Disease In Germany Research Articles

Results from the German registry for refractory celiac disease.

Refractory celiac disease (RCD) refers to a rare subgroup of patients with celiac disease who show clinical signs of malabsorption despite a gluten-free diet. RCD is divided into an autoimmune phenotype (RCD type I) and pre-lymphoma (RCD type II). To reflect the clinical reality in managing this disease in Germany, a national register was established based on a questionnaire developed specifically for this purpose. Between 2014 and 2020, a total of 53 patients were registered. The diagnosis of RCD was confirmed in 46 cases (87%). This included 27 patients (59%) with RCD type I and 19 patients (41%) with RCD type II. A wide range of diagnostic and therapeutic measures was used. Therapeutically, budesonide was used in 59% of the RCD patients regardless of the subtype. Nutritional therapy was used in only 5 patients (11%). Overall mortality was 26% (12 patients) with a clear dominance in patients with RCD type II (9 patients, 47%). In summary, RCD needs to become a focus of national guidelines to increase awareness, establish standards, and thus enable the treating physician to make the correct diagnosis in a timely manner. Moreover, we concluded that when treating such patients, contacting a specialized center is recommended to ensure sufficient management.

Cutaneous leishmaniasis in Germany-still atravel-related disease

Cutaneous leishmaniasis is an infectious disease caused by several Leishmania species. It is transmitted to humans by the bite of the infected female phlebotomus sandfly. Today, more than 1billion people in leishmaniasis endemic areas are at risk of infection. More than 1.5million new cases of cutaneous leishmaniasis occur every year. On the basis of two cases, we show that cutaneous leishmaniasis is still an imported tropical disease in Germany. However, due to the increasing intercontinental travel, cases may increase. Therefore, cutaneous leishmaniasis should be considered in the differential diagnosis in patients with nonhealing wounds, ulcers, papules or nodules and the corresponding travel history.

An empirical study on hospital-based prevention of recurrent urinary stone disease in Germany

PurposeUrinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements.MethodsTwo hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease.ResultsSixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon.ConclusionThe quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended.

Impact of thyroid disorders on the incidence of non-alcoholic fatty liver disease in Germany.

BackgroundStudies investigating a potential association between hypothyroidism and non‐alcoholic fatty liver disease (NAFLD) showed conflicting results and large‐scale population‐based data from Germany on this topic are currently missing.ObjectiveIt was the aim of this analysis to investigate the impact of thyroid gland disorders on the prevalence of NAFLD in Germany.MethodsIn this case‐control study, using the German disease Analyzer database (IQVIA), NAFLD patients were matched to patients without NAFLD by age, sex, index year, treating physician, diabetes mellitus type II, and obesity. The main outcome of the study was an association between thyroid gland disorders (hypothyroidism, hyperthyroidism and autoimmune thyroiditis) and incident NAFLD and was evaluated using logistic regression analyses.Results57,483 patients with NAFLD were matched to 57,483 patients without liver disease. Mean age of the cohort was 60.3 years (±14.1) and 52.3% were men. In regression analyses, hypothyroidism (OR 1.17, 95% CI 1.10 ‐ 1.24, p < 0.001) as well as autoimmune thyroiditis (OR 1.53, 95% CI 1.35–1.73, p < 0.001) were associated with a higher risk of NAFLD. In contrast, hyperthyroidism was associated with a lower risk of NAFLD (OR 0.85, 95% CI 0.77–0.94, p < 0.001). The effect of hypothyroidism on the prevalence of NAFLD remained significant across men (OR 1.31, 95% CI 1.15–1.48) as well as women (OR 1.12, 95% CI 1.05–1.21).ConclusionHypothyroidism seems to be a risk factor for incident NAFLD.

Cannabis use of patients with inflammatory bowel disease in Germany: a cross-sectional survey.

Progressive legalization and increasing utilization of medical cannabis open up potential new applications, including for inflammatory bowel disease (IBD). This study aimed to collect current figures on the use of and experience with cannabis among IBD patients in Germany. A 71-item questionnaire was mailed to a randomly selected representative sample of 1000 IBD patients. Questionnaires were returned by 417 patients (mean age 49.1 ± 17.0 years; 55.8 % women; 43.4 % ulcerative colitis and 54.7 % Crohn's disease). Seventy-three respondents (17.5 %) stated past cannabis use for recreational purposes, while 12 users mentioned usage at the time the questionnaire was completed (2.9 %). Seventeen patients (4.1 %) indicated past use of cannabis, and 18 participants (4.3 %) reported current use of cannabis to treat IBD. Perceived benefits of cannabis use by its users included reduced abdominal pain, improved sleep quality, and relief of unease and worry. They reported lower quality of life and higher levels of anxiety or depression than non-users. Of notice, 52.9 % of cannabis users obtained their cannabis from the black market. A total of 76.5 % of former and 50 % of current users did not report their cannabis use to the physician. This survey reveals the largest data set on cannabis use among IBD patients in Germany, with the potential for further research. Cannabis is mainly procured from the black market, with unknown quality.

Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020.

BackgroundThe COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) affect healthcare seeking behaviour, access to healthcare, test strategies, disease notification and workload at public health authorities, but may also lead to a true change in transmission dynamics. We aimed to assess the impact of the pandemic and NPIs on other notifiable infectious diseases under surveillance in Germany.MethodsWe included 32 nationally notifiable disease categories with case numbers >100/year in 2016–2019. We used quasi-Poisson regression analysis on a weekly aggregated time-series incorporating trend and seasonality, to compute the relative change in case numbers during week 2020–10 to 2020–32 (pandemic/NPIs), in comparison to week 2016–01 to 2020–09.FindingsDuring week 2020–10 to 2020–32, 216,825 COVID-19 cases, and 162,942 (-35%) cases of other diseases, were notified. Case numbers decreased across all ages and notification categories (all p<0•05), except for tick-borne encephalitis, which increased (+58%). The number of cases decreased most for respiratory diseases (from -86% for measles, to -12% for tuberculosis), gastro-intestinal diseases (from -83% for rotavirus gastroenteritis, to -7% for yersiniosis) and imported vector-borne diseases (-75% dengue fever, -73% malaria). The less affected infections were healthcare associated pathogens (from -43% infection/colonisation with carbapenem-non-susceptible Acinetobacter, to -28% for Methicillin-resistant Staphylococcus aureus invasive infection) and sexually transmitted and blood-borne diseases (from -28% for hepatitis B, to -12% for syphilis).InterpretationDuring the COVID-19 pandemic a drastic decrease of notifications for most infectious diseases and pathogens was observed. Our findings suggest effects of NPIs on overall disease transmission that require further investigation.FundingThe Robert Koch Institute is the National Public Health Institute of Germany, and is an institute within the portfolio of the Federal Ministry of Health.

Pneumococcal vaccine uptake and vaccine effectiveness in older adults with invasive pneumococcal disease in Germany: A retrospective cohort study.

BackgroundInvasive pneumococcal disease (IPD) in people ≥60 years old is on the rise in Germany. There has been a recommendation for pneumococcal vaccination in this age group since 1998.MethodsWe determined the vaccination status of people ≥60 years old with IPD in Germany. We assessed vaccine effectiveness (VE) of the recommended 23-valent polysaccharide vaccine (PPV23) against IPD using the indirect cohort method.ResultsThe rate of pneumococcal vaccination in older adults with IPD is low, 26%, with only 16% of people receiving a pneumococcal vaccine within five years of the IPD episode. Age- and gender- adjusted vaccine effectiveness (VE) for PPV23 was 37% (95% confidence interval 12% - 55%). For people vaccinated with PPV23 less than two years prior to IPD, VE was -20% (-131% - 34%), between two and four years prior to IPD, VE was 56% (20% - 76%), and 47% (17% - 63%) for those vaccinated ≥5 five years ago. Excluding serotype 3, overall VE for the remaining serotypes in PPV23 was 63% (49% - 74%). For people receiving PPV23 within the past two years, VE against all serotypes except 3 was 49% (12% - 71%); for people vaccinated between two and four years prior to IPD 66% (37% - 82%); for those vaccinated ≥five years ago, 69% (50% - 81%). VE of PPV23 against serotype 3 IPD only was -110% (-198% - -47%).ConclusionsTo reduce IPD in older adults in Germany, we must increase the rate of pneumococcal vaccine uptake. For 22/23 serotypes, PPV23 was effective. Serotype 3 remains a major problem.FundingThis work was supported by an investigator-initiated research grant from Pfizer.

Personalized medicine drugs and the burden of disease in Germany

Abstract Objectives This study aimed to assess the burden attributable to diseases with subtypes that are indications for the personalized medicine (PM) drugs approved in Germany. Methods A secondary analysis of a PM drug database and Global Burden of Disease (GBD) Study 2019 data was conducted. Indications of the PM drugs approved in Germany for biomarker-targeted therapy were matched with disease burden causes to quantify the portion of the disease burden attributable to causes that, in some instances, may be treated with PM drugs. Results Between 1995 and 2020, the number of PM drugs approved in Germany rose from 0 to 83. Accordingly, the portion of the disease burden due to causes of disease with subtypes that are PM drug indications has risen. Indications for use of the 83 PM drugs approved in Germany by the end of 2020 related to 39 of 369 GBD causes, to which 7825 disability-adjusted life years (DALYs) or 24.3% of the total burden of 32 162 DALYs per 100 000 population in Germany were attributed. Twenty years earlier, in 2000, 5 PM drugs related to 2 GBD causes, to which 978 DALYs (3.1%) of a total burden of 31 878 DALYs per 100 000 population were attributed. Considering the median frequency of biomarkers that can change pharmacological treatment resulted in estimating that not more than 3.0% (interquartile range: 1.1–7.3) of the current German disease burden is affected by personalized pharmacotherapy. Conclusions Mapping PM drug indications to disease burden causes allowed to quantify the disease burden within and outside the domain of personalized pharmacotherapy in Germany.

Quality in acute inpatient rheumatology 2021 : Current aspects of the KOBRA quality label of the Association of Rheumatological Acute Care Clinics

Mit einer umfassenden gesundheitspolitischen Qualitätsoffensive ab 2021 sollen die Qualität und Transparenz in der Versorgung von Menschen mit Krankheiten in Krankenhäusern in Deutschland verbessert werden. Gesetzliche Vorgaben zu Mindestmengen und die Ausweitung von Qualitätsverträgen zwischen Kostenträgern und Krankenhäusern sowie die Verwendung von planungsrelevanten Qualitätsindikatoren für eine bedarfs- und qualitätsorientierte Weiterentwicklung der stationären Versorgung werden den Wettbewerb in der Versorgungsqualität zwischen den Krankenhäusern verstärken. Dem Thema „Entwicklung und Definition von Qualität in der Medizin“ hat sich auch der Verband der Rheumatologischen Akutkliniken e. V. (VRA) schon früh nach der Gründung im Jahr 1998 umfassend angenommen. Im Zentrum der akutstationären Qualitätssicherung stehen verbindlich festgelegte Strukturkriterien in Verknüpfung mit dem 2003 in der Rheumatologie gestarteten und bis heute kontinuierlich durchgeführten KOBRA-Projekt (Kontinuierliches Outcome Benchmarking in der Rheumatologischen Akutversorgung) mit der Messung von Prozess- und Ergebnisqualität. Auf der Basis dieses Rahmenkonzeptes (Erfüllung der Strukturkriterien und Durchführung des KOBRA-Projektes) können erfolgreich teilnehmende rheumatologische Einrichtungen für jeweils 2 Jahre das KOBRA-Label erwerben, welches von der Projektleitung – dem aQua-Institut – vergeben wird. Die herausragende Stellung des KOBRA-Projektes wird beispielhaft anhand von Datenauswertungen des Projektzyklus 2018 gezeigt mit Auswertungen zum Therapiestrategiewechsel bei aktiver rheumatoider Arthritis, Diagnosesicherung von Kollagenosen und Vaskulitiden während des stationären Aufenthaltes sowie zur partizipativen Entscheidungsfindung bei rheumatoider Arthritis. Auf den gesundheitspolitisch geforderten „Paradigmenwechsel – weg vom Bett, hin zu einer leistungs-, bedarfs- und qualitätsorientierten Planung“ – ist die akutstationäre Rheumatologie mit der Verankerung von Projekten zur Struktur‑, Prozess- und Ergebnisqualität sehr gut vorbereitet. Für die in der vom Gemeinsamen Bundesausschuss (G-BA) erstellten Richtlinie zu „Rheumatologischen Zentren“ geforderten Qualitätssicherung ist das KOBRA-Projekt ebenfalls eine sehr gute Voraussetzung.

Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

PurposeCollective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce.MethodsWe analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression.ResultsThe mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures.ConclusionRates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

Educational Level, but Not Income or Area Deprivation, is Related to Macrovascular Disease: Results From Two Population-Based Cohorts in Germany.

Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany. Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke). Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models. Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.

The Current Therapy of Asbestos-Associated Malignant Pleural Mesothelioma - An Expert Consensus Paper

ZusammenfassungAsbestverursachte maligne Mesotheliome gehören in Deutschland mit etwa 1000 jährlichen Neuerkrankungen zu den häufigen arbeitsbedingten Krebserkrankungen. Die Prognose ist oftmals schlecht, da die Erkrankung lange symptomlos bleibt und deshalb meist erst als Zufallsbefund in bereits fortgeschrittenen Stadien diagnostiziert wird.Die deutsche gesetzliche Unfallversicherung (DGUV) hat in den letzten Jahren erhebliche Anstrengungen unternommen, eine Vorverlagerung des Diagnosezeitpunkts zu erreichen, um die Erkrankung möglichst in Frühstadien zu detektieren. Die aus diesen Bestrebungen resultierenden neuen medizinisch-wissenschaftlichen Erkenntnisse zeigen, dass die Kombination der Biomarker Calretinin und Mesothelin in einer Hochrisikogruppe die Vorverlegung der Diagnose um bis zu 12 Monaten ermöglicht.Die Diagnose eines Mesothelioms im Frühstadium wird idealerweise von der individuell bestmöglichen Therapie gefolgt. Die Standardtherapie basiert auf operativer Entfernung des Tumors und Chemotherapie, ergänzt um Strahlentherapie und Psychoonkologie. In den letzten Jahren wurden einige neue Therapieansätze entwickelt. Die Übersicht stellt den aktuellen Stand der Therapie des Mesothelioms, basierend auf den internationalen Leitlinien und neuen Studien, dar.

Peripheral artery disease in Germany (2009-2018): Prevalence, frequency of specialized ambulatory care and use of guideline-recommended therapy - A population-based study.

BackgroundPeripheral artery disease (PAD) patients have high morbidity and mortality rates, demonstrating a need for improved treatment strategies. While underuse and undertreatment have been reported, there is no clear picture of patterns in population-level disease prevalence, prescription of guideline-recommended pharmacotherapy, or frequency of contact with dedicated specialists. We present population-level data on changes in prevalence, care and treatment of PAD from 2009 to 2018 in Germany.MethodsWe analyzed the ambulatory claims data for all statutorily insured patients comprising 70.1 million patients each year and 87% of the German population. Prevalence was assessed by documentation of PAD and stratified by age and sex within the 10-year study timeframe. In addition, current ambulatory care, stratified by vascular specialists (vascular surgeons or angiologists), internists, cardiologists and primary care physicians, were examined.FindingsPrevalence increased from 1·85% in 2009 to 3·14% in 2018, affecting 2·3 million patients in 2018 and more males (55%) than females (45%). A low level of visits to vascular specialists, with 11·1% receiving care from vascular surgeons and 8·1% from angiologists, was shown. Moreover, analysis of guideline-recommended prescriptions revealed increasing, but still insufficient, prescription frequencies among PAD patients between 2009 and 2016, from 42·6% to 56% for statins and from 40·2% to 48·0% for antiplatelets.InterpretationOur results show that the prevalence of PAD in Germany, as assessed by outpatient PAD documentation, is increasing and PAD patients are underutilizing specialized vascular care; moreover, the prescription frequency of guideline-recommended therapies remains low. There is a clear need to improve the referral and treatment algorithms in the high-risk PAD population.FundingNone.

Clinical Profiles and Mortality of COVID-19 Inpatients with Parkinson's Disease in Germany.

BackgroundComprehensive, nationwide data regarding Parkinson's disease (PD) hospitalizations, coronavirus disease 2019 (COVID‐19) in‐hospital frequency, and COVID‐19‐associated inpatient mortality during the first wave of the COVID‐19 pandemic are not available.ObjectiveTo provide a nationwide analysis on hospitalized PD patients in Germany and evaluate the impact of the COVID‐19 pandemic.MethodsWe conducted a cross‐sectional study using an administrative claims database covering 1468 hospitals and 5,210,432 patient hospitalizations including a total of 30,872 COVID‐19+ cases between January 16 and May 15, 2020.ResultsCompared to 2019, hospitalizations for PD transiently decreased by up to 72.7% in 2020. COVID‐19 frequency was significantly higher in the population of 64,434 PD patients (693 being COVID‐19+) than in non‐PD patients (1.1% vs. 0.6%, P < 0.001), especially in subjects with advanced age (≥ 65 years). Regarding established COVID‐19 risk comorbidities, COVID‐19+ inpatients with PD showed higher incidences than non‐PD COVID‐19+ subjects, particularly hypertension and chronic kidney disease. Advanced age and male sex were significantly more frequent in COVID‐19+ than in COVID‐19− PD patients. The COVID‐19 inpatient mortality rate was much higher in PD patients than in non‐PD patients (35.4% vs. 20.7%, P < 0.001), especially in patients aged 75–79 years. Of note, overall inpatient mortality of PD patients was significantly higher in 2020 than in 2019 (5.7% vs. 4.9%, P < 0.001).ConclusionsPD inpatients are more frequently affected by COVID‐19 and suffer from increased COVID‐19‐associated mortality in comparison to non‐PD patients. More comprehensive studies are needed to assess the significance of associated comorbidities for COVID‐19 risk and mortality in PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach.

In 2017, ovarian cancer due to asbestos exposure was designated a new, and thereby the first, gynaecological occupational disease in Germany. Asbestos is a naturally occurring mineral fibre with an annual usage in Germany of 160 000 – 180 000 metric tonnes in the 1960s and 1970s. The carcinogenicity of asbestos for the target organs lungs, larynx, pleura including pericardium, and peritoneum including tunica vaginalis testis has been clearly established for many years. Recent meta-analyses of data from cohort studies have demonstrated that the risk of ovarian cancer roughly doubles in women with occupational exposure to asbestos. Since the group of people with double the risk of developing lung cancer due to work-related asbestos exposure has a 2.25-fold increased risk of mortality from ovarian cancer on average, work-related ovarian cancer has been assigned the same recognition requirements as in occupational lung (and laryngeal) cancer. Thus, gynaecologists must obtain a thorough history of occupational exposure to asbestos, even if it may have taken place long in the past. The law mandates that suspected such cases must be reported to the Statutory Accident Insurance carrier or the State Occupational Safety and Health Agency.

Prescription of analgesics in patients with rheumatic diseases in Germany : Aclaims data analysis.

ObjectiveTo investigate the prescription frequency of analgesics in persons diagnosed with rheumatoid arthritis (RA), axial spondylarthritis (axSpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE) in 2019 using claims data.MethodsPersons ≥ 18 years insured in 2019 with a diagnosis of RA (M05, M06), axSpA (M45), PsA (M07.0-3) or SLE (M32.1,8,9) were included. Analgesics were identified by the anatomic therapeutic classification (ATC) system. Reported is the percentage of individuals with ≥ 1 analgesics prescription for the respective rheumatic diagnosis in 2019 and for opioids age-standardized in each of the years 2005–2019. In addition, the proportion of long-term opioid use (prescriptions in ≥ 3 consecutive quarter years) in 2006 and 2019 is compared.ResultsMetamizole (29–33%) was the most commonly prescribed analgesic. Nonsteroidal anti-inflammatory drugs (NSAID)/coxibs were prescribed from 35% (SLE) to 50% (axSpA). Of the patients 11–13% were prescribed weak and 6–8% strong opioids. From 2005 to 2019, the proportion of persons with an opioid prescription remained stable, with similar or slightly decreasing proportions of weak opioids and more frequent prescriptions of strong opioids. The proportion of long-term opioid prescriptions increased from 2006 to 2019 from 8.9% to 11.0% (RA), from 6.9% to 9.1% (axSPA), from 7.8% to 9.5% (PsA), and from 7.5% to 8.8% (SLE), corresponding to a 17–24% increase.ConclusionThe prescription of opioids for persons with inflammatory rheumatic diagnoses is not as high in Germany as in other countries; however, the proportion of long-term prescriptions has considerably increased. The frequent prescription of metamizole is conspicuous.

Systematic assessment of health care perception in adults with congenital heart disease in Germany.

The number of adults with congenital heart disease (ACHD) is steadily rising due to increased survival rate and improved medical resources. Accordingly, more than 330,000 ACHD are currently living in Germany. Almost all of them require lifelong specialized medical follow-up for their chronic heart disease, often accompanied by residua, sequelae, or comorbidities. Primary care physicians (PCPs) are a crucial factor in directing patients to ACHD specialists or specialized institutions, but despite all efforts, the number of ACHD under specialized care is low, the lost-to-follow-up rate is high, and the morbidity and mortality is substantial. The present cross-sectional study was designed to systematically characterize the health care of ACHD from a patient perspective, including (I) use of medical care by ACHD, (II) medical counselling needs, and (III) perceived satisfaction with health care. The German-wide analysis was based on a 25-item questionnaire designed to address different aspects of medical status and health issues of ACHD from their own perspective, performed between May of 2017 and July of 2020. A total of 4,008 ACHD (52% female; mean age 41.9±17.2 years) completed the questionnaire. The majority of ACHD (3,524, 87.9%) reported, that they consulted their PCP for non-cardiac health problems, and 49.7% (n=1,991) consulted their PCP also for medical problems associated with the underlying CHD. Almost all ACHD reported a need for medical advice concerning exercise capacity and daily life activities, occupational skills, pregnancy, rehabilitation, genetic counselling, insurance, and retirement. A total of 1,840 (45.9%) patients were not aware of the existence of certified ACHD specialists or centers. Moreover, 2,552 (67.6%) of those surveyed were uninformed about patient organizations for ACHD. The present study demonstrates that ACHD are largely uninformed about the ACHD care structures available nationwide, although the patients have a great need for specialized follow-up, advice, and care.

Costs for late-stage Parkinson's disease in Germany determined

Costs for late-stage Parkinson's disease in Germany determined

Abolition of the obligation to cease an occupation for acknowledgment of an occupational skin disease: Backgrounds and perspectives.

The occupational disease skin No.5101 ("severe or recurrent skin diseases that have forced the patient to refrain from all activities that were or could be the cause of the development, aggravation or resurgence of the disease") is the most frequently notified occupational disease in Germany. Since 1936, the medical-objective obligation to refrain from risky work activities, which has been necessary for the recognition of this occupational disease, was intended to delimit trivial diseases, facilitate the determination of occupational causality and promote prevention. The abolition of the legal obligation to refrain from risky work activities as a criterion for the recognition of the occupational disease 5101 as of 01.01.2021 has significant effects on the occupational dermatological care and expert assessment of this occupational disease. For less severe occupational skin diseases, however, the preventive dermatologist's procedure established since 1972 will continue to apply.

Resource Utilization of Patients with Parkinson's Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study.

ObjectiveThe Care of Late-Stage Parkinsonism (CLaSP) study aimed to collect qualitative and standardized patient data in six European countries (France, Germany, Netherlands, Portugal, UK, Sweden) to enable a detailed evaluation of the underexplored late stages of the disease (Hoehn and Yahr stage > 3) using clinical, neuropsychological, behavioral, and health economic data. The aim of this substudy was to provide a health economic evaluation for the German healthcare system.MethodsIn Germany, 228 patients were included in the study. Costs were calculated from a societal perspective for a 3-month period. Univariate analyses were performed to identify cost-driving predictors. Total and direct costs were analyzed using a generalized linear model with a γ-distributed dependent variable and log link function. Indirect costs were analyzed using a binomial generalized linear model with probit link function.ResultsThe mean costs for the 3-month period were approximately €20,000. Informal care costs and hospitalization are approximately €11,000 and €5000. Direct costs amounted to 89% of the total costs, and the share of indirect costs was 11%. Independent predictors of total costs were the duration of the disease and age. The duration of the disease was the main independent predictor of direct costs, whereas age was an independent predictor of indirect costs.DiscussionCosts in the late stage of the disease are considerably higher than those found in earlier stages. Compared to the latter, the mean number of days in hospital and the need for care is increasing. Informal caregivers provide most of the care.Clinical Trial RegistrationThe protocol was registered at ClinicalTrials.gov as NCT02333175 on 7 January, 2015.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01011-y.