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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: Mental health in the workplace is a growing concern for enterprises and policy makers. MENTUPP is a multi-level mental health intervention implemented in small and medium size enterprises from three work sectors in nine countries. This pilot study aimed to evaluate the feasibility, delivery, and instruments for the MENTUPP intervention to inform the planning of a clustered randomized controlled trial., Methods: We administered items from the Copenhagen Psychosocial Questionnaire and the Danish Work Environment Cohort Study measuring psychosocial workplace factors. The questionnaire was answered by 382 participants at baseline, of which 98 participants also answered after six months at follow-up. We calculated mean scores of 19 psychosocial factors at baseline and conducted repeated measures ANOVAs to assess differences in eight psychosocial factors at follow-up. We also examined whether outcomes differed between work sectors and job positions at follow-up., Results: The construction sector and workers with no or a lower leadership role reported more negative working environment factors at baseline. We observed a statistically significant decline in social support from colleagues and social community at work, and a marginally significant decline in justice at work. For the rest of the constructs, we did not observe statistically significant changes., Conclusions: We found significant differences in psychosocial work environment factors among work sectors and job positions at baseline. Contrary to our hypotheses, three psychosocial work environment factors decreased at follow-up. Possible explanations are the utilization of specific psychosocial factors as resources to cope with psychosocial stressors, high participant expectations that were not met by the intervention, insufficient time for structural changes, or the intervention prompting critical evaluations of the work environment. These findings will inform the design and implementation of the forthcoming clustered randomized controlled trial, where they will also be further investigated to validate their significance., (© 2024. The Author(s).)

Background: To date there is no causal treatment for post-COVID syndrome, leaving symptomatic treatments as the primary recourse. However, the practical implementation and effectiveness of these interventions remain underexplored. This study aimed to investigate the utilization frequency of symptomatic therapies and patient-reported effectiveness across various treatment modalities at a German post-COVID center., Methods: As the baseline investigation we conducted a single-cohort retrospective study to analyze the frequency of symptomatic therapies among post-COVID patients who attended the post-COVID center of the University Hospital of Erlangen, between December 2022 to July 2023. Additionally, we administered a follow-up at least 3 months after the initial presentation, using a questionnaire to assess patient-reported improvements in post-COVID symptoms associated with the symptomatic therapies received., Results: Our study included 200 patients (mean age: 44.6 ± 12.6 years; 69.0% women; mean duration since acute infection: 15.3 ± 8.3 months). Pharmacotherapy was the predominant symptomatic treatment (79.5%), with psychotropic drugs (32.5%) and analgesics (31.5%) being the most frequently prescribed. Over half of the patients (55.5%) utilized vitamins and nutritional supplements. Hospital admission rates to acute care occurred in 35.5% of cases; 33.0% underwent inpatient rehabilitation and 31.0% pursued outpatient psychotherapy. Cardiologists (76.5%), pulmonologists (67.5%), and neurologists (65.5%) were the most consulted specialists. Therapies involving medical devices were infrequently employed (12.0%). In a follow-up questionnaire (response rate: 82.5%, 6.3 ± 2.2 months post-baseline), beta-blockers were the most effective pharmacological intervention with 31.5% of patients reporting strong to very strong symptom improvement, followed by antibiotics (29.6%). Furthermore, 33.0% of the patients perceived plasmapheresis to strongly alleviate symptoms. Only a small proportion of the sample attributed a strong or very strong symptom improvement to outpatient psychotherapy (11.0%)., Conclusion: This study provides initial insights into symptomatic therapy utilization and patient-reported symptom improvement in post-COVID syndrome. Further research into symptoms clusters and interdisciplinary collaboration are warranted to comprehensively address the multifaceted physical and psychological symptomatology., Trial Registration: The study was registered at the German Clinical Trials Register (DRKS-ID: DRKS00033621) on March 20, 2024., (© 2024. The Author(s).)

Background and Objective: The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course., Methods: The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment., Results: In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre., Conclusions: Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.

Purpose: CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax., Materials and Methods: One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis., Results: The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate., Conclusion: Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort., (© 2024. The Author(s).)

Objective: To assess diagnostic capabilities of a modern handheld ultrasound device (HUD) for portal vein (PV) evaluation in pediatric patients and to verify if age, body mass index (BMI) and object depth correlate to imagequality., Methods: 45 patients (3.9 months- 17.9 years; 10.3 years±5.4) were examined using a HUD and cart-based high-end ultrasound system (HEUS). The intra-and extrahepatic PV was scanned using B-Mode and Color-coded Doppler sonography (CCDS). A five-point Likert scale was applied to evaluate image quality. Results were interpreted by two readers in consensus. Scores were compared between the scanners and correlated to age, BMI and skin-to-portal-vein-distance (SPVD). The influence on image quality and the difference between the two devices were analyzed using ordinal and Bayesian logistic regression models., Results: ≥4 points (mild or no limitations) were achieved by the HUD in 60% for B-Mode and 56% for CCDS. There was a statistically significant negative correlation between the image quality achieved by the HUD and the SPVD for B-Mode and CCDS. The effect of BMI and SPVD on having≥4 points differed significantly between the HUD and HEUS for B-Mode and for CCDS., Conclusions: Sufficient to excellent image quality for portal vein assessment in pediatric patients was achieved by the HUD except for the most deep-lying structures. Compared to HEUS, diagnostic performance of the HUD is lower, based on a negative correlation with object depth.

Background: Rapid evolution of ultrasound technology has allowed widespread use of handheld ultrasound devices (HHUDs) for many possible applications. Along with the adult population, the use of HHUDs for Point of Care Ultrasound (POCUS) in pediatric medicine has been increasing over the last few years. However, pediatric-specific literature is still scarce on mobile vascular ultrasound., Objective: To evaluate diagnostic capabilities of Vscan Air™ in comparison with high-end ultrasound for the assessment of the internal jugular vein in children and adolescents., Methods: 42 Internal Jugular Veins (IJVs) of 21 pediatric patients were scanned by an experienced examiner using a WLAN-supported handheld ultrasound device (Vscan Air™) and high-end cart-based ultrasound (LOGIQ E9) as reference. B-Mode and Color-coded Doppler (CCDS) were performed and compared. Image quality was assessed using a score of 0 to 5 and statistically analyzed. Results were interpreted independently by two readers in consensus., Results: 21 patients (2-17 years; mean 11,00±4,5 years; female n = 11, male n = 10) were examined. The rating score never dropped below 3 for both devices. The median score evaluation of B-Mode and CCDS for the high-end device was 5.00, of Vscan Air™ 5.00 for B-Mode and 4.00 for CCDS. A significant difference was shown between the two devices in the evaluation of CCDS., Conclusions: Vscan Air™ ultrasound device allows sufficient assessability of the IJV in pediatric patients, opening up new possibilities for fast and mobile POCUS of cervical veins and potential guidance of central venous catheter placement.

Aim: To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs)., Material and Methods: 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus., Results: 10 patients (4-17 years; 10.0±4.32 years; female n = 6, male n = 4) with 10 VMs (4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality., Conclusion: Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs.