Regional and temporal variations in coding of hospital diagnoses referring to upper gastrointestinal and oesophageal bleeding in Germany

<p>Abstract</p> <p>Background</p> <p>Health insurance claims data are increasingly used for health services research in Germany. Hospital diagnoses in these data are coded according to the International Classification of Diseases, German modification (ICD-10-GM). Due to the historical division into West and East Germany, different coding practices might persist in both former parts. Additionally, the introduction of Diagnosis Related Groups (DRGs) in Germany in 2003/2004 might have changed the coding. The aim of this study was to investigate regional and temporal variations in coding of hospitalisation diagnoses in Germany.</p> <p>Methods</p> <p>We analysed hospitalisation diagnoses for oesophageal bleeding (OB) and upper gastrointestinal bleeding (UGIB) from the official German Hospital Statistics provided by the Federal Statistical Office. Bleeding diagnoses were classified as "specific" (origin of bleeding provided) or "unspecific" (origin of bleeding not provided) coding. We studied regional (former East versus West Germany) differences in incidence of hospitalisations with specific or unspecific coding for OB and UGIB and temporal variations between 2000 and 2005. For each year, incidence ratios of hospitalisations for former East versus West Germany were estimated with log-linear regression models adjusting for age, gender and population density.</p> <p>Results</p> <p>Significant differences in specific and unspecific coding between East and West Germany and over time were found for both, OB and UGIB hospitalisation diagnoses, respectively. For example in 2002, incidence ratios of hospitalisations for East versus West Germany were 1.24 (95% CI 1.16-1.32) for specific and 0.67 (95% CI 0.60-0.74) for unspecific OB diagnoses and 1.43 (95% CI 1.36-1.51) for specific and 0.83 (95% CI 0.80-0.87) for unspecific UGIB. Regional differences nearly disappeared and time trends were less marked when using combined specific and unspecific diagnoses of OB or UGIB, respectively.</p> <p>Conclusions</p> <p>During the study period, there were substantial regional and temporal variations in the coding of OB and UGIB diagnoses in hospitalised patients. Possible explanations for the observed regional variations are different coding preferences, further influenced by changes in coding and reimbursement rules. Analysing groups of diagnoses including specific and unspecific codes reduces the influence of varying coding practices.</p

Herb-Induced Liver Injury in the Berlin Case-Control Surveillance Study

Herb-induced liver injury (HILI) has recently attracted attention due to increasing reports of hepatotoxicity associated with use of phytotherapeutics. Here, we present data on HILI from the Berlin Case-Control Surveillance Study. The study was initiated in 2000 to investigate the serious toxicity of drugs including herbal medicines. Potential cases of liver injury were ascertained in more than 180 Departments of all 51 Berlin hospitals from October 2002 to December 2011. Drug or herb intake was assessed through a standardized face- to-face interview. Drug or herbal aetiology was assessed based on the updated Council for International Organizations of Medical Sciences scale. In ten of all 198 cases of hepatotoxicity included in the study, herbal aetiology was assessed as probable (once ayurvedic herb) or possible (Valeriana five times, Mentha piperita once, Pelargonium sidoides once, Hypericum perforatum once, Eucalyptus globulus once). Mean age was 56.4 ± 9.7 years, and the predominant pattern of liver injury was hepatocellular. No cases of acute liver failure or death were observed. This case series corroborates known risks for ayurvedic herbs, supports the suspected association between Valeriana use and liver injury, and indicates a hepatotoxic potential for herbs such as Pelargonium sidoides, Hypericum perforatum or Mentha piperita that were rarely associated with liver injury before. However, given that possible causality does not prove clinical significance, further studies in this field are needed

Risk of acute myocardial infarction with NSAIDs in real world use : bayesian meta-analysis of individual patient data

OBJECTIVE To characterise the determinants, time course, and risks of acute myocardial infarction associated with use of oral non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN Systematic review followed by a one stage bayesian individual patient data meta-analysis. DATA SOURCES Studies from Canadian and European healthcare databases. REVIEW METHODS Eligible studies were sourced from computerised drug prescription or medical databases, conducted in the general or an elderly population, documented acute myocardial infarction as specific outcome, studied selective cyclo-oxygenase-2 inhibitors (including rofecoxib) and traditional NSAIDs, compared risk of acute myocardial infarction in NSAID users with non-users, allowed for time dependent analyses, and minimised effects of confounding and misclassification bias. EXPOSURE AND OUTCOMES Drug exposure was modelled as an indicator variable incorporating the specific NSAID, its recency, duration of use, and dose. The outcome measures were the summary adjusted odds ratios of first acute myocardial infarction after study entry for each category of NSAID use at index date (date of acute myocardial infarction for cases, matched date for controls) versus non-use in the preceding year and the posterior probability of acute myocardial infarction. RESULTS A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days the probability of increased myocardial infarction risk (posterior probability of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios (95% credible intervals) were 1.24 (0.91 to 1.82) for celecoxib, 1.48 (1.00 to 2.26) for ibuprofen, 1.50 (1.06 to 2.04) for diclofenac, 1.53 (1.07 to 2.33) for naproxen, and 1.58 (1.07 to 2.17) for rofecoxib. Greater risk of myocardial infarction was documented for higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations. CONCLUSIONS All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.Peer reviewe

Case-control study on analgesics and nephropathy (SAN): protocol

BACKGROUND: The association between intake of non-phenacetin-containing analgesics and the occurrence of chronic renal failure is still controversially discussed. A new epidemiologic study was planned and conducted in Germany and Austria. METHODS/DESIGN: The objective of the international, multicenter case-control study was to evaluate the association between end-stage renal disease (ESRD) and use of non-phenacetin-containing analgesics with particular emphasis on combined formulations. A targeted sample of 1000 new (incident) dialysis patients, aged less than 50 years, was planned to recruit between January 1, 2001 and December 31, 2004. The age limit was chosen to avoid contamination of the study population with phenacetin-containing analgesics to the extent possible. Four control subjects per ESRD case, matched by age, sex, and region were selected from the population living in the region the case came from. Lifetime exposure to analgesics and potential renal risk factors were recorded in a single face-to-face interview. A set of aids was introduced to reinforce the memory of study participants. A standardized, pre-tested interview questionnaire (participants), a medical documentation sheet (physicians in dialysis centres), a logbook for all activities (dialysis centres) were used to collect the necessary data. Quality management consisted of the standardized procedures, (re-) training and supervision of interviewers, regular checks of all incoming data for completeness and plausibility. The study is scientifically independent and governed by a international Scientific Advisory Committee that bridged the gap between the sponsoring companies and the investigators. Also other advisory groups assisted the managing committee of the study. All relevant German and Austrian nephrological associations supported the study, and the study design was carefully reviewed and approved by the Kidney Foundation of Germany. DISCUSSION: The study is expected to answer the main research question by end 2005. There is however a high potential for various biases that we tried to address with adequate measure. One limitation however cannot be overcome: The methodologically needed age-limitation of the study will make it not easy to generalize the results to age groups over 50 years. It might be suggested to repeat the study for persons over 50 years in 10 years when contamination with phenacetin use early in life is likely to be outgrown

Beschluss und Wissenschaftliche Begründung der Ständigen Impfkommission (STIKO) für die Aktualisierung der Influenza-Impfempfehlung für Personen im Alter von ≥ 60 Jahren

Die STIKO empfiehlt allen Personen im Alter von ≥60 Jahren im Herbst eine jährliche Impfung gegen die saisonale Influenza mit einem inaktivierten, quadrivalenten Influenza-Hochdosis-Impfstoff mit aktueller von der WHO empfohlener Antigenkombination. Solange Hochdosis-Impfstoffe für die Altersgruppe 60-64 Jahre nicht zugelassen sind, werden für die Influenza-Impfung von Personen in diesem Alter weiterhin inaktivierte, quadrivalente Influenza-Impfstoffe (unabhängig vom Impfstofftyp) empfohlen. Eine Empfehlung für die Anwendung eines Influenza-Hochdosis-Impfstoffs ist in gleichem Maße bei der Impfempfehlung für Reisende zu berücksichtigen. Die Veröffentlichung dieser Empfehlung zu diesem Zeitpunkt, ohne Berücksichtigung der aktuellen Verfügbarkeit von Influenza-Hochdosis-Impfstoffen, soll gewährleisten, dass der entsprechende Impfstoffbedarf bei der Planung, Produktion und Beschaffung von Influenza-Impfstoffen ab der Saison 2021/2022 berücksichtigt werden kann

Incidence of anogenital warts in Germany: a population-based cohort study

<p>Abstract</p> <p>Background</p> <p>Human papilloma virus (HPV) types 6 and 11 account for 90 percent of anogenital warts (AGW). Assessment of a potential reduction of the incidence of AGW following introduction of HPV vaccines requires population-based incidence rates. The aim of this study was to estimate incidence rates of AGW in Germany, stratified by age, sex, and region. Additionally, the medical practitioner (gynaecologist, dermatologist, urologist etc.) who made the initial diagnosis of AGW was assessed.</p> <p>Methods</p> <p>Retrospective cohort study in a population aged 10 to 79 years in a population-based healthcare insurance database. The database included more than 14 million insurance members from all over Germany during the years 2004-2006. A case of AGW was considered incident if a disease-free period of twelve months preceded the diagnosis. To assess regional variation, analyses were performed by federal state.</p> <p>Results</p> <p>The estimated incidence rate was 169.5/100,000 person-years for the German population aged 10 to 79 years. Most cases occurred in the 15 to 40 years age group. The incidence rate was higher and showed a peak at younger ages in females than in males. The highest incidence rates for both sexes were observed in the city-states Berlin, Hamburg and Bremen. In females, initial diagnosis of AGW was most frequently made by a gynaecologist (71.7%), whereas in males, AGW were most frequently diagnosed by a dermatologist (44.8%) or urologist (25.1%).</p> <p>Conclusions</p> <p>Incidence of AGW in Germany is comparable with findings for other countries. As expected, most cases occurred in the younger age groups. The frequency of diagnoses of AGW differs between sexes and women and men receive treatment by doctors of different specialties.</p

Wissenschaftliche Begründung der STIKO für die Empfehlung zur Impfung gegen Affenpocken mit Imvanex (MVA-Impfstoff)

In Deutschland sind im Mai 2022 erstmals Fälle von Affenpocken aufgetreten. Weitere Fälle sind in verschiedenen anderen europäischen Ländern, in Kanada, den USA und Australien registriert worden. Die Betroffenen waren nicht in afrikanische Länder gereist, wo das Virus in nicht-humanen Primaten und Nagetieren endemisch zirkuliert und auf den Menschen übergehen kann. Die gegenwärtigen Übertragungen außerhalb Afrikas erfolgten offenbar meist durch engen körperlichen (sexuellen) Kontakt. In Deutschland und der EU ist bisher kein Impfstoff zum Schutz vor Affenpocken zugelassen. Jedoch ist in Europa ein Pockenimpfstoff der dritten Generation (Imvanex) zum Schutz vor Pocken (Variola maior) von der Europäischen Arzneimittel-Agentur autorisiert. Die Erreger der Affenpocken sind mit denen der Pocken eng verwandt und es wurden weltweit verschiedene Untersuchungen durchgeführt, um eine Kreuzprotektion nachzuweisen und zu belegen, dass eine Impfung gegen Pocken auch vor Affenpocken schützt. Die STIKO hat nach Prüfung der verfügbaren wissenschaftlichen Daten entschieden, eine Impfempfehlung für die postexpositionelle Prophylaxe nach Affenpockenexposition und für diePeer Reviewe

Wissenschaftliche Begründung der STIKO zur Empfehlung, im Alter unter 30 Jahren ausschließlich Comirnaty zur COVID-19-Grundimmunisierung und -Auffrischimpfung zu verwenden

Seit dem Frühjahr 2021 ist bekannt, dass im Zusammenhang mit der Anwendung der mRNA-Impfstoffe Comirnaty und Spikevax insbesondere bei Jungen und jungen Männern Myo- und/oder Perikarditiden auftreten können. Aufgrund dieser Berichte hat die STIKO ihre Empfehlung zur COVID-19-Impfung mit Spikevax und Comirnaty überprüft und auf der Basis aktueller Daten die im Epidemiologischen Bulletin 46/2021 veröffentlichte erneute Risiko-Nutzen-Analyse durchgeführt

Wissenschaftliche Begründung zur COVID-19-Impfempfehlung der STIKO für Personen mit durchgemachter SARS-CoV-2-Infektion und bisher unvollständiger Immunität

Die STIKO geht davon aus, dass erst eine mehrmalige Auseinandersetzung mit dem SARS-CoV-2-Spikeprotein einen soliden Schutz vor einer SARS-CoV-2-Infektion und einer schweren COVID-19-Erkrankung bietet. Dies kann durch eine 3-malige Impfung oder durch eine Kombination von natürlicher Infektion und Impfung (hybride Immunität) erreicht werden. Daher sollen auch Personen mit zurückliegenden SARS-CoV-2-Infektionen geimpft werden. Zwischen den jeweiligen Ereignissen muss jedoch ein zeitlicher Mindestabstand bestehen. Der Beitrag gibt eine Übersicht über die Impfempfehlungen bei unterschiedlichen Impfanamnesen und nach durchgemachten SARS-CoV-2-Infektionen.Peer Reviewe