Age In Germany Research Articles

Death anxiety among the oldest old in Germany. Evidence from the nationally representative 'Old Age in Germany (D80+)'.

There is a lack of studies investigating death anxiety among the oldest old based on a large, nationally representative sample during the pandemic. Thus, our aim was to investigate the prevalence and determinants of death anxiety among the oldest old in Germany during the Covid-19 pandemic. Cross-sectional data were taken from the 'Old Age in Germany' (D80+) study. This is a large, nationwide representative study including individuals 80 years and over living at home and individuals in institutionalised settings (N = 9542 individuals in the analytic sample). Overall, 30% of the respondents reported the absence of death anxiety, 45.5% reported a rather not strong death anxiety, 20.2% reported a rather strong death anxiety, and 4.3% reported a very strong death anxiety. Linear regressions revealed that higher death anxiety was significantly associated with being female (β = 0.21, P < 0.01), younger age (β = -0.02, P < 0.001), being married (β = 0.09, P < 0.001), high education (compared to low education, β = 0.07, P < 0.05), the presence of meaning in life (β = 0.13, P < 0.001), higher loneliness levels (β = 0.18, P < 0.001), the presence of multimorbidity (β = 0.07, P < 0.05), and poorer self-rated health (β = -0.07, P < 0.001). A further analysis showed that probable depression (β = 0.31, P < 0.001) is also associated with higher death anxiety. About one in four individuals had a strong or very strong fear of death during the pandemic. Several sociodemographic, psychosocial, and health-related factors are associated with higher death anxiety. This better understanding of the determinants of death anxiety can be relevant for, among others, the affected individuals, informal and professional carers, as well as friends and relatives.

Perception of one's social environment and loneliness: results of the nationally representative "Old age in Germany (D80+)" study.

To examine the association between perception of one's social environment (in terms of residential attachment and neighborhood trust) and loneliness among the oldest old and whether these associations differ by living arrangement. We used data from the nationally representative "Old Age in Germany (D80+)" study that included individuals residing in private households and institutionalized settings. The analytic sample was 9,621 individuals (average age: 85.5 years, SD: 4.1 years; 62% female). Data collection took place from November 2020 to April 2021. Multiple linear regressions were conducted with adjustment for relevant covariates. Higher residential attachment (β=-0.02, p < .05) and higher neighborhood trust (β=-0.12, p < .001) were associated with less loneliness. The latter association was moderated by living arrangement (β=-0.09, p = .04) such that the association between neighborhood trust and loneliness was stronger among individuals living in institutionalized settings compared to individuals in private households. Greater residential attachment and neighborhood trust, particularly among individuals living in institutionalized settings, are associated with less loneliness among the oldest old. Finding ways to improve perceived attachment and trust may assist in avoiding loneliness among older individuals.

Subjective Well-Being of Parents and Childless People in Older Age in Germany

AbstractThe growing number of older childless individuals in Western societies has raised concerns about their subjective well-being. In this study, we scrutinize the subjective well-being of parents and childless individuals aged 60 years and older. We examine subjective well-being as a multi-dimensional construct encompassing life satisfaction, positive affect, and negative affect. Based on the value-of-children approach, we hypothesize that childless individuals experience lower subjective well-being than parents and that the disparity in well-being differs with age, gender, and the quality of the parent-child relationship. For our analysis, we use data from a nationally representative sample of adults aged 60 years and older (n = 10,682) drawn from the German Ageing Survey. Our findings from random effects regression models show that childless individuals report lower life satisfaction, less positive affect, and more negative affect than parents. These associations are larger for men than for women but do not vary significantly across age groups. Furthermore, our results suggest that the benefits of parenthood strongly depend on the quality of the parent-child relationship. Childless people report lower subjective well-being than parents with a close emotional bond with their children, but similar or even higher subjective well-being than parents with an emotionally distant parent-child relationship. In sum, our study indicates that childless people experience, on average, lower well-being across all three dimensions of subjective well-being in older age. However, under specific circumstances, childless individuals may fare better than parents.

Clinical and economic inpatient burden of respiratory syncytial virus (RSV) infections in children < 2 years of age in Germany, 2014-2019: a retrospective health claims analysis.

Respiratory syncytial virus (RSV) is a common cause for severe lower respiratory tract infections (LRTI) in children < 2 years of age in Germany - though little is known about the clinical and economic burden of RSV in children with and without risk factors per month of life. In a retrospective health claims analysis, we identified RSV inpatient cases between 2014 and 2019. We assessed incidence rates, mortality rate, healthcare resource utilization, associated direct costs per case and excess costs for 30, 90 and 365 days after hospital admission matched to a control group. The outcomes are reported separately for the first and second year of life (i.e., for infants and toddlers) and were stratified by month of life, preterm and risk status (i.e., presence of underlying disease: chronic respiratory or cardiac disease, immunosuppression, neurological diseases, diabetes, conditions originating in the perinatal period). RSV-attributable hospital incidence rate was higher in infants (30.25/1,000) than toddlers (14.52/1,000), highest in the first three months of life (44.21/1,000), in infants born preterm (64.76/1,000) or with any underlying disease (54.85/1,000). Mortality rate was also higher for infants (0.08/1,000) than toddlers (0.04/1,000). Mean 30-day excess costs ranged from 2,953 € for infants born full-term at no risk, hospitalized for 5 days, to 6,694 € for infants born extremely premature, hospitalized for 7 days. In Germany, the clinical and economic burden of RSV is substantial, especially in the most vulnerable population, that is, very young infants, those born premature and/or those with an underlying disease.

Sex differences in symptoms following the administration of BNT162b2 mRNA COVID-19 vaccine in children below 5 years of age in Germany (CoVacU5): a retrospective cohort study

BackgroundSex differences exist not only in the efficacy but also in adverse event rates of many vaccines. Here we compared the safety of BNT162b2 vaccine administered off-label in female and male children younger than 5 years in Germany.MethodsThis is a retrospective cohort study, in which we performed a post-hoc analysis of a dataset collected through an authentication-based survey of individuals having registered children aged 0-<5 years for vaccination against SARS-CoV-2 in six private practices and/or two lay person-initiated vaccination campaigns. We analyzed the safety profiles of the first 3 doses of 3–10 µg BNT162b2. Primary outcome was comparison in frequencies of 4 common post-vaccination symptom categories such as local, general, musculoskeletal symptoms and fever. Data were analyzed according to sex in bivariate analyses and regression models adjusting for age, weight, and dosage. Interaction between sex and BNT162b2 dosage was assessed. An active-comparator analysis was applied to compare post-vaccination symptoms after BNT162b2 versus non-SARS-CoV-2 vaccines.ResultsThe dataset for the present analysis consisted of 7801 participants including 3842 females (49%) and 3977 males (51%) with an age of 3 years (median, interquartile: 2 years). Among individuals receiving 3 µg BNT162b2, no sex differences were noted, but after a first dose of 5–10 µg BNT162b2, local injection-site symptoms were more prevalent in girls compared to boys. In logistic regression, female sex was associated with higher odds of local symptoms, odds ratio (OR) of 1.33 (95% confidence interval [CI]: 1.15–1.55, p < 0.05) and general symptoms with OR 1.21 (95% CI: 1.01–1.44, p < 0.05). Following non-BNT162b2 childhood vaccinations, female sex was associated with a lower odds of post-vaccination musculoskeletal symptoms (OR: 0.29, 95% CI: 0.11–0.82, p < 0.05). An active comparator analysis between BNT162b2 and non-SARS-CoV-2 vaccinations revealed that female sex positively influenced the association between BNT162b2 vaccine type and musculoskeletal symptoms.ConclusionsSex differences exist in post-vaccination symptoms after BNT162b2 administration even in young children. These are of importance for the conception of approval studies, for post-vaccination monitoring and for future vaccination strategies (German Clinical Trials Register ID: DRKS00028759).

Multinational Analysis of Marginal Liver Grafts Based on the Eurotransplant Extended Donor Criteria.

To evaluate the outcome of marginal liver grafts based on the Eurotransplant extended donor criteria (ECD) criteria. Eurotransplant uses a broad definition of ECD criteria (age >65 years, steatosis >40%, BMI >30kg/m2, ICU stay >7 days, DCD, and certain laboratory parameters) for allocating organs to recipients who have consented to marginal grafts. Historically, marginal liver grafts were associated with increased rates of dysfunction. Retrospective cohort analysis using the German Transplant Registry (GTR) and the US Scientific Registry of Transplant Recipients (SRTR) from 2006-2016. Results were validated with recent SRTR data (2017-2022). Donors were classified according to the Eurotransplant ECD criteria, DCD was excluded. Data were analyzed with cut-off prediction, binomial logistic regression, and multivariate Cox regression. The study analyzed 92,330 deceased brain-dead donors (87% SRTR) and 70,374 transplants (87% SRTR) in adult recipients. Predominant ECD factors were donor age in Germany (30%) and BMI in the US (28%). Except for donor age, grafts meeting ECD criteria were not associated with impaired 1- or 3-year survival. Cut-offs had little to no predictive value for 30-day graft survival (AUROC 0.49 - 0.52) and were nominally higher for age (72 vs. 65 years) in Germany as compared to those defined by current Eurotransplant criteria. The outcome of transplanted grafts from higher risk donors was nearly equal to standard donors with Eurotransplant criteria failing to predict survival of marginal grafts. Modifying ECD criteria could improve graft allocation and potentially expand the donor pool.

Impact of neighborhood context on self-rated health among very old adults living in Germany: a cross-sectional representative study

BackgroundIncreasingly, evidence has shown that different aspects of neighborhood context play a significant role in self-rated health, one of the key health indicators in advanced age. Nevertheless, very old adults are often under represented or excluded from such research. Therefore, the first aim of this study was to examine whether social, socioeconomic, and physical neighborhood context is associated with self-rated health in the very old population of Germany. The second objective was to explore whether the link of socioeconomic and physical neighborhood context with self-rated health is moderated by availability of social resources in neighborhoods.MethodsData from the representative survey, “Old Age in Germany” (D80+) were employed. In total, the study sample of D80+ included 10,578 individuals aged 80 years and over. Additionally, the D80+ data were matched with the freely accessible regional dataset of the Federal Institute for Research on Building, Urban Affairs, and Spatial Development. Two self-rated items (place attachment and social cohesion) were used to assess social neighborhood context. Socioeconomic context of neighborhoods was operationalized by German index of socioeconomic deprivation. To evaluate physical context, perceived measures of building conditions and walkability were included. Using the maximum likelihood estimator with robust standard errors, logistic regression models were estimated to analyze the relationship between neighborhood context (social, socioeconomic, and physical context, as well as their interactions) and self-rated health.ResultsIncluding 8,066 participants in the analysis, the findings showed that better condition of residential building, higher walkability, being closely attached to outdoor places, and higher social cohesion were associated with higher chance to report good self-rated health of very old adults. In the adjusted models, the German socioeconomic deprivation index was not related to self-rated health. The effect of socioeconomic and physical neighborhood context on self-rated health did not differ according available neighborhood social resources.ConclusionsThe results indicate that especially more favorable conditions in social and physical neighborhood context are associated with good self-rated health in the very old population of Germany. Further studies should consider multiple aspects of neighborhood context as well as their interplay when examining the neighborhood impact on self-rated health in older populations.

Pet ownership and psychosocial outcomes among the oldest old in Germany during the Covid-19 pandemic. Findings based on the nationally representative "Old Age in Germany (D80+)".

To examine the association between pet ownership and psychosocial outcomes among the oldest old in Germany during the Covid-19 pandemic. Data from the "Old Age in Germany (D80+)" study were used, a large, nationwide representative study covering both individuals living at home and individuals in nursing homes aged 80years and above (n=2867 individuals). The telephone interviews were conducted from May to October 2021. Established tools (e.g., "Short Form of the Depression in Old Age Scale", DIA-S4) were used to quantify the outcomes. Five groups were generated: (1) no pet ownership, (2) having at least one dog (but no other pets), (3) having at least one cat (but no other pets), (4) having at least one other pet (but neither dogs nor cats), (5) having at least two different types of pets (in any combination). Multiple linear regressions showed that compared to individuals without a pet, individuals having at least one dog had significantly lower loneliness levels (β=-0.21, p<0.01). In the fully-adjusted models, other forms of pet ownership were not significantly associated with the outcomes examined. Particularly living with a dog was associated with lower loneliness among the oldest old people in Germany. If living with a dog is in line with the preferences and attitudes of the very old, this could be a strategy for reducing loneliness in this age group.

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study.

To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Factors associated with institutionalization among the oldest old: Results based on the nationally representative study 'old age in Germany (D80+)'.

To examine the factors associated with institutionalization among individuals aged 80years and over in Germany (total sample and stratified by sex). We used data from the nationally representative 'Old Age in Germany (D80+)' (analytic sample: n=9572 individuals), including individuals aged 80years and over in Germany. Institutionalization (private living vs. institutionalization) served as an outcome measure. For the written interview, data collection took place from November 2020 to April 2021. Multiple logistic regressions of the overall sample (also stratified by sex) were applied. In the analytic sample, 10.2% (95% CI: 9.2%-11.3%) of the participants were institutionalized. The odds of being institutionalized were positively associated with being female (OR: 2.02, 95% CI: 1.08 to 3.80), being 90years and over (compared to 80-84years, OR: 1.67, 95% CI: 1.17 to 2.40), not being married (e.g., being single compared to being married: OR: 14.06, 95% CI: 6.73 to 29.37), higher education (e.g., high education compared to low education: OR: 1.88, 95% CI: 1.25 to 2.84), more favorable self-rated health (OR: 1.32, 95% CI: 1.07 to 1.62) and greater functional impairment (OR: 15.34, 95% CI: 11.91 to 19.74). Sex-stratified regressions were also conducted, mostly yielding similar results. Our study highlighted the role of several sociodemographic factors (particularly marital status, e.g., being single) and functional impairment for the risk of institutionalization among the oldest old in Germany. This study confirms findings in studies in younger samples that functional decline is the main factor associated with institutionalization. As functional decline may be modifiable, efforts to maintain functional abilities may be important. This knowledge is important for relevant groups (such as clinicians and policy-makers) because it may guide early intervention and prevention efforts, can help allocate healthcare resources effectively and shape policies to support independent living. Further insights using longitudinal data is recommended.

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

ObjectivesTo clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex). MethodsData from the nationally representative “Old Age in Germany (D80+)” were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire). ResultsHigher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex). ConclusionSeveral sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Gendered repartnering in later life: structural and processual dimensions of the transition into new relationships

Abstract Against the backdrop of demographic change and the pluralisation of living arrangements, the article focuses on repartnering after widowhood, divorce and separation in older age in Germany. While theoretically framing repartnering as a lifecourse transition, the question arises of how later-life relationships form in relation to gender- and ageing-specific as well as structural and processual dimensions. Since previous research indicates that there are gender-specific patterns when repartnering in older age which differ from repartnering in middle age, the article explicitly accounts for gendered ageing and attitudes towards ageing. Using data from the German Ageing Survey (1996–2017), longitudinal hybrid panel regressions are modelled for 3,653 respondents, 11,628 observations and 179 new relationships. I propose to understand within-effects as processual and between-effects as structural dimensions of repartnering. The results for the structural dimensions show that the likelihood of repartnering is higher for men and for individuals with more negative attitudes towards ageing. The results for the processual dimensions show how repartnering becomes less likely the older one gets and the more positive one's attitudes towards ageing become. The interaction term for gender and ageing shows that ageing has a stronger influence on the likelihood to repartner for women than for men. Additionally, the findings reveal a difference between forms of singlehood: in the short term, repartnering is less likely for divorced or separated individuals than for widowed individuals, whereas the opposite effect shows in the long term. In sensitising the lifecourse perspective with gender- and ageing-specific concepts and analytically separating processual and structural dimensions, this article demonstrates the importance of gendered ageing and of the linkage between relationship transitions. Applying hybrid panel models to lifecourse transitions in older age reveals the processual dynamic and structural embeddedness of repartnering in older age.

Use of leflunomide among girls and women of childbearing age and occurrence of leflunomide-exposed pregnancies in Germany

Leflunomide is contraindicated during pregnancy and treatment cessation is recommended two years before pregnancy. We aimed to describe leflunomide use in women of childbearing age in Germany, the occurrence of pregnancies in women using leflunomide and malformations among children possibly exposed in utero. Using the GePaRD database (claims data, ∼20% of the German population), we determined annual age-standardized prevalences of leflunomide use between 2004 and 2019 among females aged 13–49 years. Further, we estimated the number of exposed pregnancies by assessing whether the exposure window assigned to the last dispensation before pregnancy (days covered by the dispensation plus two years) overlapped the onset of pregnancy or whether there was a dispensation in the first eight weeks of pregnancy. For exposed live births, a mother-baby linkage was performed and the presence of congenital malformation was assessed. The age-standardized prevalence of leflunomide use ranged between 0.34 and 0.46 per 1000 females during the study period. About one third of the users were ≤40 years. We identified 205 leflunomide-exposed pregnancies ending during the study period. 71% of these pregnancies ended in a live birth (26% preterm) and 10% in an induced abortion. In 86% of the live births (n=125) the mother-baby linkage was successful. Among these 125 children, 13 children (10%) had congenital malformations. In conclusion, we observed a considerable number of pregnancies in women using leflunomide in the two years before or during early pregnancy. This highlights the importance of monitoring the implementation of existing risk minimization measures for leflunomide in Germany.

Use of isotretinoin among girls and women of childbearing age and occurrence of isotretinoin-exposed pregnancies in Germany: A population-based study.

Exposure to isotretinoin during pregnancy must be avoided due to its teratogenicity, but real-world data on its use are scarce. We aimed to describe (i) isotretinoin use in women of childbearing age in Germany; (ii) the occurrence of isotretinoin-exposed pregnancies; and (iii) malformations among children exposed in utero. Using observational data from the German Pharmacoepidemiological Research Database (GePaRD, claims data from approximately 20% of the German population), we conducted annual cross-sectional analyses to determine age-standardized prevalence of isotretinoin use between 2004 and 2019 among girls and women aged 13 to 49 years. In cohort analyses, we estimated the number of exposed pregnancies by assessing whether there was prescription supply overlapping the beginning of pregnancy (estimated supply was varied in sensitivity analyses) or a dispensation within the first 8 weeks of pregnancy. Data of live-born children classified as exposed in a critical period according to these criteria were reviewed to assess the presence of congenital malformations. The age-standardized prevalence of isotretinoin use per 1,000 girls and women increased from 1.20 (95% confidence interval [CI]: 1.16, 1.24) in 2004 to 1.96 (95% CI: 1.92, 2.01) in 2019. In the base case analysis, we identified 178 pregnancies exposed to isotretinoin, with the number per year doubling during the study period, and at least 45% of exposed pregnancies ended in an induced abortion. In sensitivity analyses, the number of exposed pregnancies ranged between 172 and 375. Among live-born children, 6 had major congenital malformations. The main limitation of this study was the lack of information on the prescribed dose, i.e., the supply had to be estimated based on the dispensed amount of isotretinoin. Isotretinoin use among girls and women of childbearing age increased in Germany between 2004 and 2019, and there was a considerable number of pregnancies likely exposed to isotretinoin in a critical period. This highlights the importance of monitoring compliance with the existing risk minimization measures for isotretinoin in Germany.

IMPACT OF ENVIRONMENTAL CHARACTERISTICS ON SELF-RATED HEALTH AMONG THE VERY OLD IN GERMANY DURING THE COVID-19 PANDEMIC

Abstract Current research demonstrates negative impact of COVID-19 pandemic on health. Nevertheless, there is evidence that older population might be more resilient against the effect of pandemic than younger adults. Since very old adults are often underrepresented or excluded from these studies, the aim of this paper was to examine the link between environmental characteristics and self-reported health in very old population in Germany during COVID-19 pandemic. Data from the representative survey “Old Age in Germany” of the population aged 80 and older were used. The study sample included 10,578 community-dwelling as well as institutionalized persons. Multilevel analysis was conducted to investigate the association of environment characteristics on individual, and community level with self-rated health. The results showed that higher perceived walkability of outdoor environment, better housing condition, being closer attached to home environment, higher neighborhood trust, and living in a house increased self-rated health (individual level). On community level, residency in one of the communities in western Germany (compared to eastern Germany) was associated with better self-rated health. 35% of the variance in self-rated health was explained at individual and 21% at community level. The findings revealed that very old adults who lived in better home environment experienced better health during the COVID-19 pandemic in Germany. These findings may indicate that the capacity of the very old to adapt to health losses depends on available environmental resources. Therefore, improvements of home environment inside and outside of houses and apartments (e.g., ensuring barrier-free accessibility) may strengthen the resilience in later life.

EPH84 Burden of Respiratory Syncytial Virus in Children ≤ 2 Years of Age in Germany: Retrospective Analysis of Health Claims Data from 2014-2019

EPH84 Burden of Respiratory Syncytial Virus in Children ≤ 2 Years of Age in Germany: Retrospective Analysis of Health Claims Data from 2014-2019

Inpatient burden of respiratory syncytial virus in children ≤2 years of age in Germany: A retrospective analysis of nationwide hospitalization data, 2019-2022.

Respiratory syncytial virus (RSV) causes respiratory tract disease in seasonal waves, primarily in infants and young children. This study aims to quantify the number of RSV-related hospitalizations in children ≤2 years of age and to determine corresponding resource use and costs in Germany. We retrospectively analyzed population-wide hospital data from the Institute for the Hospital Remuneration System (InEK) from 2019 to 2022. RSV cases were identified using the RSV-specific 10th revision of the International Classification of Diseases (ICD-10) codes J12.1, J20.5, and J21.0. The RSV-associated proportion of all hospitalizations caused by severe acute respiratory infections (SARIs), clinical manifestations, length of stay (LOS), intensive care unit (ICU) admissions, ventilation rates, and hospitalization costs were retrieved. We identified 98,220 hospitalizations (26,052, 15,407, 31,362, and 25,399 in 2019, 2020, 2021, and 2022, respectively) with a principal RSV diagnosis in children aged ≤2 years in Germany. The majority of RSV hospitalizations (73,178) occurred in infants (<1 year), with annual incidence rates ranging from 14.9 to 28.6 per 1000 population. Fifty-eight percent of all SARI hospitalizations in this age group were attributable to RSV. In children aged ≤2 years, mean LOS was 4.5 days, 6.1% of cases were admitted to ICU, and 5.3% of cases were ventilated. Mean hospitalization costs per case ranged from €3001 to €3961 over the study period. RSV causes substantial disease burden and is a leading cause of SARI-related hospital admissions of children ≤2 years of age in Germany. Our results confirm the need to explore and evaluate strategies to prevent RSV in infants and young children.

Public knowledge and attitudes about mental health in older age in Germany – Focus on dementia and late-life depression

Older people with mental disorders represent a particularly vulnerable group in the health care system. Despite this, mental disorders in this group often remain undiagnosed or are not treated in accordance with guidelines, potentially due to a lack of knowledge or unfavorable attitudes regarding mental disorders in older individuals. Therefore, in an anonymous online survey of 1,284 participants (71.8% female, mean age 52.3 ± 18.0 years), we assessed knowledge and attitudes regarding mental health in old age in general and regarding dementia and late-life depression in particular. Regression analyses were conducted to determine predictors of higher knowledge and more favorable attitudes based on sociodemographic data. On average, participants answered 11 ± 2 out of 15 of the knowledge questions correctly. Items on the prevention of dementia, late-life depression symptoms, and associated suicide risk were most likely to be answered incorrectly. Participants showed less favorable attitudes towards people living with dementia than towards people with late-life depression, and higher knowledge scores were associated with more favorable attitudes. Our findings highlight a clear need for psychoeducation in the field of dementia and late-life depression, with a special emphasis on prevention-related knowledge. Fostering knowledge in this area is highly relevant, as it might positively influence attitudes towards older people with mental disorders, in turn facilitating health care and health-promoting behavior among older people.

Collective bargaining in the digital age in Germany

The article examines the legal mechanisms for minimizing the effects of digitalization on staff employment using the experience of regulating collective bargaining relations in the Federal Republic of Germany as an example.

Use of Methotrexate in Girls and Women of Childbearing Age, Occurrence of Methotrexate-Exposed Pregnancies and Their Outcomes in Germany: A Claims Data Analysis

Methotrexate should be withdrawn before pregnancy because of its teratogenic potential. We aimed to describe the use of methotrexate in women of childbearing age in Germany and the occurrence and outcomes of pregnancies exposed to methotrexate. Using the German Pharmacoepidemiological Research Database (GePaRD,covering ~ 20% of the German population), we determined the age-specific and age-standardized prevalence of methotrexate use for each year between 2004 and 2019 among women aged 13-49 years (cross-sectional analyses). In a cohort analysis, we assessed the number and outcomes of pregnancies exposed to methotrexate in the critical time window. Exposure was defined as a dispensation overlapping with the onset of pregnancy or a dispensation in the first 8 weeks of pregnancy. For children born from exposed pregnancies, the mother's and children's data were linked and the occurrence of malformations was assessed by reviewing all available data of these children. The age-standardized prevalence of methotrexate use per 1000 females increased from 1.5 in 2004 to 2.3 in 2019, i.e., by 52%. Overall, we identified 184 pregnancies exposed to methotrexate. Of these, 53% ended in a live birth (21% preterm) and 11% in an induced abortion. Among 81 live-born children linked to their mothers, five children (6%) had relevant malformations including congenital heart defects and musculoskeletal malformations. In Germany, the use of methotrexate in women of childbearing age has substantially increased since 2004. Despite the known teratogenic effect, there was a considerable number of exposed pregnancies. Also, malformations likely associated with methotrexate and thus avoidable were observed.