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[english] Objective: Newer non-benzodiazepines zolpidem and zopiclone are often prescribed instead of benzodiazepine hypnotics, although there is no evidence of differences in effectiveness and safety. Aim was to compare perceptions on benefits and harms of benzodiazepines and Z-drugs between general practitioners (GPs) and community pharmacists (CPs).Methods: A questionnaire was mailed to a random sample of 1,350 GPs and 600 CPs in 2012. They were asked to rate perceptions on a five-point Likert scale used for both benzodiazepines and Z-drugs. Wilcoxon signed rank test was performed for the comparison of perceptions between GPs and CPs. Due to multiple testing, only p-values ≤0.01 were considered statistically significant.Results: 458 GPs and 202 CPs returned questionnaires (response 33.9% and 33.7%). Mean age of GPs was 53.3 years (40.6% female) and 48.8 years for CPs (59.2% females). Perceptions on benefits of benzodiazepines (and Z-drugs) between GPs and CPs were not different for 3 (and 2) of 5 items. Concerning side effects of benzodiazepines, there were no statistically significant differences for 3 of 5 comparisons. CPs perceived that 4 of 5 studied side effects of Z-drugs occur significantly more often than GPs (p=0.003 or less). For instance, whereas 45.2% of CPs answered that withdrawal effects on stopping happen often or very often/always on Z-drugs, these were only 28.3% of the GPs. Conclusions: Although it is difficult to draw unambiguous conclusions from these findings, pharmacists might have a somewhat more critical view on Z-drugs, especially concerning side effects.[german] Hintergrund und Fragestellung: Die neueren Benzodiazepinrezeptor-Agonisten Zolpidem und Zopiclon (“Z-Drugs”) werden in letzter Zeit häufiger als Hypnotika vom Benzodiazepintyp verschrieben, obwohl keine Belege für Unterschiede bezüglich des Nutzens und Schaden existieren. Ziel dieser Studie war es zu vergleichen, wie Hausärzte und Apotheker erwünschte und unerwünschte Wirkungen dieser Mittel einschätzen.Methoden: Ein schriftlicher Fragebogen wurde 2012 an eine Zufallsauswahl von 1.350 Hausärzten und 600 Apothekenleitern versendet. Die gleichen Items wurden auf einer 5-Punkte-Likert-Skala sowohl für Benzodiazepine wie Z-Drugs abgefragt. Zum Vergleich zwischen Hausärzten und Apothekern wurden Wilcoxon Signed Rank Tests durchgeführt. Aufgrund der zahlreichen Tests wurden nur p-Werte ≤0,01 als statistisch signifikant angesehen.Ergebnisse: Insgesamt antworteten 458 Hausärzte und 202 Apotheker (Rücklauf 33,9% und 33,7%). Hausärzte waren durchschnittlich (40,6% weiblich) und Apotheker 48,8 Jahre alt (59,2% weiblich). Keine Unterschiede in der Einschätzung des Nutzens von Benzodiazepinen (bzw. Z-Drugs) fanden sich bei 3 (bzw. 2) von 5 Items. Keine Unterschiede zeigten sich auch bei 3 von 5 Items zu unerwünschten Wirkungen von Benzodiazepinen. Hingegen schätzten Apotheker, dass 4 der 5 untersuchten unerwünschten Wirkungen von Z-Drugs häufiger vorkamen als Hausärzte (p=0,003 oder kleiner). Beispielsweise antworteten 45,2% der Apotheker, dass Entzugserscheinungen häufig bzw. sehr häufig/immer unter Z-Drugs auftreten, hingegen nur 28,3% der Hausärzte.Schlussfolgerungen: Obwohl es insgesamt schwierig ist, eindeutige Schlussfolgerungen aus diesen Befunden zu ziehen, scheinen Apotheker einen kritischeren Blick auf Z-Drugs und deren unerwünschte Wirkungen zu haben.

[english] Aims: To estimate the impact of diabetes on mortality in patients after first stroke event. Methods: Using claims data of a nationwide statutory health insurance fund (Gmünder ErsatzKasse, GEK), we assessed all deaths in a cohort of all 5,757 patients with a first stroke between 2005 and 2007 (69.3% male, mean age 68.1 years, 32.2% diabetic) up to 2009. Using Cox regression, we estimated time dependent hazard ratios (HR) to compare patients with and without diabetes stratified by sex. Results: The cumulative 5 year mortality was 40.0% and 54.2% in diabetic men and women, and 32.3% and 38.1% in their non-diabetic counterparts, respectively. In males, mortality was significantly lower in diabetic compared to non-diabetic patients in the first 30 days (multiple-adjusted HR 0.67; 95% confidence interval 0.53–0.84). In the following time, the diabetes risk increased yielding crossed survival curves after about a quarter year. Later on, mortality risk tended to be similar in diabetic and non-diabetic men (1–2 years HR 1.42; 1.09–1.85; 3–5 years HR 1.00; 0.67–1.41) (time-dependency of diabetes, p=0.008). In women, the pattern was similar, however, time dependency was not statistically significant (p=0.89). Increasing age, haemorrhagic stroke, renal failure (only in men), levels of care dependency, and the number of prescribed medications were significantly associated with mortality. Conclusions: We found a time dependent mortality risk of diabetes following first stroke in men. Possible explanations may be type of stroke, or earlier and more intensive treatment of risk factors in diabetic patients.[german] Ziel: Untersuchung des Einflusses von Diabetes auf die Mortalität in Patienten nach erstem Schlaganfall.Methoden: Anhand von Routinedaten einer bundesweiten Krankenkasse (Gmünder ErsatzKasse, GEK) wurden alle Todesfälle in einer Kohorte von 5.757 Patienten mit erstem Schlaganfall zwischen 2005 und 2007 ermittelt (69,3% männlich, durchschnittliches Alter: 68,1 Jahre, 32,2% mit Diabetes).Mit Hilfe der Cox-Regression wurden stratifiziert nach Geschlecht zeitabhängige Hazard Ratios (HR) geschätzt, um die Mortalität von Patienten mit und ohne Diabetes miteinander zu vergleichen.Ergebnisse: Die kumulative 5-Jahres Mortalität nach Schlaganfall betrug für männliche und weibliche Personen mit Diabetes 40,0% und 54,2%, während sie bei entsprechenden Personen ohne Diabetes bei 32,3% bzw. 38,1% lag. Innerhalb der ersten 30 Tage nach Schlaganfall war das Mortalitätsrisiko bei diabetischen Männern signifikant niedriger im Vergleich zu männlichen Patienten ohne Diabetes (multipel-adjustiertes HR: 0,67; 95% Konfidenzintervall 0,53–0,84). In der darauf folgenden Zeit erhöhte sich das Risiko der Personen mit Diabetes derart, dass sich nach etwa einem Vierteljahr die Überlebenskurven überkreuzten und das Risikoverhältnis sich signifikant umkehrte (1-2 Jahre HR: 1,42; 1,09–1,85). Am Ende des Beobachtungsraumes glichen sich die Überlebenskurven wieder an, so dass das Risiko für Männer mit und ohne Diabetes wieder auf einem ähnlichen Niveau lag (3-5 Jahre HR: 1,00; 0,67–1,41, Zeitabhängigkeit des Diabetes, p=0,008). Bei den Frauen war ein ähnliches Muster zu erkennen, wenngleich die Zeitabhängigkeit nicht statistisch signifikant war (p=0,89). Des Weiteren waren zunehmendes Alter, durch Blutung verursachter Schlaganfall, Nierenversagen (nur bei Männern), erhöhte Pflegestufe sowie die Anzahl verschriebener Medikationen signifikant assoziiert mit der Mortalität.Schlussfolgerungen: Mögliche Erklärungen für das mit der Zeit variierende Mortalitätsrisiko des Diabetes könnten der Schlaganfalltyp oder die frühere und intensivere Behandlung potentieller Risikofaktoren bei Patienten mit Diabetes sein.

