Trends in incidence of atopic disorders in children and adolescents - Analysis of German claims data.

Background: This claims-based study aimed to assess recent nationwide trends in pediatric incidence of atopic diseases in Germany. Methods: Incidence of atopic dermatitis, asthma, and hay fever was assessed from 2013 to 2021 in annual cohorts of 0- to 17-year-old children and adolescents with statutory health insurance (N = 11,828,525 in 2021). Results: Incidence of atopic dermatitis remained largely unchanged (15.2 cases per 1000 children in 2021) while hay fever incidence exhibited a fluctuating trend over the study period and amounted to 8.8 cases per 1000 in 2021. Asthma incidence decreased gradually between 2013 (12.4/1000) and 2019 (8.9/1000). This downward trend was followed by a further disproportionate reduction from 2019 to 2020 (6.3/1000) and a re-increase in 2021 (7.2/1000). Conclusion: The findings complement nationwide prevalence surveys of atopic diseases in children and adolescents in Germany. Knowledge about temporal variations in risk of atopic diseases are crucial for future investigations of explanatory factors to enhance the development of preventive measures. While asthma incidence followed a declining trend throughout the study period, an unprecedentedly strong reduction in pediatric asthma risk was observed in 2020, the first year of the COVID-19-pandemic.

Falling incidence of Parkinson's disease in Germany.

BACKGROUND AND PURPOSE: Idiopathic Parkinson's disease (IPD) is a progressive neurodegenerative disorder that is strongly associated with age. The aim of the present study was to describe current sex- and age-specific trends and regional differences in the incidence of IPD diagnosed in older people in Germany. METHODS: This study was based on nationwide outpatient claims and drug prescription data from the German Statutory Health Insurance, covering approximately 87% of the general population. We conducted a cohort study in patients aged 50 years or older with observation time of at least 4 years. To assess the robustness of nationwide annual IPD incidence trends from 2013 to 2019, three case definitions with varying levels of stringency regarding coded outpatient diagnoses and drug prescriptions were applied. RESULTS: In 2019, the population at risk comprised 30,575,726 persons. Using the primary and most specific case definition, annual age- and sex-standardized cumulative IPD incidence decreased stepwise from 137 (2013) to 106 (2019) new cases per 100,000 persons. The decline in incidence was seen in both sexes, in all age groups and in the majority of German regions. The relative decrease (2013-2019) in the annual age- and sex-standardized IPD incidence varied from 23% to 28% among case definitions. CONCLUSION: Our findings indicate a nationwide decline in the age- and sex-standardized incidence of IPD from 2013 to 2019 in Germany. This trend was consistent using different case definitions. Further research is needed to elucidate the factors underlying this trend.

The Effect of the COVID-19 Pandemic on Outpatient Antibiotic Prescription Rates in Children and Adolescents-A Claims-Based Study in Germany.

The aim of the study was to examine whether the COVID-19 pandemic had any effect on antibiotic prescription rates in children in Germany. Using the nationwide outpatient prescription data from the Statutory Health Insurance from 2010 to 2021, changes in the monthly prescriptions of systemic antibiotics dispensed to children aged 0-14 years were examined (n = 9,688,483 in 2021). Interrupted time series analysis was used to assess the effect of mitigation measures against SARS-COV-2, introduced in March and November 2020, on antibiotic prescription rates. In the pre-pandemic period, the antibiotic prescription rates displayed a linear decrease from 2010 to 2019 (mean annual decrease, -6%). In 2020, an immediate effect of mitigation measures on prescription rates was observed; in particular, the rate decreased steeply in April (RR 0.24, 95% CI: 0.14-0.41) and November 2020 (0.44, 0.27-0.73). The decrease was observed in all ages and for all antibiotic subgroups. However, this effect was temporary. Regionally, prescription rates were highly correlated between 2019 and 2020/2021. Substantial reductions in antibiotic prescription rates following the mitigation measures may indicate limited access to medical care, changes in care-seeking behavior and/or a decrease of respiratory infections. Despite an all-time low of antibiotic use, regional variations remained high and strongly correlated with pre-pandemic levels.

Secular Trends and Rural-Urban Differences in Diagnostic Prevalence of Hay Fever: A Claims-Based Study in Germany.

Purpose: We aimed to examine possible variations in diagnostic prevalence of hay fever between urban and rural regions as well as in age-specific temporal developments. Patients and Methods: We used nationwide outpatient claims data from the years 2010 to 2019. The data contain information for all individuals with statutory health insurance (SHI) in Germany who were treated at least once in respective years (n = 71,410,121 in 2019). Individuals with a confirmed diagnosis of hay fever were defined as prevalent cases. We examined the association between the degree of urbanization and age- and sex-standardized prevalence of hay fever. We used the age- and sex-structure of SHI insurees in the year 2010 as a reference population for direct standardization. Results: The standardized prevalence of hay fever increased from 6.2% in 2010 to 7.2% in 2019, corresponding to a relative increase of 16%. However, we observed a clear decrease in prevalence among children, with the strongest relative reduction in young children (0-2 years: -53%). The standardized prevalence in the total population in 2019 was lowest in rural areas with a low population density (6.6%) and highest in big urban municipalities (7.8%). In stark contrast, prevalence in 0-14-year-olds was lowest in big urban municipalities (4.3%). Conclusion: We observed a decrease in the prevalence of hay fever in children and increase in the older age groups. A clear urban-rural association observed over years may be explained by environmental factors. Deviations from this general regional pattern in children of the age group 0-14 years may be explained by differing age-specific risk factors of hay fever.

Epidemiology of Lyme borreliosis based on outpatient claims data of all people with statutory health insurance, Germany, 2019.

IntroductionEvidence of nationwide and regional morbidity of Lyme borreliosis (LB) in Germany is lacking.AimsWe calculated the total number of incident LB cases in Germany in 2019, compared regional variations, investigated the extent of possible under-reporting in notification data and examined the association between high incidence areas and land cover composition.MethodsWe used outpatient claims data comprising information for people with statutory health insurance who visited a physician at least once between 2010 and 2019 in Germany (n = 71,411,504). The ICD-10 code A69.2 was used to identify incident LB patients. Spatial variations of LB were assessed by means of Global and Local Moran's Index at district level. Notification data were obtained for nine federal states with mandatory notification from the Robert Koch Institute (RKI).ResultsOf all insured, 128,177 were diagnosed with LB in 2019, corresponding to an incidence of 179 per 100,000 insured. The incidence varied across districts by a factor of 16 (range: 40-646 per 100,000). We identified four spatial clusters with high incidences. These clusters were associated with a significantly larger proportion of forests and agricultural areas than low incidence clusters. In 2019, 12,264 LB cases were reported to the RKI from nine federal states, while 69,623 patients with LB were found in claims data for those states. This difference varied considerably across districts.ConclusionsThese findings serve as a solid basis for regionally tailored population-based intervention programmes and can support modelling studies assessing the development of LB epidemiology under various climate change scenarios.

[Routine Data from Emergency Departments: Varying Documentation Standards, Billing Modalities and Data Custodians at an Identical Unit of Care]. / Routinedaten aus Notaufnahmen: Unterschiedliche Dokumentationsanforderungen, Abrechnungsmodalitäten und Datenhalter bei identischem Ort der Leistungserbringung.

BACKGROUND: Currently, there is a big need for data on emergency department (ED) utilization in Germany. One reason is the ongoing reorganisation of emergency care. Possible sources are routine data that are being collected based on legal regulations. Different payers and compensation systems have their own requirements for data collection. METHODOLOGICAL CHALLENGES: Due to the sectoral separation of health care services, there is no dataset or data holder to provide information on all ED treatments in Germany. From an administrative point of view, emergency care in Germany is considered ambulatory outpatient or inpatient care from the time point of admission to the ED. In contrast, clinical decision about inpatient admission can sometimes only be made towards the end of emergency care. EDs themselves cannot be identified in claims data; only the medical discipline (e. g. surgery) is classified. In the case of outpatient treatment, reimbursed by the Association of Statutory Health Insurance Physicians, at least one coded diagnosis (ICD) has to be recorded, accompanied by an additional code for the likelihood of this diagnosis. In case of multiple ICDs, a primary diagnosis cannot be specified. In the case of in-hospital treatment, an admission diagnosis must be recorded. After completion of hospital treatment, the main diagnosis and possibly secondary diagnoses are transferred to the respective health insurance fund. The statutory occupational accident insurance has its own requirements. SOLUTIONS: Depending on the research question and study design, different approaches are required. If data are queried directly in emergency departments or hospitals, additional information on the designated data holder and billing mode is crucial. When using health insurance data from inpatient care, the identification of emergency departments can be estimated on the basis of the reason for hospital admission and defined "unique" emergency ICDs. The case-related hospital statistics has its own limitations, but includes inpatients of all payers. DISCUSSION: Differing requirements for the administrative documentation cause a high workload in emergency departments. A standardised data collection system for all payers for inpatient and outpatient emergency care is recommended. This would contribute to the creation of valid and comparable datasets. The introduction of a particular identifier for EDs in claims data would enhance health services research.

[Diagnosis Coding in German Medical Practices: A Retrospective Study Using Routine Data]. / Diagnosenkodierung in deutschen Arztpraxen aus klassifikatorischer Sicht: Eine retrospektive Studie mit Routinedaten.

OBJECTIVES: Primary care physicians and specialists deal with a wide range of diseases. The diagnoses are coded by using the annual version of the International Statistical Classification of Diseases and Related Health Problems, 10th revised version, German modification (ICD-10-GM). The aim of this study was to describe the current spectrum of documented diagnoses by physicians. Based on the underlying conditions, a broad variety of ICD-10-GM codes could be expected, which in many cases would not be coded to the final character (terminal). METHODS: 22,287,583 data sets of 900 medical practices of 13 various physician groups were included in this retrospective study. The data originate from the regions Brandenburg and North Rhine and the accounting period October 2014 - September 2015. The normalized Gini coefficient was applied as a measure for inequality. RESULTS: 97.6 % of the total data set were coded to the final character using the ICD-10-GM. ENT physicians used the highest rate of terminal codes (99.6 %), whereas orthopedists and cardiologists used the lowest rate (94.0 %). The broadest variety of different ICD-10-GM codes was used by primary care physicians (71.1 % of all possible terminal codes), the smallest variety was used by ophthalmologists (22.9 %). The lowest inequality of using ICD-10-GM codes could be detected for primary care physicians (Gini coefficient: 0.56), the highest inequality could be shown for ophthalmologists (Gini coefficient: 0.93). CONCLUSIONS: The specialists mainly use a circumscribed set of ICD-10-GM codes, whereas primary care physicians not only use a broad variety of different ICD-10-GM codes, but very often code them to their final character. This indicates a high quality of coding.

Vibration measurements of high-heat-load monochromators for DESY PETRA III extension.

The requirement for vibrational stability of beamline optics continues to evolve rapidly to comply with the demands created by the improved brilliance of the third-generation low-emittance storage rings around the world. The challenge is to quantify the performance of the instrument before it is installed at the beamline. In this article, measurement techniques are presented that directly and accurately measure (i) the relative vibration between the two crystals of a double-crystal monochromator (DCM) and (ii) the absolute vibration of the second-crystal cage of a DCM. Excluding a synchrotron beam, the measurements are conducted under in situ conditions, connected to a liquid-nitrogen cryocooler. The investigated DCM utilizes a direct-drive (no gearing) goniometer for the Bragg rotation. The main causes of the DCM vibration are found to be the servoing of the direct-drive goniometer and the flexibility in the crystal cage motion stages. It is found that the investigated DCM can offer relative pitch vibration down to 48 nrad RMS (capacitive sensors, 0-5 kHz bandwidth) and absolute pitch vibration down to 82 nrad RMS (laser interferometer, 0-50 kHz bandwidth), with the Bragg axis brake engaged.

Metabolomics in toxicology and preclinical research.

Metabolomics, the comprehensive analysis of metabolites in a biological system, provides detailed information about the biochemical/physiological status of a biological system, and about the changes caused by chemicals. Metabolomics analysis is used in many fields, ranging from the analysis of the physiological status of genetically modified organisms in safety science to the evaluation of human health conditions. In toxicology, metabolomics is the -omics discipline that is most closely related to classical knowledge of disturbed biochemical pathways. It allows rapid identification of the potential targets of a hazardous compound. It can give information on target organs and often can help to improve our understanding regarding the mode-of-action of a given compound. Such insights aid the discovery of biomarkers that either indicate pathophysiological conditions or help the monitoring of the efficacy of drug therapies. The first toxicological applications of metabolomics were for mechanistic research, but different ways to use the technology in a regulatory context are being explored. Ideally, further progress in that direction will position the metabolomics approach to address the challenges of toxicology of the 21st century. To address these issues, scientists from academia, industry, and regulatory bodies came together in a workshop to discuss the current status of applied metabolomics and its potential in the safety assessment of compounds. We report here on the conclusions of three working groups addressing questions regarding 1) metabolomics for in vitro studies 2) the appropriate use of metabolomics in systems toxicology, and 3) use of metabolomics in a regulatory context.

Inter- and intra-observer reliability of clinical movement-control tests for marines.

BACKGROUND: Musculoskeletal disorders particularly in the back and lower extremities are common among marines. Here, movement-control tests are considered clinically useful for screening and follow-up evaluation. However, few studies have addressed the reliability of clinical tests, and no such published data exists for marines. The present aim was therefore to determine the inter- and intra-observer reliability of clinically convenient tests emphasizing movement control of the back and hip among marines. A secondary aim was to investigate the sensitivity and specificity of these clinical tests for discriminating musculoskeletal pain disorders in this group of military personnel. METHODS: This inter- and intra-observer reliability study used a test-retest approach with six standardized clinical tests focusing on movement control for back and hip. Thirty-three marines (age 28.7 yrs, SD 5.9) on active duty volunteered and were recruited. They followed an in-vivo observation test procedure that covered both low- and high-load (threshold) tasks relevant for marines on operational duty. Two independent observers simultaneously rated performance as "correct" or "incorrect" following a standardized assessment protocol. Re-testing followed 7-10 days thereafter. Reliability was analysed using kappa (κ) coefficients, while discriminative power of the best-fitting tests for back- and lower-extremity pain was assessed using a multiple-variable regression model. RESULTS: Inter-observer reliability for the six tests was moderate to almost perfect with κ-coefficients ranging between 0.56-0.95. Three tests reached almost perfect inter-observer reliability with mean κ-coefficients > 0.81. However, intra-observer reliability was fair-to-moderate with mean κ-coefficients between 0.22-0.58. Three tests achieved moderate intra-observer reliability with κ-coefficients > 0.41. Combinations of one low- and one high-threshold test best discriminated prior back pain, but results were inconsistent for lower-extremity pain. CONCLUSIONS: Our results suggest that clinical tests of movement control of back and hip are reliable for use in screening protocols using several observers with marines. However, test-retest reproducibility was less accurate, which should be considered in follow-up evaluations. The results also indicate that combinations of low- and high-threshold tests have discriminative validity for prior back pain, but were inconclusive for lower-extremity pain.