Practice In Germany Research Articles

Sanctuary Space, Racialized Violence, and Memories of Resistance

Sanctuary, which comes from the Latin sanctus, meaning “holy,” has played a strategic role in political resistance for hundreds of years. Today the concept has returned as one of importance in the protection of refugees worldwide. In this article, which focuses on sanctuary practices in Germany, we examine the importance of the spaces of church-based asylum—the structure, physical spaces, and neighborhood of the church itself. We investigate the ways in which these spaces are constitutive of collective memories of alternative justice and resistance and how these memories are used to transform the actions and possibilities of the present. The article builds off other nonlinear, counterhegemonic concepts of space and time, such as the demonic, as ways of moving beyond normative assumptions of the cultural landscape. The demonic challenges both the abstract space of modern liberalism as well as the absolute space of the sacred; it is a radical reworking—one that relies on forgotten or hidden pasts yet remains new and open-ended. For sanctuary to contest the racialized violence of modern state governance it likewise must both remember and rework the idea of sacred space and sacred time in new, materialist, and fluid forms. Drawing on a case study from Berlin, the article explores ways to conceptualize the temporal and spatial anchoring of alternative, nonliberal memories and their potential for contemporary resistance. The Heilig-Kreuz church and its pastors and allies, as well as an associated church network, the German Ecumenical Committee on Church Asylum, provide the empirical case studies. Key Words: memory, race, refugees, sanctuary, space.

An elevated FIB-4 score is not associated with cardiovascular events: a longitudinal analysis from 137 842 patients with and without chronic liver disease.

Liver diseases and cardiovascular diseases are closely associated. Noninvasive tests (NITs), such as the FIB-4 score, have been recommended by different guidelines to rule out advanced fibrosis and estimate the risk of liver-related outcomes in patients with chronic liver diseases (CLDs). However, the association of an elevated FIB-4 score with the development of myocardial infarction and/or stroke/transient ischemic attack (TIA) is unknown. By using the Disease Analyzer database (IQVIA), which compiles diagnoses, laboratory values as well as basic medical and demographic data of over 7.5 million patients followed in general practices in Germany, we identified 68 921 patients with available lab values for FIB-4 score calculation between 2005 and 2019. Patients with an FIB-4 score of less than 1.3 were matched 1:1 to patients with an FIB-4 score of at least 1.3 by age, sex and yearly consultation frequency. In regression analysis, the incidence rate ratio (IRR) of myocardial infarction was similar among patients with an FIB-4 score of at least 1.3 compared with patients with a low FIB-4 score of less than 1.3, regardless of whether patients with or without preexisting liver disease were analyzed. Moreover, there was no significant increase in the IRR of stroke/TIA between patients with a high or low FIB-4 score, both in the general population and patients with CLD. Our study suggests that the FIB-4 score is not associated with cardiovascular events both in the general population as well as in patients with CLD.

Factors Associated with Non-Severe Adverse Reactions after Vaccination against SARS-CoV-2: A Cohort Study of 908,869 Outpatient Vaccinations in Germany.