Background: Information on the developing process and on data validity is crucial when using health insurance claims data (on medications) for research purposes. In Germany, different prescription forms are available for narcotics (so-called 'Betäubungsmittelrezepte') and other medications (so-called 'Muster 16'). The aim of this study was to compare the correctness of the recorded research relevant information between them. Methods: We used data of the Gmünder ErsatzKasse (GEK) for the year 2006. Out of 7.2 million prescriptions we drew a simple random sample of 600 prescriptions for narcotics and 600 for other medications. Data on the scanned original prescription, which was used as a gold standard, were validated against that information in claims data. Results: Compared to prescriptions for other medications, dates of prescription (92.5% vs. 68.1%; p

Cochrane reviews are known to be a high-quality source of evidence synthesis supporting health care decisions. In a recently conducted study, we analyzed the trends in epidemiology and reporting of published systematic reviews over the last 20 years. This sample of 1132 systematic reviews included 84 Cochrane reviews. We have learned several peculiarities of Cochrane reviews that are worth being discussed in more detail due to their practical implications. Methodologists, clinicians and health care professionals should be aware of these limitations: (1) Cochrane reviews are not identified as systematic reviews in title, (2) Cochrane reviews do not always follow PRISMA reporting guidelines, (3) Some updates are only available via the Cochrane Library, and (4) Indexing of Cochrane reviews in PubMed may be suboptimal.

International studies show disadvantages for adults with autism spectrum disorder (ASD) in the labor market. Data about their participation in the German labor market are scarce. The aim of this study was to examine the integration of adults with ASD in the German labor market in terms of education, employment and type of occupation by means of a cross-sectional-study, using a postal questionnaire. Findings show above average levels of education for adults with ASD compared to the general population of Germany and simultaneously, below average rates of employment and high rates of financial dependency. That indicates a poor integration of adults with ASD in the German labor market and emphasizes the need for vocational support policies for adults with ASD.

Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce. Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed. Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs. In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.

Background and purpose: This systematic review examines the effectiveness of motivational interviewing (MI) on medication adherence for preventing recurrent stroke and transient ischemic attack (TIA). Methods: MEDLINE (via PubMed), CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov were searched from inception to 12 June 2023. Randomized controlled trials comparing MI with usual care or interventions without MI in participants with any stroke type were identified and summarized descriptively. Primary outcome was medication adherence. Secondary outcomes were quality of life (QoL) and different clinical outcomes. We assessed risk of bias with RoB 2 (revised Cochrane risk‐of‐bias tool) and intervention complexity with the iCAT_SR (intervention Complexity Assessment Tool for Systematic Reviews). Results: We screened 691 records for eligibility and included four studies published in five articles. The studies included a total of 2751 participants, and three were multicentric. Three studies had a high risk of bias, and interventions varied in complexity. Two studies found significantly improved medication adherence, one at 9 (96.9% vs. 88.2%, risk ratio = 1.098, 95% confidence interval = 1.03–1.17) and one at 12 months (97.0% vs. 95.0%, p = 0.026), but not at other time points, whereas two other studies reported no significant changes. No significant differences were found in QoL or clinical outcomes. Conclusions: Evidence on MI appears inconclusive for improving medication adherence for recurrent stroke and TIA prevention, with no benefits on QoL and clinical outcomes. There is a need for robustly designed studies and process evaluations of MI as a complex intervention for people with stroke. Registration: PROSPERO (CRD42023433284). [ABSTRACT FROM AUTHOR]

Purpose: Pain is a common symptom following proximal femoral fractures (PFF), however, information on its treatment in terms of agents and type of use (scheduled vs. pro re nata [PRN]) is scarce. The main objective of this study was to examine pain medication regimens according to pain intensity following PFF. Furthermore, we explored the utilization of medication plans. Methods: The "ProFem"‐study on healthcare provision, functional ability, and quality of life after PFF is a German population‐based prospective cohort study based on statutory health insurance data and individually linked survey data from different time points including information on the currently used medication. This present analysis refers to the participants' baseline interviews (about 3 months following PFF) conducted from 2018 to 2019 in the participants' private surroundings. Results: The study population comprised 444 participants (mean age: 81.2 years, 71.0% female). Half of them reported high intensity pain, and the mean value for the EuroQol visual analogue scale was 50.8. Most commonly used analgesics were metamizole and tilidine/naloxone. Among participants with high intensity pain, 21.9% received only PRN pain medication and 17.2% no pain medication at all. Overall, 61.5% of participants presented any (printed) medication plan and only 25.2% a "federal standardized medication plan" (BMP). Conclusion: As a substantial number of patients reports high intensity pain about 3 months following a PFF, the large proportion of those receiving no or only PRN pain medication raises questions regarding the appropriateness of the therapy. The overall low utilization of the BMP indicates potential for improvement. [ABSTRACT FROM AUTHOR]

Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind-body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects.