[Prevalence of Rheumatoid Arthritis in Germany: Analysis of Longitudinal Data of Statutory Health Insurance]. / Prävalenz der Rheumatoiden Arthritis in Deutschland: Analyse von Längsschnittdaten der Gesetzlichen Krankenversicherung.

BACKGROUND: Rheumatoid arthritis (RA) is a progressive chronic inflammatory systemic autoimmune disease with destructive joint changes. Data on prevalence in adult patients are only available to a limited extent in Germany. METHODOLOGY: Anonymised diagnosis and prescription data for 2008-2013 were evaluated at patient level for approximately 2.3 million insured adults (total data set; status 2013) and approx. 1.2 million insured adults (smaller data set with additional information such as treatment by a specialist; status 2013) from 7 different statutory health insurance companies. RA was diagnosed if the code M05 (seropositive chronic polyarthritis) or M06 (other chronic polyarthritis) was present (diagnosis group M0[5,6]) and if the patient was either an outpatient at least twice (in 2 different quarters) or at least once an inpatient within a calendar year (according to the BVA criteria, inpatient diagnoses were thus classified as more reliable). The data were extrapolated to the SHI-insured and total population in Germany for 2013. RESULTS: The prevalence of RA in the total data set was 1.26% on average over all years (2008-2013). More than 90% of the diagnosis was based on the diagnosis code M06. In 88% of the cases, the classification was based exclusively on outpatient diagnoses. Taking into account a diagnosis by a specialist based on a smaller data set containing this additional information to determine a "reliable" RA diagnosis, the average RA rate for 2011-2013 was about 0.99%. Related to the diagnosis group M0[5,6] in the total data set, the prevalence of RA in 2013 was about 1.8% of women and about 0.8% of men. Only about 40% of diagnosed patients were treated with DMARDs. CONCLUSIONS: The prevalence estimates for RA derived from the larger data set correspond to those of previous surveys with partially different methodological approaches. Based on the analysis of the health insurance data presented, the prevalence of diagnosed RA in adults in Germany is 1.26%, which is within the range of 0.81-1.62% that can be found in the literature. This represents about 721,000 adult SHI-insured persons. The low rate of DMARD prescriptions may indicate inadequate care of these patients.

[Epidemiology and treatment of adult patients with atopic dermatitis : Analysis of longitudinal data of the statutory health insurance scheme]. / Epidemiologie und Therapie von erwachsenen Patienten mit atopischer Dermatitis : Analyse von Längsschnittdaten der gesetzlichen Krankenversicherung.

BACKGROUND: The goal was to report incidence, prevalence, and treatment patterns in adult atopic dermatitis (AD) patients in the German statutory health insurance system. PATIENT AND METHODS: Anonymized claims data were evaluated at patient level for 3.3 million persons insured by six different statutory health insurance companies (SHI). Patients for whom the ICD-10 diagnosis code L20 (AD) was applied at least twice were analyzed and data on prescription patterns for AD were reported for the years 2011-2015. RESULTS: AD prevalence in adults was 1.6-1.9% in 2012-2015. Annual incidence was 0.28%. In Q3/Q4 2015, 44.2% of the adult population with AD diagnosis by a dermatologist received prescriptions for AD medications: 1.6% low-potency topical glucocorticoids (without previous prescription of systemic drugs), 46.9% moderate or high-potency topical glucocorticoids or topical calcineurin inhibitors, 23.9% current systemic therapy (systemic glucocorticoids, ciclosporin, methotrexate, azathioprine, mycophenolate mofetil) and 27.6% systemic therapy in the past. CONCLUSIONS: The AD prevalence estimate was in the range of previous reports (1.35-4%) that used different methodologies. Based on treatment proxy, it appeared that almost more than half of AD patients treated with prescription ready-to-use drugs had a severe form of AD which required treatment with systemic drugs.

Prevalence and economic burden of pulmonary embolism in Germany.

The prevalence of pulmonary embolism (PE), PE mortality and treatment-associated costs for the years 2000 to 2006 were analysed using a statutory health insurance sample of AOK Hesse/KV Hesse, which contained information for an 18.75% random sample of 1.9 million persons insured with the AOK Hesse. Within the sample a PE diagnosis was accepted as valid if it was documented as the main discharge diagnosis or as an additional hospital diagnosis during hospitalization and if at least one of the following criteria was met: prescription of oral anticoagulants or heparins, PE documented for at least two quarterly periods or documented in only one quarter for patients who died within 28 days after hospital discharge. The economic burden from the perspective of the insurance fund was assessed by an analysis of resource consumption (direct costs) and by a matched pair analysis with controls without PE to estimate excess costs. A 99% winsorization of each cost category was performed to control for extreme outlying values. The prevalence of PE as the main discharge diagnosis and an additional hospital diagnosis varied from 55.3 to 71.7 per 100,000 insurants in the years 2000 to 2006. Insurants aged 80 years and more had a prevalence of 406.9 per 100,000 (year 2006). From 2001 to 2003 the in-hospital mortality rate ranged from 20.4% to 24.9% and decreased to 14% in 2006. A total of 85% of all patients with PE who survived the first year had at least one prescription of vitamin K antagonists. For patients who survived the first year, treatment costs exceeded € 20,000, with an estimation of additional costs of € 5816 for men and € 8962 for women in the matched-pair analysis. Owing to high in-hospital costs, the overall cost of treatment was highest for patients younger than 60 years. In conclusion, the prevalence rate of PE in Germany is comparable to international data. Treatment costs within the first year after hospital discharge are high, and there is a need to clarify the settings associated with PE in Germany with its high rate of prophylaxis.

Coordination Chemistry of 2,2'-Dipyridyl Diselenide: X-ray Crystal Structures of PySeSePy, [Zn(PySeSePy)Cl(2)], [(PySeSePy)Hg(C(6)F(5))(2)], [Mo(SePy)(2)(CO)(3)], [W(SePy)(2)(CO)(3)], and [Fe(SePy)(2)(CO)(2)] (PySeSePy = C(5)H(4)NSeSeC(5)H(4)N; SePy = [C(5)H(4)N(2-Se)-N,Se]).

The coordination chemistry of 2,2'-dipyridyl diselenide (PySeSePy) (2) (C(10)H(8)N(2)Se(2)) has been investigated and its crystal structure has been determined (monoclinic, P2(1)/c, a = 10.129(2) Å, b = 5.7332(12) Å, c = 19.173(3) Å, beta = 101.493(8) degrees, Z = 4). In metal complexes the ligand was found to coordinate in three different modes, as also confirmed by X-ray structure determination. N,N'-coordination was found in the zinc complex [Zn(PySeSePy)Cl(2)] (3) (C(10)H(8)Cl(2)N(2)Se(2)Zn, triclinic, P&onemacr;, a = 7.9430(10) Å, b = 8.147(2) Å, c = 11.999(2) Å, alpha = 93.685(10) degrees, beta = 107.763(10) degrees, gamma = 115.440(10) degrees, Z = 2) and Se,Se'-coordination in the adduct of the ligand with bis(pentafluorophenyl)mercury(II) [PySeSePyHg(C(6)F(5))(2)] (5) (C(10)H(8)F(10)HgN(2)Se(2), monoclinic, P2(1)/n, a = 7.7325(10) Å, b = 5.9974(14) Å, c = 25.573, beta = 98.037(10) degrees, Z = 2), which however displays only weak interactions between selenium and mercury. The reaction of the ligand with norbornadiene carbonyl complexes of molybdenum and tungsten leads to reductive cleavage of the selenium-selenium bond with oxidation of the metal center and concomitant addition of the resulting selenolate to the metal carbonyl fragment. Thus the 7-coordinate complexes [Mo(SePy)(2)(CO)(3)] (6) (C(13)H(8)MoN(2)O(3)Se(2), monoclinic, P2(1)/n, a = 9.319(3) Å, b = 12.886(5) Å, c = 13.231(6) Å, beta = 109.23(3) degrees, Z = 4) and [W(SePy)(2)(CO)(3)] (7) (C(13)H(8)N(2)O(3)Se(2)W, monoclinic, P2(1)/n, a = 9.303(2) Å, b = 12.853(2) Å, c = 13.232(2) Å, beta = 109.270(10) degrees, Z = 4) were obtained. The same N,Se-coordination pattern emerges from the reaction of [Fe(2)(CO)(9)] with (2) leading to [Fe(SePy)(2)(CO)(2)] (8) (C(12)H(8)FeN(2)O(2)Se(2), monoclinic, P&onemacr;, a = 8.6691(14) Å, b = 12.443(2) Å, c = 14.085(2) Å, alpha = 105.811(10) degrees, beta = 107.533(8) degrees, gamma = 92.075(10) degrees, Z = 4).

Prolonged thromboprophylaxis with enoxaparin in early neurological rehabilitation.

Prevention of venous thromboembolism (VTE) is essential in neurological patients. Little is known about the optimal duration, efficacy, and safety of prolonged off-label use of low-molecular-weight heparin (LMWH). We enrolled n = 1176 early neurological rehabilitation cases in a retrospective study. In most cases (n = 1151, 97.9%), 4000 anti-Xa (activated coagulation factor X [factor Xa]) units enoxaparin were administered, only 25 received 2000 units for approximately 2 months (mean of 57.5 days). In 969 cases, enoxaparin was administered for more than 2 weeks. Incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) were 0.43% (n = 5) and 1.11% (n = 13), respectively. Hemorrhages during enoxaparin therapy were more frequent. Bleeding occurred in 1.96% (n = 23) of cases, mainly gastrointestinal, urinary tract, and vitreous body bleeding. In short-term (up to 2 weeks) treatment, bleeding and VTE were more frequent than in long-term treatment. Results from this study suggest that prolonged enoxaparin thromboprophylaxis in neurological rehabilitation is safe and effective.