Epidemiology of Tumor-Induced Osteomalacia in Germany Based on Real World Data

Tumor-induced osteomalacia (TIO) is an ultra-rare disease caused mostly by benign tumors that secrete fibroblast growth factor-23. Because of nonspecific symptoms, the diagnostic delay is long, and therapy can be challenging. Moreover, epidemiological data on TIO are scarce owing to its rarity. Therefore, this study aimed to quantify TIO's incidence rates and prevalence in Germany. Retrospective longitudinal and cross-sectional analyses were conducted using anonymized German claims data from the statutory health insurance (SHI) database. This database, which comprises the data of approximately 5 million insurants, is a representative sample of the German population and supports national projections. As there is no unique International Statistical Classification of Diseases and Related Health Problems (ICD) code for TIO, operational categories based on different surrogates were defined to determine the prevalence and incidence rates of TIO among probable patients. This study showed that TIO has a prevalence of (documented code, advanced imaging, medication, or tumor removal) 0.187 per 100,000 persons and an incidence rate of ≤ 0.094 per 100,000 person years. This analysis provides the first epidemiological insight into German patients with TIO. Despite the general limitations associated with the analysis of SHI claims data of ultra-rare diseases, we believe that this analysis provides a sound basis for further analysis, particularly with regard to the care situation of patients with TIO.

Risk of accidents and unintentional injuries in men and women with attention deficit hyperactivity disorder across the adult lifespan

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is associated with risk-taking behavior, leading to accidents and unintentional injuries (summarized here as incidents). Main aim of this study is to determine if men and women with and without ADHD differ in the risk of mild (treated outpatient) and severe (treated inpatient) incidents across the adult lifespan (age groups: 18-29; 30-59, and ≥60 years). Secondary aim: investigate the role of comorbid mental disorders and drugs for the treatment of these comorbidities, and ADHD-medication.

METHODS

Using anonymized German claims data (N = 4,575,027), adults with ADHD diagnosis during 2016-2019 (N = 17,041) were compared with a 1:4 age and sex-matched group without ADHD diagnosis. Regression analyses statistically tested group differences.

RESULTS

Incidents occur in a U-shaped form across the adult lifespan. Individuals with ADHD show the same pattern but at a substantially increased risk of both mild and severe incidents throughout the lifespan. Women without ADHD are at lower risk in young adulthood than men but at higher risk in older adulthood. Women with ADHD show the same pattern for severe incidents, but for mild incidents they have the highest risk throughout the lifespan. Co-occurring anxiety disorder and the use of psycholeptics and ADHD-medication decreased the incident risk.

CONCLUSION

We extend available knowledge which has hitherto focused on young adult males and traffic accidents. ADHD is associated with increased incidents across the adult lifespan, with distinct patterns regarding age, sex, and incident severity. An accurate diagnosis of ADHD in adulthood provides the first step towards prevention of accidents and unintentional injuries.

[Regional and gender variations in appendicectomy : Nationwide small-area development of operation rates in the time series]

Hintergrund

Frühere Analysen kleinräumiger Appendektomieraten zeigen erheblich höhere regionale Unterschiede der Operationshäufigkeiten bei Frauen als bei Männern.

Ziel

Die Arbeit identifiziert valide Messgrößen zur Darstellung regionaler Unterschiede und analysiert geschlechtsspezifische Veränderungen der Appendektomieraten auf Landkreisebene in der Zeitreihe.

Material und Methoden

Datengrundlage sind die der DRG-Statistik entnommenen Appendektomiehäufigkeiten für 2014, 2016 sowie 2018 nach Geschlecht auf Landkreisebene. Die regionalen Unterschiede werden mittels der „systematic component of variation“ (SCV) berechnet und beurteilt. Die SCV ist im Vergleich zu Extrem-Ratio und Variationskoeffizient robuster gegenüber stark schwankender Nennerpopulationen. SCV-Werte über 5 geben einen Hinweis auf hohe Variationen und größer 10 auf sehr hohe Variationen.

Ergebnisse

Bei der männlichen Population lassen sich nur geringe regionale Unterschiede der Operationsraten feststellen, die im Zeitverlauf stabil bleiben (SCV₂₀₁₄ = 2,1, SCV₂₀₁₆ = 1,8 und SCV₂₀₁₈ = 2,0). Bei Frauen hingegen liegt die SCV in den Jahren 2014 sowie 2016 (SCV₂₀₁₄ = 6,1, SCV₂₀₁₆ = 5,3) über 5 und sinkt 2018 auf 4,5 ab. Darstellungen als Funnel-Plot berücksichtigen höhere Streuungen der Operationsraten in Landkreisen mit niedrigen Einwohnerzahlen.

Diskussion

Bei Frauen ist ein rückläufiger Trend in den Appendektomiehäufigkeiten zu erkennen. Unklar ist, ob dieser Trend auf einer Veränderung der Indikationsstellung oder auf einem geänderten allgemeinen Behandlungsmanagement bei einem Appendizitisverdacht beruht. Durch robuste Variationsmaße und der graphischen Aufbereitung als Funnel-Plots ist es möglich, systematisch bedingte regionale Versorgungsunterschiede von Zufallseffekten zu unterscheiden.

Disease burden and direct medical costs of incident adult ADHD: A retrospective longitudinal analysis based on German statutory health insurance claims data

Background.

Adult attention-deficit/hyperactivity disorder (aADHD) is still a largely unrecognized psychiatric condition despite its strong impact on individuals’ well-being. Here, we describe the healthcare situation of individuals with incident aADHD over 4 years before and 4 years after initial administrative diagnosis.

Methods.

A retrospective, longitudinal cohort analysis was conducted using German claims data. The InGef database contained approximately 5 million member-records from over 60 nationwide statutory health insurances (SHI). Individuals were indexed upon initial diagnosis of aADHD.

Results.

Average age at diagnosis of aADHD was 35 years, and 60% of individuals were male. Comorbidities, resource use, and healthcare costs were substantial before initial diagnosis and decreased within the 4 years thereafter. Only 32% of individuals received initial ADHD medication and adherence was low. The majority received psychotherapy. Individuals with initial ADHD medication showed the highest share in comorbidities, physician visits, medication use for comorbidities, psychotherapy, and costs. Overall, healthcare costs were at over €4,000 per individual within the year of aADHD diagnosis.

Conclusions.

We conclude that earlier recognition of aADHD could prevent the development and aggravation of comorbid mental illnesses. At the same time, comorbid conditions may have masked (“over-shadowed”) aADHD and delayed diagnosis. The burden of disease in aADHD is high, which was noticeable especially among individuals who received initial ADHD-medication, suggesting that psychopharmacological treatment was mainly considered for the most severely ill. We conclude that measures to facilitate access of aADHD patients to clinical experts are required to improve reality of care in the outpatient setting.

Alternative light therapy with luminescent textiles

Current research shows, that light directly influences the course of the inner biological rhythm. Light synchronizes the biological clock by controlling the concentration of various hormones in the human body. A well-known example is the discharge of melatonine due to increased blue spectral parts in daylight. Light affects the quality of sleep, general performance and even the phenomenon Season Affected Disorder (SAD).

Economic and clinical benefits of endometrial radiofrequency ablation compared with other ablation techniques in women with menorrhagia: a retrospective analysis with German health claims data

OBJECTIVE

To evaluate the economic and clinical benefits of endometrial radiofrequency ablation (RFA) compared with other ablation techniques for the treatment of menorrhagia.

METHODS

Using German health claims data, women meeting defined inclusion criteria for the intervention group (RFA) were selected. A comparable control group (other endometrial ablations) was established using propensity score matching. These two groups were compared during the quarter of treatment (QoT) and a follow-up of 2 years for the following outcomes: costs during QoT and during follow-up, repeated menorrhagia diagnoses during follow-up and necessary retreatments during follow-up.

RESULTS

After performing propensity score matching, 50 cases could be allocated to the intervention group, while 38 were identified as control cases. Patients in the RFA group had 5% fewer repeat menorrhagia diagnoses (40% vs 45%; not significant) and 5% fewer treatments associated with recurrent menorrhagia (6% vs 11%; not significant) than cases in the control group. During the QoT, the RFA group incurred €578 additional costs (€2,068 vs €1,490; ns). However, during follow-up, the control group incurred €1,254 additional costs (€4,561 vs €5,815; ns), with medication, outpatient physician consultations, and hospitals costs being the main cost drivers. However, none of the results were statistically significant.

CONCLUSION

Although RFA was more cost-intensive in the QoT compared with other endometrial ablation techniques, an average total savings of €676 was generated during the follow-up period. While having evidence that RFA is clinically equivalent to other endometrial ablation procedures, we generated indications that RFA is non-inferior and favorable with regard to economic outcomes.

[Disseminated extrapulmonary tuberculosis in idiopathic CD4-lymphocytopenia]

A previously healthy, now 42-year-old man suddenly fell ill with bouts of septic fever up to 39.5 degrees C, sweats and weight loss without any demonstrable organ involvement. Physical examination on hospitalization 3 weeks after onset of the illness was unremarkable. Blood sedimentation rate at one hour was 123 mm. There was also a moderate increase in gamma-GT and alkaline phosphatase. Routine bacteriological and serological tests failed to discover a causative microorganism. After imaging tests had provided first indication of splenic and hepatic involvement, biopsies of these two organs demonstrated disseminated epithelioid granulomas and Langhans giant cells. Staining and culturing of pelvic crest biopsy tissue showed evidence of Mycobacterium tuberculosis, but there was no evidence of pulmonary involvement. In addition to four-drug tuberculostatic treatment the patient was given glucocorticoids for several weeks to control the fever bouts. Persistent CD4+ T-lymphocytopenia was demonstrated as the cause of the entirely extrapulmonary tuberculosis in this HIV-negative patient. This is an only recently described and so far unexplained syndrome.

Study of the antiallergic component of inosine pranobex (Inosiplex, Isoprinosine)

Inosine pranobex (INPX) at concentrations greater than 10(-3) M inhibits significantly the concanavalin A or antihuman IgE induced histamine release from human mast cells. The inosine moiety of the compound does not contribute to this effect, but rather interferes with it. The other component, the salt of dimethylaminopropanol and acetamidobenzoic acid, produces a small but significant inhibition of the histamine release already at 10(-6) M. This effect is due to the acetamidobenzoic acid although the base (dimethylaminopropanol) adds to it. With increasing incubation time, the salt of dimethylaminopropanol and acetamidobenzoic acid looses its histamine release inhibiting effect.