Background: Vaccination against SARS-CoV-2 significantly reduces the transmissibility of the virus and the likelihood of a severe course of COVID-19, and is thus a critical component in overcoming the current pandemic. The factors associated with adverse reactions after vaccination against SARS-CoV-2 have not yet been sufficiently evaluated. Methods: We used the Disease Analyzer database (IQVIA) to identify 531,468 individuals who received a total of 908,869 SARS-CoV-2 vaccinations in 827 general practices in Germany between April and September 2021. Cox regression models were used to analyze the frequency of vaccination-related side effects reported within 14 days after SARS-CoV-2 vaccination, as well as subjects’ demographic characteristics and comorbidities. Results: The total number of side effects documented was 28,287 (3.1% of all vaccinations). Pain in the limb (24.3%), fatigue (21.0%), dizziness (17.9%), joint pain (15.7%), fever (9.5%), nausea (7.5%), and myalgia (6.4%) were the most common side effects documented among the 12,575 vaccinations with definite side effects. In the multivariate regression analysis, young age was associated with much higher odds of reported side effects (OR18–30 years: 4.45, OR31–40 years: 3.50, OR41–50 years: 2.89). In addition, pre-existing comorbidities such as dementia (OR: 1.54), somatoform disorder (OR: 1.53), anxiety disorder (OR: 1.43), depression (OR: 1.37), chronic respiratory tract disease (OR: 1.27), hypertension (OR: 1.20), and obesity (1.14) significantly increased the odds of side effects. Finally, the male sex was associated with increased odds of reported side effects (OR: 1.17). Conclusion: Our study, based on a large outpatient database from Germany, identified young age, male sex, and pre-existing comorbidities such as dementia, somatoform disorders, anxiety disorders, and depression as factors associated with vaccine-related adverse events diagnosed in GP practices. These data could help to identify subgroups needing particular advice and care in the context of SARS-CoV-2 vaccinations.

Preventive and health-promoting activities in general practices in Germany: A scoping review.

General practices are rooted in the local community and considered to be particularly well-positioned for engaging in preventive and health-promoting activities. The overall aim of the scoping review is to identify priorities and gaps in research published in the past 20years on preventive and health-promoting activities provided by general practitioners or their teams in general practices in Germany. MEDLINE and Embase databases were systematically searched in November 2020. Papers were selected in dual-review mode and extracted in single-review mode. Data analysis was finished by May 2021. In total, 530 papers were included in the synthesis. Little research has been carried out into collaboration opportunities both within the general practice team and in communities as a whole, with specialists (18%), hospitals (9%), and health insurance companies (6%) being the most frequent cooperation partners of GPs. 15%-20% of papers each dealt with 'early detection', 'information provision' and 'cardiovascular prevention'. Secondary (53%) and tertiary prevention (43%) was more often the subject of research than primary (39%) and quaternary prevention (15%). Healthy subjects (26%) were less often studied than people with pre-existing conditions (42%) and risk factors (48%). Little information was available on preventive activities in terms of gender, young people, migration background, housing conditions or educational background. Personal counselling (15%) was the most frequently described approach to health promotion in general practices, along with printed information materials (10%). This scoping review provides information on which to base targeted interventions and future research that can contribute towards transforming general practices into promoters of health within the community.

Obesity and lipid metabolism disorders determine the risk for development of long COVID syndrome: a cross-sectional study from 50,402 COVID-19 patients

PurposeMetabolic disorders have been identified as major risk factors for severe acute courses of COVID-19. With decreasing numbers of infections in many countries, the long COVID syndrome (LCS) represents the next major challenge in pandemic management, warranting the precise definition of risk factors for LCS development.MethodsWe identified 50,402 COVID-19 patients in the Disease Analyzer database (IQVIA) featuring data from 1056 general practices in Germany. Multivariate logistic regression analysis was used to identify risk factors for the development of LCS.ResultsOf the 50,402 COVID-19 patients included into this analysis, 1,708 (3.4%) were diagnosed with LCS. In a multivariate regression analysis, we identified lipid metabolism disorders (OR 1.46, 95% CI 1.28–1.65, p < 0.001) and obesity (OR 1.25, 95% CI 1.08–1.44, p = 0.003) as strong risk factors for the development of LCS. Besides these metabolic factors, patients’ age between 46 and 60 years (compared to age ≤ 30, (OR 1.81 95% CI 1.54–2.13, p < 0.001), female sex (OR 1.33, 95% CI 1.20–1.47, p < 0.001) as well as pre-existing asthma (OR 1.67, 95% CI 1.39–2.00, p < 0.001) and depression (OR 1.27, 95% CI 1.09–1.47, p = < 0.002) in women, and cancer (OR 1.4, 95% CI 1.09–1.95, p = < 0.012) in men were associated with an increased likelihood of developing LCS.ConclusionLipid metabolism disorders and obesity represent age-independent risk factors for the development of LCS, suggesting that metabolic alterations determine the risk for unfavorable disease courses along all phases of COVID-19.

Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study

BackgroundCoordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.MethodsA cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.ResultsWe included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.ConclusionsThis study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.Trial registrationWe registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.

The Current Practice of Gradual Return to Work in Germany: A Qualitative Study Protocol.

(1) Background: The increase in working age and long-term illnesses is a challenge for society to maintain the health of employees and to support their work participation. In many countries, such as Germany, a gradual return to work (GRTW) is used frequently to support returning employees, but little is known about its facilitators and obstacles. This protocol aims to provide an overview of the national state of the art in workplace adjustments during return to work and to outline the design of a qualitative study examining current GRTW practices in Germany. (2) Methods: Our qualitative study will examine the current implementation of GRTW by means of 32 narrative interviews and 10 group discussions from different perspectives. Therefore, we will ask returning employees as well as organisational stakeholders and external experts about their experiences with GRTW and attitudes towards the measure. The verbal data obtained will be analysed using the documentary method of interpretation. (3) Discussion: This study will reveal facilitating and hindering factors for the implementation of GRTW in Germany. The findings of the study may contribute to an improved implementation of GRTW not only in Germany.

The Impact of the COVID-19 Pandemic on Immunization Rates for Preventable Diseases in Primary Care and Pediatric Practices in Germany.

The Impact of the COVID-19 Pandemic on Immunization Rates for Preventable Diseases in Primary Care and Pediatric Practices in Germany.

No increased incidence of venous thrombosis or pulmonary embolism after SARS-CoV-2 vaccination in Germany

ObjectivesVaccination is one of the most effective measures to combat the COVID-19 pandemic. The main reason for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination hesitancy is the potential side-effects. This study aimed to investigate the incidence of venous thrombosis and pulmonary embolism in patients who received SARS-CoV-2 vaccination. Study designThis was a retrospective cohort study. MethodsIndividuals aged ≥18 years who received an initial vaccination for COVID-19 in one of 1134 general practices in Germany between April and June 2021 were included in the study. Vaccinated patients were matched to unvaccinated individuals by age, sex, index month (April to June 2020 [unvaccinated cohort] or April to June 2021 [vaccinated cohort]) and diagnoses that may be associated with an increased incidence of thrombosis documented within 12 months before the index date. The incidences of thrombosis and non-fatal pulmonary embolism as a function of COVID-19 vaccination were analysed. ResultsThe present study included 326,833 individuals who were vaccinated against COVID-19 and 326,833 matched unvaccinated individuals. During the follow-up period, 406 vaccinated patients and 342 individuals in the control group received a diagnosis of thrombosis or non-fatal pulmonary embolism. This resulted in an incidence rate of 11.9 vs 11.3 cases per 1000 patient-years for vaccinated vs unvaccinated individuals, respectively, and a non-significant overall incidence rate ratio (IRR: 1.06; 95% confidence interval [CI]: 0.93–1.22). The highest IRR was observed in the 41–60 years age group (IRR: 1.30; 95% CI: 0.98–1.73), and the lowest IRR was seen in the 18–40 years age group (IRR: 0.6; 95% CI: 0.0–1.05); however, none of the individual age group incidence rates was significant. ConclusionsThe results indicate that the occurrence of thrombosis or pulmonary embolism after COVID-19 vaccination is a coincidental finding rather than a consequence of vaccination.

Paediatric gastroenterological and hepatological care in Germany: results of a nationwide survey

ZusammenfassungEinleitung Kinder und Jugendliche mit chronischen Magen-, Darm-, Pankreas-, und Lebererkrankungen benötigen eine altersgerechte und qualifizierte Behandlung. Anhand einer repräsentativen Umfrage wird die strukturelle und personelle ambulante und stationäre Versorgung von Kindern mit chronischen Magen-, Darm-, Pankreas- und Lebererkrankungen in Deutschland analysiert. Methodik 319 Kliniken für Kinder- und Jugendmedizin sowie 50 kindergastroenterologische Praxen in Deutschland wurden eingeladen, an der anonymen Online-Umfrage über EFS Survey teilzunehmen. Es wurden die Struktur der Einrichtungen, Weiterbildungsbefugnisse, Kooperationen, Behandlungs- bzw. Betreuungsdaten und eine Einschätzung des Versorgungsbedarfs systematisch erfasst und deskriptiv ausgewertet. Ergebnisse An der Umfrage haben 81 Kliniken und 10 Praxen teilgenommen. Fast zwei Drittel der Kliniken (n=52) erbringen ambulante kindergastroenterologische Leistungen. Meist bis zu 10 (25,4%) oder 20 Stunden/Woche (33,8%). Ein Viertel der Kliniken bietet keine Sprechstunden an. Der ambulante Versorgungsbedarf kann von zwei Dritteln der Institutionen nicht gedeckt werden. Die Hälfte aller Kliniken gab an, dass der stationäre kindergastroenterologische Versorgungsbedarf gedeckt werden kann. Ein Drittel kann diesen jedoch nicht abdecken und nur selten gibt es ungenutzte Kapazitäten. 35 Kliniken (43,2%) verfügen über eine Weiterbildungsbefugnis gemäß Landesärztekammer (n=33) und/oder sind Weiterbildungszentrum der Gesellschaft für pädiatrische Gastroenterologie und Ernährung (GPGE) (n=18). Schlussfolgerung Es besteht sowohl ein ambulantes als auch stationäres Versorgungsdefizit in der Kinder- und Jugendgastroenterologie. Dieses resultiert unter anderem aus den ökonomischen Rahmenbedingungen und Personalmangel. Gut ausgebildete Fachärzt*innen mit Spezialisierung in Kinder- und Jugendgastroenterologie werden für eine flächendeckende qualifizierte Versorgung weiterhin benötigt. Zukünftige Studien sollten auch den kindergastroenterologischen Versorgungsbedarf aus Sicht anderer Gruppen einbeziehen, wie betroffener Patienten*innen, internistischer Gastroenterolog*innen und niedergelassener Kinder- und Jugendärzt*innen.

Association between ivy leaves dry extract EA 575 prescriptions and antibiotic use, sick leave duration, and repeated infections in adult patients

ABSTRACT Objectives The present study aimed to analyze the association between the prescription of ivy leaf dry extract EA 575 (licensed under the trade name Prospan® in Germany) and the incidence of antibiotic use, incident bacterial complications, and days of sick leave in adult patients with cold diseases. Methods This retrospective cohort study was based on the IQVIA Disease Analyzer database and included adult patients from 1032 general practices in Germany with a documentation of common cold between 2017 and 2020 (index date) and prescription of either EA 575 or an antibiotic drug within 3 days after index date. 1:1 propensity score matching based on age, sex, index month, physician, health insurance status, and the Charlson Comorbidity Index was carried out. Univariable regression models were used to investigate the association between EA 575 prescription and defined outcomes. Results Data of 7034 patients treated with EA 575 and 7034 matched patients receiving an antibiotic were available. EA 575 prescription was associated with significantly lower odds of an antibiotic prescription in the time periods of 4–30 days (OR: 0.83; 95% CI: 0.72–0.96) and 31–365 days (OR: 0.44; 95% CI: 0.40–0.48) after the index date. EA 575 prescription was significantly associated with a lower rate of sick leave of more than 7 days (33.0% vs. 37.7%, OR: 0.81; 95% CI: 0.73–0.90) in patients with any sick leave, as well as with lower odds of a new cough diagnosis (OR: 0.91, 95% CI: 0.85–0.98) when compared to antibiotic prescription. Conclusion Our study provides further evidence that the use of phytopharmaceuticals, in particular ivy leaf dry extract EA 575, could contribute to a reduction in the number of inappropriate antibiotic prescriptions for respiratory infection with cough symptoms.

Imposition of disciplinary actions against the employees of Pre-trial detention centres (Germany, Poland, Ukraine)

The purpose of this study is the comprehensive analysis of imposition of disciplinary actions against employees of pre-trial detention centres using the example of Germany, Poland and Ukraine. The study used the method of sociological analysis, systemic-structural approach and comparative, logical-semantic, Aristotelian and dialectical methods of research. The research has proven the necessity to complement the laws and regulations in Poland and to differentiate the practice of imposition of disciplinary actions against employees of pre-trial detention centres from the generic practice in Germany and Ukraine. In addition, in Ukraine there is a need to designate a body that could be responsible for analysing the practice of imposition of disciplinary actions against employees of pre-trial detention centres. Further compliance with these recommendations will reveal how effective the legislative control is and how effective the work of employees of pre-trial detention centres is in relation to the application of disciplinary actions against employees of pre-trial detention centres and will allow to improve their work through the analysis of statistics on the application of disciplinary actions against employees of pre-trial detention centres.

Climate resilience and environmental justice: state of research and implementation in planning practice in Germany and beyond

Climate-change adaptation has become a well-established priority in urban and regional development in Germany since the adoption of the German Adaptation Strategy in 2008. Recently, the socioeconomic aspects and concepts of vulnerability and resilience have received growing attention with regard to climate-change adaptation. This article introduces the TPR special issue on climate resilience and environmental justice. In so doing, it discusses the relationship between climate change and socio-spatial inequalities, and their significance for climate-resilient urban and regional development. Based on this discussion and empirical findings from German practice, as well as the assessment of the policy context and participatory reflection, the article identifies several loose ends in research and practice that need to be connected by further converging concepts and indicators in climate-change and environmental-justice research and policies.

Clinical Implementation and Evaluation of Three Implementation Interventions for a Family-Oriented Care for Children of Mentally Ill Parents (ci-chimps): Study Protocol for a Randomized Controlled Multicenter Trial.

BackgroundIn Germany, approximately three million children under the age of eighteen have a mentally ill parent. These children are at an increased risk of developing a mental illness themselves (1) as well as a physical illness (2). While research has identified numerous evidence-based family-oriented interventions, little is known about how to implement such interventions effectively and efficiently in clinical practice in Germany. This implementation study (ci-chimps) evaluates three clinical implementation projects with three different implementation interventions for the optimal implementation of the tailored family-oriented preventive and therapeutic interventions in the CHIMPS-NET (children of mentally ill parents—research network) with an implementation model for children of mentally ill parents.MethodsA two-group randomized controlled multicenter trial will examine changes in family-oriented practice and aspects of implementation at baseline as well as at 12- and 24-months follow-up. The CHIMPS-Network consists of 20 clinical centers. The centers in the intervention group receive the support of all of the three implementation interventions: (1) optimal pathways to care, (2) education and a training program for professionals, and (3) systematic screening for children. The centers in the control group do not receive this specific implementation support.DiscussionWhile we know that children of mentally ill parents are an important target group to be addressed by preventive and therapeutic interventions, there is often a lack of structured implementation of family-oriented interventions in clinical practice in Germany. Using a randomized controlled multicenter trial design with a large and wide-ranging sample (clinics for adult psychiatry and clinics for child and adolescent psychiatry, university clinics and clinics at the real health care) will provide a robust understanding of implementing family-oriented changes in German clinical practice.Trial RegistrationThe CHIMPS-NET-study was registered with the German Clinical Trials Register on 2019-12-19 (DRKS00020380) and with Clinical Trials on 2020-4-30 (NCT04369625), the ci-chimps-study was registered with the German Clinical Trials Register (DRKS00026217) on 2021-08-27, the Clinical Trials registration is in review process.

Ansätze zur Integration von Ökosystemleistungen in die formelle räumliche Planung

Due to global changes and changes in land use, ecosystems and their services are increasingly affected. Against this background, it is questionable how ecosystems and the services they provide can be better and sufficiently taken into account in land-use planning as well as spatial development in Germany. Currently little chance is seen to establish new ecosystem service-based processes that would be comprehensively integrated in the spatial planning practice in Germany. However, modernisation of formal and informal planning instruments is conceived in a long-term perspective. The ecosystem service approach can essentially contribute to this modernisa[1]tion methodically as well as conceptually. Therefore, this paper discusses possibilities how to integrate the ecosystem service approach in formal spatial planning in a short to medium term and which societal and ecological added value can be generated. Chances and risks of different implementation options will be discussed and specific approaches outlined.

Prevalence of and factors associated with long-term sick leave in working-age adults with chronic low back pain in Germany.

There are little data on the impact of chronic low back pain (CLBP) on long-term sick leave. Thus, the aim was to investigate the prevalence of and the factors associated with long-term sick leave in working-age adults with CLBP in Germany. This retrospective study included adults aged 18-65years diagnosed for the first time with CLBP in one of 1193 general practices in Germany between 2000 and 2019. CLBP was defined as the presence of two diagnoses of low back pain with > 90days between them. Long-term sick leave was assessed in the year following the first diagnosis of low back pain, and was defined as > 42days of absence from work for health-related reasons. In Germany, employees on sick leave lasting > 42days are not paid by the employer anymore but by the health insurance fund. Finally, an adjusted logistic regression model was used to assess the association between predefined variables (e.g., age, sex, and comorbidities) and long-term sick leave. A total of 59,269 working-age adults were included in this study [mean (SD) age 32.8 (11.5) years; 41.4% women]. The prevalence of long-term sick leave in the sample was 49.1%. Long-term sick leave was significantly associated with young age, male sex, and several physical and psychiatric comorbidities (e.g., reaction to severe stress and adjustment disorder, gastritis and duodenitis, and depression). Based on these results, public health measures are urgently needed to mitigate the deleterious effects of CLBP on work participation in Germany.

The spectrum of comorbidities at the initial diagnosis of heart failure a case control study

The prognosis of heart failure (HF) patients is determined to a decisive extent by comorbidities. The present study investigates the association between a broad spectrum of diseases and the occurrence of HF in a large collective of outpatients. This retrospective case control study assessed the prevalence of 37 cardiac and extracardiac diseases in patients with an initial diagnosis of heart failure (ICD-10: I50) in 1,274 general practices in Germany between January 2005 and December 2019. The study is based on the Disease Analyzer database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Patients with and without heart failure were matched by sex, age, and index year. Hazard regression models were conducted to evaluate the association between different disease entities and heart failure. The present study included 162,246 patients with heart failure and 162,246 patients without heart failure. Mean age [SD] was 73.7 [12.1] years; 52.6% were women. Out of 37 predefined diagnoses, 36 were more prevalent in HF patients. The highest prevalence was primary hypertension (63.4% in HF patients vs. 53.3% in controls, p < 0.001) followed by lipid metabolism disorders (34.6% in HF patients vs. 29.1% in HF patients p < 0.001) and diabetes mellitus type II (32.2% in HF patients vs. 25.2% in controls, p < 0.001). In the regression analysis, 19 diseases were significantly associated with heart failure. Non-cardiovascular diagnoses strongly associated with HF were obesity (HR = 1.46), chronic bronchitis and COPD (HR = 1.41), gout (HR: 1.41), and chronic kidney disease (HR = 1.27). In the present study, we identified a variety of cardiac and extracardiac diseases associated with heart failure. Our data underscore the immense importance of comorbidities, even as early as at the stage of initial diagnosis of heart failure.

