Waning waves of mood: The declining trend of hospitalized patients with affective disorders in Germany.

INTRODUCTION: Affective disorders profoundly affect individuals' emotional well-being and quality of life. This study investigates the epidemiology of affective disorders in Germany from 2011 to 2021, focusing on incidence rates, age- and sex-standardized rates, and developmental trends. METHODS: Using nationwide data of ICD-10 diagnosis codes from 2011 to 2021, this cross-sectional study analyzed inpatient cases of affective disorders in individuals aged 20 years or older. Age- and sex-standardized incidence rates were calculated based on the population size of each birth cohort in the 16 German federal states. Incidence rate ratios (IRRs) for 2011 to 2021 and 2019 to 2021 were compared with a two-sample z-test. RESULTS: Between 2011 and 2021, F30 (manic episode) showed a decline of 42.8 % to an incidence of 4.9 per 100,000 inhabitants, even though not statistically significant (p = 0.322). F31 (bipolar affective disorder) remained relatively stable with a reduction of 15.3 % to an incidence of 13.6 per 100,000 inhabitants in 2021 (p = 0.653). F32 (depressive episode) decreased statistically significant by 25.7 % to an incidence of 64.1 per 100,000 inhabitants (p = 0.072). F33 (recurrent depressive disorder) slightly increased by 18.3 % to an incidence of 94.6 per 100,000 inhabitants (p = 0.267). No statistically significant differences were found when comparing the COVID-19 pandemic year 2021 to 2019 incidences (p ≥ 0.529). CONCLUSION: The study provides valuable insights into the changing landscape of affective disorders in Germany over the past decade. The observed decline in incidence rates underscores the importance of continued efforts to promote mental health awareness and access to care.

Attention deficits and depressive symptoms improve differentially after rehabilitation of post-COVID condition - A prospective cohort study.

BACKGROUND: Depressive and cognitive symptoms like fatigue, loss of energy or sleep disorders characterise the post-COVID condition. Post-COVID psychosomatic rehabilitation should focus on both symptom groups. The current prospective cohort study addresses the change in these symptoms in the context of a psychosomatic rehabilitation. METHOD: N = 80 patients with post-COVID symptoms underwent psychological testing on admission and discharge: PHQ-9 questionnaire for depression, TAP - test battery for the attention test with the sub-tests working memory, sustained attention, divided attention and alertness. Sample characteristics, including health-related and work-related parameters, the general symptom load and the course of symptoms during the five weeks of rehabilitation were evaluated. RESULTS: On admission, the PHQ-9 indicated the presence of depressive symptoms in post-COVID patients (PHQ-9 = 15.15 ± 5.11). Over the course of rehabilitation, the depressive symptoms decreased to a sub-clinical level (PHQ-9 = 8.80 ± 4.61), suggesting a strong effect of post-COVID inpatient rehabilitation (Cohen's d = 1.57). At the same time, post-COVID patients showed clinically relevant impairments in attention and working memory that persisted throughout the rehabilitation period despite multimodal post-COVID treatment. CONCLUSION: Over the course of post-COVID rehabilitation, depressive symptoms appear to be significantly reduced. With regard to cognitive impairment, a comparable effect within the short period of 5 weeks is not evident. Our results suggest the need for specific treatment of persistent neuropsychological deficits following post-COVID rehabilitation.

Neurophysiological signatures of sensory-processing sensitivity.

Background: Sensory processing sensitivity is mainly captured based on questionnaires and it's neurophysiological basis is largely unknown. As hitherto no electroencephalography (EEG) study has been carried out, the aim of this work was to determine whether the self-reported level of SPS correlates with the EEG activity in different frequency bands. Methods: One hundred fifteen participants were measured with 64-channel EEG during a task-free resting state. After artifact correction, a power spectrum time series was calculated using the Fast Fourier Transform (FFT) for the following frequency bands: Delta: 1-3.5 Hz, theta: 4-7.5 Hz, alpha1: 8-10 Hz, alpha2: 10.5-12 Hz, beta1: 12.5-15 Hz, beta2: 15.5-25 Hz, gamma: 25.5-45 Hz, global: 1-45 Hz. Correlations with the 'Highly Sensitive Person Scale' (HSPS-G) scores were determined. Then, the lowest and the highest 30% of the cohort were contrasted as polar opposites. EEG features were compared between the two groups applying a paired two-tailed t-test. Results: The HSPS-G scores correlated statistically significantly positive with beta 1 and 2, and global EEG power during resting with eyes open, but not during resting with eyes closed. The highly sensitive group revealed higher beta power (4.38 ± 0.32 vs. 4.21 ± 0.17, p = 0.014), higher gamma power (4.21 ± 0.37 vs. 4.00 ± 0.25, p = 0.010), and increased global EEG power (4.38 ± 0.29 vs. 4.25 ± 0.17, p = 0.041). The higher EEG activity in the HSP group was most pronounced in the central, parietal, and temporal region, whereas lower EEG activity was most present in occipital areas. Conclusion: For the first time, neurophysiological signatures associated with SPS during a task free resting state were demonstrated. Evidence is provided that neural processes differ between HSP and non-HSP. During resting with eyes open HSP exhibit higher EEG activity suggesting increased information processing. The findings could be of importance for the development of biomarkers for clinical diagnostics and intervention efficacy evaluation.

Sensory-Processing Sensitivity Is Associated with Increased Neural Entropy.

BACKGROUND: This study aimed at answering the following research questions: (1) Does the self-reported level of sensory-processing sensitivity (SPS) correlate with complexity, or criticality features of the electroencephalogram (EEG)? (2) Are there significant EEG differences comparing individuals with high and low levels of SPS? METHODS: One hundred fifteen participants were measured with 64-channel EEG during a task-free resting state. The data were analyzed using criticality theory tools (detrended fluctuation analysis, neuronal avalanche analysis) and complexity measures (sample entropy, Higuchi's fractal dimension). Correlations with the 'Highly Sensitive Person Scale' (HSPS-G) scores were determined. Then, the cohort's lowest and the highest 30% were contrasted as opposites. EEG features were compared between the two groups by applying a Wilcoxon signed-rank test. RESULTS: During resting with eyes open, HSPS-G scores correlated significantly positively with the sample entropy and Higuchi's fractal dimension (Spearman's ρ = 0.22, p < 0.05). The highly sensitive group revealed higher sample entropy values (1.83 ± 0.10 vs. 1.77 ± 0.13, p = 0.031). The increased sample entropy in the highly sensitive group was most pronounced in the central, temporal, and parietal regions. CONCLUSION: For the first time, neurophysiological complexity features associated with SPS during a task-free resting state were demonstrated. Evidence is provided that neural processes differ between low- and highly-sensitive persons, whereby the latter displayed increased neural entropy. The findings support the central theoretical assumption of enhanced information processing and could be important for developing biomarkers for clinical diagnostics.

Psychological comorbidities in osteoarthritis in Germany.

Osteoarthritis is a degenerative joint disease associated with pain, loss of function and reduced quality of life. Concomitant psychological disorders can significantly influence treatment outcomes. Therefore, we aimed to answer the following research questions: (1) How has the incidence of primary coxarthrosis and gonarthrosis developed over the last decade? (2) How high is the prevalence of osteoarthritis patients with concomitant psychological diagnoses? (3) Which psychological comorbidities are most prevalent in coxarthrosis and gonarthrosis patients, respectively? For this cross-sectional study, a dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "M16.1" and "M17.1", unilateral primary coxarthrosis and unilateral primary gonarthrosis, were quantified. Prevalence rates of secondary diagnoses of the chapter F of the ICD-10 were determined. Incidences were 230.7/100,000 inhabitants for coxarthrosis and 224.2/100,000 inhabitants for gonarthrosis. Patients with psychological comorbidities constituted 9.0% of coxarthrosis cases and 8.9% of gonarthrosis cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by + 37.8% for coxarthrosis and by 17.9% for gonarthrosis. The most prevalent secondary diagnoses were affective disorders (F3), whereby numbers increased over the years. Increasing psychological comorbidities advocate for the implementation of screening tools, prevention strategies, interdisciplinary approaches and psychological support in the treatment of osteoarthritis.

A Comprehensive Report of German Nationwide Inpatient Data on the Post-COVID-19 Syndrome Including Annual Direct Healthcare Costs.

BACKGROUND: The aim of this study was to provide a comprehensive overview of German nationwide data including (i) the number of hospitalized Post-COVID Syndrome (PCS) cases including in-hospital mortality rates and intensive care unit treatments, (ii) the main common concomitant diagnoses associated with PCS, (iii) the most frequently performed treatment procedures, and (iv) the annual direct healthcare costs. METHODS: The incidence was calculated based on annual ICD-10 diagnosis codes "U09.9!, Post-COVID-19 condition". Data on concomitant diagnoses, treatment procedures, treatment in an intensive care unit (ICU), in-hospital mortality, the proportion of G-DRGs, and cumulative costs were assessed based on the Institute for the Hospital Remuneration System (InEK) data for 2019. RESULTS: A total of 29,808 PCS inpatients could be identified yielding a prevalence of 5.5%. In total, 1330 (4.5%) in-hospital deaths were recorded, and 5140 (17.2%) patients required ICU treatment. The majority of patients (18.6%) were aged 65-74 years. The most common concomitant diagnoses included pneumonia, critical illness polyneuropathy, dyspnea, chronic fatigue syndrome, and pulmonary embolisms. The most frequently performed procedures were computed tomography of the thorax with contrast medium, whole-body plethysmography, and the monitoring of respiration, heart, and circulation. The cost per case of the G-DRG codes that were analyzed ranged from € 620 ± 377 (E64D, Respiratory insufficiency, one day of occupancy) to € 113,801 ± 27,939 (A06B, Ventilation > 1799 h with complex OR procedure). Total cumulative direct healthcare costs of € 136,608,719 were calculated, resulting in mean costs of € 4583 per case. CONCLUSION: Post-COVID Syndrome is of major public health importance with substantial financial implications. The present article can support stakeholders in health care systems to foresee future needs and adapt their resource management. Consensus diagnostic criteria and rehabilitation guidelines are highly warranted.

Spending Time in the Forest or the Field: Investigations on Stress Perception and Psychological Well-Being-A Randomized Cross-Over Trial in Highly Sensitive Persons.

Research suggests that stays in a forest promote relaxation and reduce stress compared to spending time in a city. The aim of this study was to compare stays in a forest with another natural environment, a cultivated field. Healthy, highly sensitive persons (HSP, SV12 score > 18) aged between 18 and 70 years spent one hour in the forest and in the field at intervals of one week. The primary outcome was measured using the Change in Subjective Self-Perception (CSP-14) questionnaire. Secondary outcomes were measured using the Profile Of Mood States (POMS) questionnaire and by analyzing salivary cortisol. We randomized 43 participants. Thirty-nine were allocated and included in the intention-to-treat analysis (90% female, mean age 45 years). CSP-14 in part showed significant differences-total score (p = 0.054, Cohen's d = 0.319), item "integration" (p = 0.028, Cohen's d = 0.365)-favoring the effects of the forest. These effects were more pronounced in summer (August). In October, during rainfall, we detected no relevant differences. POMS only showed a significant difference in the subcategory "depression/anxiety" in favor of the field. The amount of cortisol in saliva was not different between the groups. A short-term stay in a forest in summer caused a greater improvement in mood and well-being in HSP than in a field. This effect was not detectable during bad weather in the fall.

Self-organized criticality as a framework for consciousness: A review study.

Objective: No current model of consciousness is univocally accepted on either theoretical or empirical grounds, and the need for a solid unifying framework is evident. Special attention has been given to the premise that self-organized criticality (SOC) is a fundamental property of neural system. SOC provides a competitive model to describe the physical mechanisms underlying spontaneous brain activity, and thus, critical dynamics were proposed as general gauges of information processing representing a strong candidate for a surrogate measure of consciousness. As SOC could be a neurodynamical framework, which may be able to bring together existing theories and experimental evidence, the purpose of this work was to provide a comprehensive overview of progress of research on SOC in association with consciousness. Methods: A comprehensive search of publications on consciousness and SOC published between 1998 and 2021 was conducted. The Web of Science database was searched, and annual number of publications and citations, type of articles, and applied methods were determined. Results: A total of 71 publications were identified. The annual number of citations steadily increased over the years. Original articles comprised 50.7% and reviews/theoretical articles 43.6%. Sixteen studies reported on human data and in seven studies data were recorded in animals. Computational models were utilized in n = 12 studies. EcoG data were assessed in n = 4 articles, fMRI in n = 4 studies, and EEG/MEG in n = 10 studies. Notably, different analytical tools were applied in the EEG/MEG studies to assess a surrogate measure of criticality such as the detrended fluctuation analysis, the pair correlation function, parameters from the neuronal avalanche analysis and the spectral exponent. Conclusion: Recent studies pointed out agreements of critical dynamics with the current most influencing theories in the field of consciousness research, the global workspace theory and the integrated information theory. Thus, the framework of SOC as a neurodynamical parameter for consciousness seems promising. However, identified experimental work was small in numbers, and a heterogeneity of applied analytical tools as a surrogate measure of criticality was observable, which limits the generalizability of findings.

Determining states of consciousness in the electroencephalogram based on spectral, complexity, and criticality features.

This study was based on the contemporary proposal that distinct states of consciousness are quantifiable by neural complexity and critical dynamics. To test this hypothesis, it was aimed at comparing the electrophysiological correlates of three meditation conditions using nonlinear techniques from the complexity and criticality framework as well as power spectral density. Thirty participants highly proficient in meditation were measured with 64-channel electroencephalography (EEG) during one session consisting of a task-free baseline resting (eyes closed and eyes open), a reading condition, and three meditation conditions (thoughtless emptiness, presence monitoring, and focused attention). The data were analyzed applying analytical tools from criticality theory (detrended fluctuation analysis, neuronal avalanche analysis), complexity measures (multiscale entropy, Higuchi's fractal dimension), and power spectral density. Task conditions were contrasted, and effect sizes were compared. Partial least square regression and receiver operating characteristics analysis were applied to determine the discrimination accuracy of each measure. Compared to resting with eyes closed, the meditation categories emptiness and focused attention showed higher values of entropy and fractal dimension. Long-range temporal correlations were declined in all meditation conditions. The critical exponent yielded the lowest values for focused attention and reading. The highest discrimination accuracy was found for the gamma band (0.83-0.98), the global power spectral density (0.78-0.96), and the sample entropy (0.86-0.90). Electrophysiological correlates of distinct meditation states were identified and the relationship between nonlinear complexity, critical brain dynamics, and spectral features was determined. The meditation states could be discriminated with nonlinear measures and quantified by the degree of neuronal complexity, long-range temporal correlations, and power law distributions in neuronal avalanches.

Relevance of the post-COVID syndrome within rehabilitation (PoCoRe): study protocol of a multi-centre study with different specialisations.

BACKGROUND: In Patients suffering from post-COVID syndrome, in addition to physical limitations, cognitive limitations, fatigue, dyspnea as well as depression and anxiety disorders may also be present. Up to now (as of May 2022), approx. 514 million people worldwide have been infected with SARS-CoV-2, in Germany this affects approx. 25 million. In Germany, 2.5 million people could potentially be affected by post-COVID syndrome. Post-COVID is thus a highly relevant public health issue. So far, there is no specific causal therapy for the post-COVID syndrome, but with multimodal symptom-oriented rehabilitation, the course can be favourably influenced. However, there is no study yet that focuses on patients in different rehabilitation indications and compares the focal symptomatology and coping strategies as well as the patients' benefit per indication. METHODS/DESIGN: As first objective, pulmonal, cardiac, neurological, cognitive or/and psychological functional impairments in rehabilitation patients after COVID-19 disease will be described. The second objective is the differentiated review of the specific rehabilitation measures, in the short term and in the longer term for the purpose of future prognoses and optimisation of therapeutic interventions. This prospective, non-randomised, controlled longitudinal study, plus multi-group comparisons will take place in seven rehabilitation clinics of different specialisations: cardiological rehab, pneumological rehab, neurological rehab, psychosomatic rehab. Within 12 months, 1000 cases across all participating centres will be included. Somatic and psychological testing will be conducted at three measurement points: Admission (t0), discharge (t1), 6-montas Catamnesis (t2). The patients receive the usual care according to the respective rehabilitation priorities, adapted to the special challenges of post-COVID symptoms. Patients of the post-COVID outpatient clinic without rehabilitation will be used as a control group. DISCUSSION: This study will precisely assess the extent to which subclinical neurological or/and psychological impairments are present in post-COVID-19 rehabilitation and the results will help, developing, providing and evaluating appropriate treatment concepts. This may also have relevant implications for the improvement of physical ability and quality of life in post-COVID-19 patients and increase the probability of return to work. Trial registration Z-2022-1749-8, registered 03. February 2022, https://studienanmeldung.zks-regensburg.de.

Managing periprosthetic joint infection-a qualitative analysis of nursing staffs' experiences.

BACKGROUND: Periprosthetic joint infection represents a major complication in orthopaedics and trauma surgery. For an ideal management approach, it is important to understand the distinct challenges for all persons involved in the treatment. Therefore, it was aimed at investigating (1) the impact of periprosthetic joint infection (PJI) on the well-being of nursing staff to (2) identify challenges, which could be improved facilitating the management of PJI. METHODS: This is a qualitative interview study. In total, 20 nurses of a German university orthopedic trauma center specialized on infectious complications were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between March 2021 and June 2021. RESULTS: Three major themes could be extracted including (i) feelings associated with the management of PJI and the need for emotional support, illustrating the negative emotional impact on nurses, whereby receiving collegial support was perceived as an important coping strategy, (ii) patients' psychological burden, highlighting the nurses' lack of time to address mental issues adequately and, (iii) realization of the severity of PJI and compliance problems. CONCLUSION: Identified facilitating factors for PJI management include strengthening of mental care in the treatment of PJI, providing opportunities for exchange among multidisciplinary team members and implementing compliance-enhancing strategies. The findings of this study can be beneficial for improving professionals' satisfaction, optimising the work environment, creating organizational structures which enhance opportunities for exchange and preventing mental health issues among the nursing team.

Neurophysiological Effects of a Singing Bowl Massage.

Background and Objectives: In recent years, singing bowl sound interventions have been progressively implemented in the fields of well-being, therapy and education; however, the effectiveness has only scarcely been investigated. Therefore, this study was aimed at determining neurophysiological effects of a singing bowl massage. Materials and Methods: In this prospective cohort study 64-channel EEG, ECG and respiration was recorded from 34 participants (mean age 36.03 ± 13.43 years, 24 females/10 males) before, during and after a professional singing bowl massage. Further, subjective changes in well-being were assessed. EEG data were analyzed by determining the effect sizes of distinct frequency bands. Significant differences were calculated by a two-tailed t-test corrected for multiple comparisons. Heart rate variability metrics, heart rate and respiration rate were estimated and compared. Results: Overall EEG power decreased during the sound condition compared to a task-free resting state (d = −0.30, p = 0.002). After the intervention, global EEG power was further reduced (d = −0.46, p < 0.001), revealing a decrease in the beta 2 (d = −0.15, p = 0.002) and the gamma frequency band (d = −0.21, p = 0.004). The mean heart rate was significantly lower after the intervention (75.5 ± 19.8 vs. 71.5 ± 17.9, p < 0.001) and the respiration rate higher (13.5 ± 5.3 vs. 15.2 ± 6.3, p = 0.018). 91.2% of the participants felt more integrated, 97.1% more balanced and 76.5% more vitalized. Conclusions: The neurophysiological effects of a singing bowl sound massage may be interpreted as a shift towards a more mindful, meditative state of consciousness. The intervention was perceived as beneficial for the wellbeing.

Prevalence of psychological comorbidities in bone infection.

OBJECTIVE: Bone infections represent a major complication in orthopedic and trauma surgery. Concomitant psychological disorders can significantly influence treatment outcomes. However, these are often overlooked. Therefore, we aimed to determine the nationwide epidemiology of fracture-related infection (FRI) and osteomyelitis in combination with psychological comorbidities. METHODS: A dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "T84.6, infection and inflammatory reaction due to internal fixation device" and "M86.-, osteomyelitis" were quantified. Proportions of secondary diagnoses of the chapter F of the ICD-10 were determined. RESULTS: Incidences were 19.1/100,000 inhabitants for osteomyelitis and 10.5/100,000 inhabitants for FRI. Patients with psychological comorbidities constituted 14.6% of osteomyelitis cases and 26.5% of FRI cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by 27.3% for osteomyelitis and by 24.1% for FRI. Most prevalent secondary diagnoses were organic, including symptomatic, mental disorders (F0), affective disorder (F3) and mental and behavioral disorders due to psychoactive substance use (F1), whereby the latter decreased over the years. CONCLUSION: The implementation of prevention strategies, interdisciplinary approaches and psychological support in orthopaedics and trauma surgery is warranted.

[Proposal of a Basic Documentation for Child, Adolescent and Family Psychosomatics Based on a Synopsis of Basic Documentations for Children, Adolescents and Adults]. / Vorschlag einer Basisdokumentation für die Kinder-, Jugend- und Familienpsychosomatik auf Basis einer Synopsis von Basisdokumentationen für Kinder, Jugendliche und Erwachsene.

BACKGROUND: In psychiatry, psychosomatics and psychotherapy, basic documentation (BaDo) is used as a quality assurance tool. For the field of child, adolescent and family psychosomatics, there is no uniform BaDo that can be used across facilities and care areas. The aim of the study was to propose a catalog of characteristics for the context of psychosomatic treatment of children and adolescents on the basis of a synoptic comparison of established BaDos METHODS: In the context of a qualitative document analysis, BaDo items from the children/youth and adult sector were evaluated in content analysis along a category system. The resulting aspects were then classified according to age and multidisciplinary content and evaluated with regard to their child/youth specificity. Descriptive statistical analysis of the results was performed RESULTS: Aspects of the categories Family Anamnesis and Biographical Anamnesis specified a BaDo for children and adolescents. For BaDos from the psychosomatic field, a record of pre-treatments was accentuated across age groups. The recording of socio-demographic data had to be adapted conceptually to the age-related needs of children and adolescents. CONCLUSION: On the basis of an empirical approach, a modular BaDo for child, youth and family psychosomatics could be formulated that enables institutional, sectoral and interdisciplinary evaluations. In a next step, the instrument should be evaluated in an application study and be consented to on a broad level.

Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave.

BACKGROUND: For a better understanding of the factors underlying the Post-Acute COVID Syndrome, we studied the relationship between symptoms and functional alterations in COVID-19 patients 10 months after hospitalization. METHODS: One-hundred-one patients hospitalized between March 1st and June 30th 2020 participated in a follow-up visit for an assessment of clinical history, comorbidities, lung function, physical capacity and symptoms, including the SGRQ for health-related quality of life, PHQ-9-D for depression, and SOMS-2 J for somatoform disorders. Data were analyzed by univariate comparisons and multiple logistic regression analyses. RESULTS: Median age was 60 years, 42% were female, 76% had at least one comorbidity, the median length of the hospital stay was 8 days, 19% had been on the ICU. The most prevalent symptoms included shortness of breath (49%), fatigue (49%) and cognitive impairment (39%). Signs of major depression (PHQ-9-D ≥ 10) occurred in 28%/2% (p < 0.05) of patients with/without self-reported cognitive impairment, with median total SGRQ score being 25.4/5.3 (p < 0.05). There were associations between shortness of breath and BMI, SGRQ and hemoglobin levels; between fatigue, SGRQ and PHQ-9-D; and between cognitive impairment and PHQ-9-D (p < 0.05 each) but not with lung function or physical capacity. Characteristics of the acute disease were not related to symptoms. CONCLUSIONS: The findings demonstrate that 10 months after discharge from a hospital stay due to COVID-19, the percentages of patients with symptoms were high. Symptoms showed a consistent pattern but could not be attributed to altered lung function or physical capacity. Our results suggest a role for alternative etiologies including psychosocial factors.

Long-term patient-related quality of life after fracture-related infections of the long bones.

AIMS: We aimed to evaluate the long-term impact of fracture-related infection (FRI) on patients' physical health and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of FRIs of long bones was assessed. METHODS: A total of 37 patients treated between November 2009 and March 2019, with achieved eradication of infection and stable bone consolidation after long bone FRI, were included. Quality of life was evaluated with the EuroQol five-dimension questionnaire (EQ-5D) and German Short-Form 36 (SF-36) outcome instruments as well as with an International Classification of Diseases of the World Health Organization (ICD)-10 based symptom rating (ISR) and compared to normative data. RESULTS: With a mean follow-up of 4.19 years (SD 2.7) after the last surgery, the mean SF-36 score was 40.1 (SD 14.6) regarding the physical health component and 48.7 (SD 5.1) regarding the mental health component, compared to German normative values of 48.4 (SD 9.2) (p < 0.001) and 50.9 (SD 8.8) (p = 0.143). The mean EQ-5D index reached 0.76 (SD 0.27) with a mean EQ-5D visual analogue scale (VAS) rating of 65.7 (SD 22.7) compared to reference scores of 0.88 (p < 0.001) and 72.9 (p < 0.001). Mean scores of the ISR did not reveal significant psychological symptom burden, while an individual analysis showed moderate to severe impairments in 21.6% (n = 8) of the patients. CONCLUSION: Even a mean 4.2 years (SD 2.7) after surgically successful treatment of FRI of long bones, patients report significantly lower quality of life in comparison to normative data. Future clinical studies on FRIs should focus on patient-related outcome measures enabling best possible shared treatment decision-making. Prevention methods and interdisciplinary approaches should be implemented to improve the overall quality of life of FRI patients. Cite this article: Bone Joint Res 2021;10(5):321-327.

Long-term patient-related quality of life after successfully treated aseptic non-unions of the long bones.

BACKGROUND: Non-union after fracture depicts a devastating complication in trauma surgery and studies assessing patient-reported outcome measures after stable bone consolidation are rare. Therefore, we aimed to evaluate the long-term impact of aseptic long bone non-union on the patients' physical health state and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of long bone non-union was assessed. METHODS: Sixty-one patients with aseptic long bone non-union surgically treated in our department between November 2009 and March 2019 with achieved bone consolidation were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. RESULTS: With a minimum follow-up time of one year after the last surgery (mean 4.7 ± 2.7 years) the mean physical health component score of the SF-36 was 38.9 ± 13.7 and the mean mental health component score of the SF-36 was 49.0 ± 5.9, indicating lower quality of life compared to German normative values of 48.4 ± 9.4 (p < .001) and 50.9 ± 8.8 (p = 1.61), respectively. The mean EQ-5D index value reached 0.827 ± 0.18 with an EQ-5D VAS rating of 64.4 ± 21.5 compared to scores of 0.922 (p < .001) and 72.9 ± 1.1 (p < .001) obtained from an age-matched reference population. Mean scores of the ISR did not reveal significant psychological symptom burden in any scale, while an individual analysis showed moderate to severe impairments in 11.5% of the patients in total. CONCLUSION: Even 4.7 years on average after surgically successful treatment of aseptic long bone non-union, patients still report significant lower quality of life in comparison to normative data. Future clinical studies on non-unions should focus on patient-related outcome measures. Newly emerging treatment strategies and interdisciplinary approaches should be implemented to improve the overall quality of life of non-union patients.

[Prosthetic infections and the increasing importance of psychological comorbidities : An epidemiological analysis for Germany from 2009 through 2019]. / Protheseninfektionen und die zunehmende Bedeutung psychologischer Komorbiditäten : Eine epidemiologische Analyse für Deutschland von 2009 bis 2019.

BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication in orthopedics and trauma surgery. A potential increase in PJI diagnoses, especially in combination with psychological comorbidities may become a significant challenge for healthcare stakeholders. So far, the prevalence for Germany is unknown, which makes it difficult to estimate future treatment demand or to predict developments that can be influenced by adapting prevention and treatment measures. OBJECTIVES: The present study provides a detailed overview of the epidemiology of periprosthetic joint infections and psychological comorbidities. MATERIALS AND METHODS: A dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 through 2019 was analyzed. Incidences of the code "T84.5-Infection and inflammatory reaction due to joint arthroplasty" were quantified, and a detailed breakdown of this data by age group and gender was performed. Prevalence rates of secondary diagnoses of the ICD-10 chapter F were determined. RESULTS: PJI diagnoses have been steadily increasing since 2009. The incidence declined in 2018. In 2019, 16,174 cases were registered, corresponding to a prevalence of 23.8/100,000 population. A trend towards more diagnoses in elderly patients became evident. Twenty-five percent of all patients had a secondary diagnosis regarding mental and behavioural disorders. The number of patients with psychological comorbidities doubled in the last decade. CONCLUSIONS: Guidelines on prevention strategies as well as psychological support services should be implemented in trauma surgery.

[Effectiveness of Biofeedback for Primary Headache - A Randomized Controlled Study]. / Wirksamkeit von Biofeedback bei primärem Kopfschmerz ­ Eine randomisierte, kontrollierte Studie.

BACKGROUND: Biofeedback-treatment for primary headache is highly recommended. Its expenses are mostly not or not completely covered by health funds, hindering the implementation in the care system. This randomized controlled study aimed at evaluating the efficacy of a biofeedback-treatment for primary headache in the outpatient care system all over Germany. METHODS: The participants were divided into a direct treatment-group (n=41) and a waiting control-group (n=29). The treatment was carried out for 8-11 sessions with vasoconstriction-/vasodilation training for migraine, with electromyography training for headache of the tension type (diagnosis according to the criteria of the International Headache Association). Headache characteristics (frequency, duration, intensity) were collected via headache-diary before, during and after the treatment and headache specific disability using the Pain Disability Index before and after the treatment. The waiting group stated additional information of the questionnaires about 3 months before and again ultimately before the start of the treatment. Measurement of the headache specific self-efficacy (Headache Management Self-efficacy Scale) took place every second session. For the collected parameters the effect sizes f2 or r were computed before in comparison to after the treatment and comparing the treatment-group to the waiting-group. RESULTS: Headache characteristics decreased during the time of the study significantly linearly with medium to strong effects (frequency f2=0.302, p<0.001, duration f2=0.186, p<0.001, mean intensity f2=0.502, p<0.001, maximal intensity f2=0.546, p<0.001). Using biofeedback the self-efficacy rose significantly (p<0.001, r=0.782), even compared to the waiting time (p<0.001, r=0.604). Additionally the handling of pain, the psychological disability and the disability in everyday life improved significantly. DISCUSSION AND CONCLUSION: Overall the effects were comparable to already existing studies. Therefore biofeedback turned out to be efficient against migraine and tension-type headache in the out-patient care setting. By that a better integration in the care system seems to be qualified.