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ObjectivesPrediction models for post-stroke mortality can support medical decision-making. Although numerous models have been developed, external validation studies determining the models’ transportability beyond the original settings are lacking. We aimed to assess the performance of two prediction models for post-stroke mortality in Berlin, Germany.DesignWe used data from the Berlin-SPecific Acute Treatment in Ischaemic or hAemorrhagic stroke with Long-term follow-up (B-SPATIAL) registry.SettingMulticentre stroke registry in Berlin, Germany.ParticipantsAdult patients admitted within 6 hours after symptom onset and with a 10th revision of the International Classification of Diseases discharge diagnosis of ischaemic stroke, haemorrhagic stroke or transient ischaemic attack at one of 15 hospitals with stroke units between 1 January 2016 and 31 January 2021.Primary outcome measuresWe evaluated calibration (calibration-in-the-large, intercept, slope and plot) and discrimination performance (c-statistic) of Bray et al’s 30-day mortality and Smith et al’s in-hospital mortality prediction models. Information on mortality was supplemented by Berlin city registration office records.ResultsFor the validation of Bray et al’s model, we included 7879 patients (mean age 75; 55.0% men). We observed 763 (9.7%) deaths within 30 days of stroke compared with 680 (8.6%) predicted. The model’s c-statistic was 0.865 (95% CI: 0.851 to 0.879). For Smith et al’s model, we performed the validation among 1931 patients (mean age 75; 56.2% men), observing 105 (5.4%) in-hospital deaths compared with the 92 (4.8%) predicted. The c-statistic was 0.891 (95% CI: 0.864 to 0.918). The calibration plots of both models revealed an underestimation of the mortality risk for high-risk patients.ConclusionsAmong Berlin stroke patients, both models showed good calibration performance for low and medium-risk patients and high discrimination while underestimating risk among high-risk patients. The acceptable performance of Bray et al’s model in Berlin illustrates how a small number of routinely collected variables can be sufficient for valid prediction of post-stroke mortality.

Background Post-viral symptoms have long been known in the medical community but have received more public attention during the COVID-19 pandemic. Many post-viral symptoms were reported as particularly frequent after SARS-CoV-2 infection. However, there is still a lack of evidence regarding the specificity, frequency and persistence of these symptoms in comparison to other viral infectious diseases such as influenza. Methods We investigated a large population-based cohort based on German routine healthcare data. We matched 573,791 individuals with a PCR-test confirmed SARS-CoV-2 infection from the year 2020 to contemporary controls without SARS-CoV-2 infection and controls from the last influenza outbreak in 2018 and followed them up to 18 months. Results We found that post-viral symptoms as defined for COVID-19 by the WHO as well as tissue damage were more frequent among the COVID-19 cohort than the influenza or contemporary control cohort. The persistence of post-viral symptoms was similar between COVID-19 and influenza. Conclusion Post-viral symptoms following SARS-CoV-2 infection constitute a substantial disease burden as they are frequent and often persist for many months. As COVID-19 is becoming endemic, the disease must not be trivialized. Research should focus on the development of effective treatments for post-viral symptoms.

ObjectivesLittle is known about the age-specific excess mortality pattern of people with diagnosed diabetes in Germany. Thus, our goal was to determine the excess mortality in diagnosed diabetes overall and stratified by age and sex based on claims data.DesignRoutine data analysis using a claims dataset from all statutory health-insured persons in Germany in 2013, which accounts for about 90% of the population.ParticipantsWe included persons who lived in Germany, were insured at least 360 days, were not self-paying any health services and were aged 30 years or older leading to a total number of 47.3 million insured persons for analyses.ExposureDiabetes was determined by the International Classification of Diseases-10 codes E10–E14, which were documented in 2013 in at least two-quarters on an outpatient setting or at least once on an inpatient setting.Outcome measuresThe vital status in the study population was drawn from the claims dataset for the year 2014. We derived the excess mortality estimated as an age-adjusted mortality rate ratio (MRR) by sex and for age groups using a Poisson model.Main resultsWe found age-adjusted MRRs (95% CI) for diabetes of 1.52 (1.51 to 1.52) for women and 1.56 (1.56 to 1.56) for men. These figures declined with increasing age and were highest for ages 30–34 years with 6.76 (4.99 to 9.15) for women and 6.87 (5.46 to 8.64) for men, and lowest for age 95 years and older with 1.13 (1.10 to 1.15) for women and 1.11 (1.05 to 1.17) for men.ConclusionsWe derived deeply age-stratified figures on excess mortality in diabetes for Germany. Establishing a sustainable analysis of excess mortality is aimed at within the framework of diabetes surveillance.

Potentially avoidable hospital admissions (PAHs) due to type 2 diabetes mellitus (T2DM) occur more frequently in Germany than in the rest of Europe. Emergency departments (EDs) play an important role in understanding cross-sectoral health care utilisation resulting in inpatient admissions. Segmenting T2DM patients in homogenous groups according to their health care utilisation may help to understand the population's needs and to allocate limited resources. The aim of this study was to describe ED use and subsequent inpatient admissions among T2DM patients, and to segment the study population into homogenous subgroups based on disease stage, health care utilisation and process quality of outpatient care prior to an ED visit. This study was conducted as part of the INDEED project, comprising data on 56,821 ED visits in 2016 attributable to 40,561 patients with T2DM from 13 German EDs, as well as statutory health insurance claims data from 2014 to 2016 retrospectively linked per patient. Descriptive analyses included patient characteristics, ED admission diagnoses and discharge diagnoses in the case of inpatient admission of T2DM patients to the ED. Latent class analysis was conducted to identify different subgroups of T2DM patients based on disease stage, number of physician contacts and medical examinations prior to the ED visit. Almost half of the study population had severe comorbidities (44.3%). In addition to T2DM, multiple cardiovascular diagnoses were among the most frequently documented admission and discharge diagnoses. The proportion of hospitalised ED visits for T2DM patients was higher (59%) than that for the INDEED population (42.8%). We identified three latent classes that were characterised as \" (36.5% of the study population), \" (26.1%) and (37.4%). A substantial share of T2DM patients had not received disease monitoring according to guideline recommendations prior to ED presentation. Improving guideline-adherence in the outpatient sector could help reduce potentially avoidable ED visits. Effective interventions that aim at improving continuity and quality of care as well as reducing the share of PAH need to be identified and evaluated per identified class.

ObjectivesTo investigate whether the risk of developing an incident autoimmune disease is increased in patients with prior COVID-19 disease compared to those without COVID-19, a large cohort study was conducted.MethodA cohort was selected from German routine health care data. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through December 31, 2020. Patients were matched 1:3 to control patients without COVID-19. Both groups were followed up until June 30, 2021. We used the four quarters preceding the index date until the end of follow-up to analyze the onset of autoimmune diseases during the post-acute period. Incidence rates (IR) per 1000 person-years were calculated for each outcome and patient group. Poisson models were deployed to estimate the incidence rate ratios (IRRs) of developing an autoimmune disease conditional on a preceding diagnosis of COVID-19.ResultsIn total, 641,704 patients with COVID-19 were included. Comparing the incidence rates in the COVID-19 (IR=15.05, 95% CI: 14.69–15.42) and matched control groups (IR=10.55, 95% CI: 10.25–10.86), we found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19. This estimate was similar for common autoimmune diseases, such as Hashimoto thyroiditis, rheumatoid arthritis, or Sjögren syndrome. The highest IRR was observed for autoimmune diseases of the vasculitis group. Patients with a more severe course of COVID-19 were at a greater risk for incident autoimmune disease.ConclusionsSARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after the acute phase of infection. Key Points• In the 3 to 15 months after acute infection, patients who had suffered from COVID-19 had a 43% (95% CI: 37–48%) higher likelihood of developing a first-onset autoimmune disease, meaning an absolute increase in incidence of 4.50 per 1000 person-years over the control group.• COVID-19 showed the strongest association with vascular autoimmune diseases.

During the COVID-19 pandemic in Germany, non-pharmaceutical interventions were imposed to contain the spread of the virus. Based on cross-sectional waves in March, July and December 2020 of the COVID-19 Snapshot Monitoring (COSMO), the present study investigated the impact of the introduced measures on the perceived access to health care. Additionally, for the wave in December, treatment occasion as well as utilization and satisfaction regarding telemedicine were analysed. For 18–74-year-old participants requiring medical care, descriptive and logistic regression analyses were performed. During the less strict second lockdown in December, participants reported more frequently ensured access to health care (91.2%) compared to the first lockdown in March (86.8%), but less frequently compared to July (94.2%) during a period with only mild restrictions. In December, main treatment occasions of required medical appointments were check-up visits at the general practitioner (55.2%) and dentist (36.2%), followed by acute treatments at the general practitioner (25.6%) and dentist (19.0%), treatments at the physio-, ergo- or speech therapist (13.1%), psychotherapist (11.9%), and scheduled hospital admissions or surgeries (10.0%). Of the participants, 20.0% indicated utilization of telemedical (15.4% telephone, 7.6% video) consultations. Of them, 43.7% were satisfied with the service. In conclusion, for the majority of participants, access to medical care was ensured during the COVID-19 pandemic; however, access slightly decreased during phases of lockdown. Telemedicine complemented the access to medical appointments.

Purpose Evidence on the incidence and persistence of post-acute sequelae of COVID-19 (PASC) among children and adolescents is still limited. Methods In this retrospective cohort study, 59,339 children and adolescents with laboratory-confirmed COVID-19 in 2020 and 170,940 matched controls were followed until 2021-09-30 using German routine healthcare data. Incidence rate differences (ΔIR) and ratios (IRR) of 96 potential PASC were estimated using Poisson regression. Analyses were stratified according to age (0–11, 12–17 years), and sex. At the individual level, persistence of diagnoses in patients with onset symptoms was tracked starting from the first quarter post-infection. Results At 0–3 month follow-up, children and adolescents with a previous SARS-CoV-2 infection showed a 34% increased risk of adverse health outcome, and approximately 6% suffered from PASC in association with COVID-19. The attributable risk was higher among adolescents (≥ 12 years) than among children. For most common symptoms, IRRs largely persisted at 9–12 month follow-up. IRR were highest for rare conditions strongly associated with COVID-19, particularly inflammatory conditions among children 0–11 years, and chronic fatigue and respiratory insufficiency among adolescents. Tracking of diagnoses at the individual level revealed similar rates in the decline of symptoms among COVID-19 and control cohorts, generally leaving less than 10% of the patients with persistent diagnoses after 12 months. Conclusion Although very few patients presented symptoms for longer than 12 months, excess morbidity among children and, particularly, adolescents with a history of COVID-19 means a relevant burden for pediatric care.

Zusammenfassung Hintergrund Die fragmentierte Informationsgrundlage zum Diabetesgeschehen in Deutschland führte zur Förderung des Projekts Nationale Diabetes-Surveillance am Robert Koch-Institut (RKI) durch das Bundesministerium für Gesundheit. Ziel Es soll eine indikatorenbasierte und nutzerorientierte Berichterstattung zu Risikofaktoren, Häufigkeit, Versorgung und Folgen des Diabetes aufgebaut und weiterentwickelt werden. Methoden Die konsentierten Indikatoren werden auf Basis von RKI-Gesundheitssurveys, Abrechnungs- und Versorgungsdaten, amtlichen Statistiken und Diabetesregistern abgebildet. Die Ergebnisse werden durch interaktive Visualisierungen und weitere Formate über die Webseite der Nationalen Diabetes-Surveillance bereitgestellt. Ergebnisse Insgesamt sind über 90 % aller Diabetesfälle dem Typ 2 und etwa 5,5 % dem Typ 1 zuzuordnen. Die meisten Empfehlungen zur Versorgungsqualität des Typ-2-Diabetes werden von der Mehrheit der Erwachsenen erreicht, dennoch verbleibt ein Verbesserungspotenzial; dies steht in Einklang mit der als mittelmäßig selbsteingeschätzten Versorgungsqualität. Die Verbreitung von neuen Technologien in der Therapie bei Kindern und Jugendlichen mit Typ-1-Diabetes weist auf deren verbesserte Versorgung hin. Die Screeningquote für Gestationsdiabetes (GDM) ist angestiegen, jedoch ist bei Frauen mit GDM das Risiko für ausgewählte Komplikationen weiterhin erhöht. Kardiovaskuläre Erkrankungen und eine depressive Symptomatik treten häufiger bei Personen mit als bei Personen ohne Diabetes auf. Die Rate ambulant-sensitiver Krankenhausfälle ging zurück. Von den insgesamt verlorenen Lebensjahren sind bei Typ-2-Diabetes 67,4 % durch gesundheitliche Einschränkungen und bei Typ-1-Diabetes 54,3 % durch Versterben bedingt. Diskussion Die Nationale Diabetes-Surveillance bildet als Pilotprojekt die Basis für die Entwicklung einer umfassenden Surveillance weiterer nichtübertragbarer Krankheiten.

HintergrundDie fragmentierte Informationsgrundlage zum Diabetesgeschehen in Deutschland führte zur Förderung des Projekts Nationale Diabetes-Surveillance am Robert Koch-Institut (RKI) durch das Bundesministerium für Gesundheit.ZielEs soll eine indikatorenbasierte und nutzerorientierte Berichterstattung zu Risikofaktoren, Häufigkeit, Versorgung und Folgen des Diabetes aufgebaut und weiterentwickelt werden.MethodenDie konsentierten Indikatoren werden auf Basis von RKI-Gesundheitssurveys, Abrechnungs- und Versorgungsdaten, amtlichen Statistiken und Diabetesregistern abgebildet. Die Ergebnisse werden durch interaktive Visualisierungen und weitere Formate über die Webseite der Nationalen Diabetes-Surveillance bereitgestellt.ErgebnisseInsgesamt sind über 90 % aller Diabetesfälle dem Typ 2 und etwa 5,5 % dem Typ 1 zuzuordnen. Die meisten Empfehlungen zur Versorgungsqualität des Typ-2-Diabetes werden von der Mehrheit der Erwachsenen erreicht, dennoch verbleibt ein Verbesserungspotenzial; dies steht in Einklang mit der als mittelmäßig selbsteingeschätzten Versorgungsqualität. Die Verbreitung von neuen Technologien in der Therapie bei Kindern und Jugendlichen mit Typ-1-Diabetes weist auf deren verbesserte Versorgung hin. Die Screeningquote für Gestationsdiabetes (GDM) ist angestiegen, jedoch ist bei Frauen mit GDM das Risiko für ausgewählte Komplikationen weiterhin erhöht. Kardiovaskuläre Erkrankungen und eine depressive Symptomatik treten häufiger bei Personen mit als bei Personen ohne Diabetes auf. Die Rate ambulant-sensitiver Krankenhausfälle ging zurück. Von den insgesamt verlorenen Lebensjahren sind bei Typ-2-Diabetes 67,4 % durch gesundheitliche Einschränkungen und bei Typ-1-Diabetes 54,3 % durch Versterben bedingt.DiskussionDie Nationale Diabetes-Surveillance bildet als Pilotprojekt die Basis für die Entwicklung einer umfassenden Surveillance weiterer nichtübertragbarer Krankheiten.