Overlap between irritable bowel syndrome and common gastrointestinal diagnoses: a retrospective cohort study of 29,553 outpatients in Germany

BackgroundIrritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients.MethodsUsing the Disease Analyzer database (IQVIA) featuring patients treated within 2010 and 2019 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS.Results65,569 patients with an initial diagnosis of IBS were included into the analysis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. Mean age was 48.8 (SD: 18.4) years, 65.0% were female. Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%). Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis.ConclusionOur data provide evidence for a high overlap between IBS and other GI diagnoses. Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases.

P506 Rates of clinical remission among patients with Ulcerative Colitis from real-world clinical practice settings from Germany

Abstract Background Patients with Ulcerative Colitis (UC) may not equally respond to advanced therapies. Therapy modifications such as dose adjustments, augmentation, and use of corticosteroids (CS) are required to achieve remission. This study aimed to examine the rates of clinical remission requiring adjustments with advanced therapies among UC patients from real-world clinical practices in Germany. Methods Using a retrospective chart review, patients with UC treated with an advanced therapy (adalimumab, infliximab, golimumab, vedolizumab, and tofacitinib) between 01/2017 through 09/2019 were selected from 18 outpatient gastroenterology practices across Germany. Patients with at least 12 months of data before (baseline) and after initiating an advanced therapy (Index Date) were included. Data was collected up to 24 months after index date. Clinical remission was assessed based on a partial Mayo score ≤1. Among patients with remission, therapy adjustments were assessed based on the following: Dose escalation, augmentation with conventional therapies, CS use for ≥12 weeks, or any use of CS during the maintenance phase. Time to remission was analysed using Kaplan-Meier analysis and associated factors were assessed within a multivariate Cox regression model. Patients were censored at end of the study period or if they discontinued or switched the index therapy. Results Among 149 patients included (females: 50.3%; median age: 40 years; median follow-up: 25.9 months), 75 (50.3%) received an anti-TNF agent, 48 (32.2%) vedolizumab, and 26 (17.4%) tofacitinib. Of these, 96 (64.4%) patients were biologic-naïve, and 42 patients (28.2%) were receiving concurrent CS at the index date. Within one year, remission was achieved in 49 out of 134 patients (46.1%; median time: 19.3 months [95%-CI: 7–24 months]; Figure 1). Among patients with remission at 24 months, therapy adjustments were required in 35.8% of patients. Most common adjustments included dose escalation (9.0%) and use of CS during the maintenance phase (11.9%). In an adjusted model, chances of remission were halved in biologic-experienced patients vs. naïve patients (hazard ratio [HR]: 0.49; p&amp;lt;0.05), while patients with concurrent use of conventional therapy at baseline were associated with a higher chance of achieving remission (HR: 1.82; p&amp;lt;0.05). Conclusion Less than half of UC patients treated with advanced therapies in Germany achieved clinical remission after one year. More than half of the patients required 1.5 years to achieve clinical remission. Among those who achieved remission within two years, one third required additional therapy modifications. More effective therapies are needed to achieve earlier and better outcomes among patients with UC in Germany.

Very Low Incidence of SARS-CoV-2, Influenza and RSV but High Incidence of Rhino-, Adeno- and Endemic Coronaviruses in Children With Acute Respiratory Infection in Primary Care Pediatric Practices During the Second and Third Wave of the SARS-CoV-2 Pandemic.

Respiratory viruses were detected by multiplex-polymerase chain reaction from oropharyngeal swabs in 114/168 (67.9%) children with acute respiratory infection presenting to 5 pediatric practices in Germany between November 2020 and April 2021. In contrast to rhino- (48.8%), adeno- (14.3%) and endemic coronaviruses (14.9%), SARS-CoV-2 and influenza virus were detected only once; respiratory syncytial virus was not detected. This demonstrates differing impacts of pandemic infection control measures on the spread of respiratory viruses.