‑2 infections in 884 patients could be reported and analyzed in pediatric patients with rheumatic diseases. Juvenile idiopathic arthritis (JIA) was the most frequent diagnosis (716 infections) followed by genetic autoinflammation (103 infections), systemic autoimmune diseases (78 infections), idiopathic uveitis (25 infections) and vasculitis (5 infections). Only four patients were treated as inpatients. A 3.5-year-old female patient died during the first wave from encephalopathy and respiratory failure. The patient was treated with methotrexate (MTX) and steroids for systemic JIA. Genetic tests revealed a previously unknown congenital immune defect. No other patient had to be ventilated or treated on the intensive care unit. A case of uncomplicated pediatric inflammatory multisystem syndrome (PIMS) was registered in a patient with JIA treated with MTX. At the time of the infection over 60% of the patients were treated with standard disease modifying antirheumatic drugs (DMARD) and/or biologics. Although the patients treated with MTX showed a slightly longer duration of symptoms, the antirheumatic treatment did not appear to have a negative influence on the severity or outcome of the SARS-CoV‑2 infection., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Sleep apnea is a widespread and yet still underdiagnosed condition. Various studies from the past have provided evidence that there is a link between sleep apnea and various cardiovascular diseases, including arrhythmias., Objective: The aim of this article is to provide an overview of the current study situation and to point out possible consequences relevant to everyday life., Material and Methods: A systematic search was carried out in various databases using the keywords sleep apnea (OSAS/SA) and arrhythmias/dysrhythmias., Results: There are several pathophysiological links between sleep-related breathing disorders and cardiac arrhythmias, the most important of which appear to be intrathoracic pressure, increased adrenergic tone as well as recurrent hypoxia and hypercapnia. This results in an increased occurrence of clinically relevant arrhythmias, such as atrial fibrillation, symptomatic bradycardia, high-grade atrioventricular (AV) blocks as well as ventricular arrhythmias in patients with untreated sleep apnea. These pathologies also appear to be positively influenced by the treatment of sleep apnea., Conclusion: A close correlation between sleep apnea and cardiac arrhythmias is undisputed. Large randomized studies in this respect are so far rare but it is undisputed that a thorough search should be carried out for sleep apnea and consistently treated in patients with a history of cardiac disease as this can have a relevant influence on the treatment and ultimately the prognosis of the patient., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)