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Background Chronic kidney disease (CKD) is common in aging men and women. In contrast to other European countries, Germany lacks CKD registries. The aim of this study was to determine the incidence of CKD stages 2–5 in men and women in Germany. Furthermore, differences between the sexes in terms of comorbidities, potentially inappropriate medications (PIM), and healthcare utilization were examined. Methods In this retrospective observational study, claims data from members of a statutory health insurance fund aged 18 years or older with incident CKD between 2011 and 2018 were analyzed. Incident CKD was defined as having two confirmed diagnoses of CKD stages 2–5 from outpatient care or one primary or secondary diagnosis from inpatient care. Results The age- and sex-standardized incidence of all CKD stages was 945/100 000 persons between 2011 and 2018. Incident CKD, especially stages 3 and 4, occurred more frequently in women, while the incidence of stages 2 and 5 was higher in men. While women visited their GP more frequently and were prescribed PIMs more often, men were more likely to visit a nephrologist and were more often hospitalized after the incident CKD diagnosis. Conclusion More awareness needs to be raised towards the early detection of CKD and the use of PIMs, especially in women. Improved care coordination is needed to avoid an overprovision of patients with uncomplicated incident stages and ensure that patients with advanced CKD stages get timely access to specialist care.

Purpose Preeclampsia occurs in up to 15% of pregnancies and constitutes a major risk factor for cardiovascular disease. This observational cohort study aimed to examine the association between preeclamptic pregnancies and cardiovascular outcomes as well as primary and specialized care utilization after delivery. Methods Using statutory claims data we identified women with singleton live births between 2010 and 2017. Main outcomes included the occurrence of either hypertension or cardiovascular disease after one or more preeclamptic pregnancies, number of contacts to a general practitioner or cardiologist after delivery and prescribed antihypertensive medication. Data were analyzed using Cox proportional hazard regression models adjusted for maternal age, diabetes, dyslipidemia, and obesity. Results The study cohort consisted of 181,574 women with 240,698 births. Women who experienced preeclampsia once had an increased risk for cardiovascular (hazard ratio, HR = 1.29) or hypertensive (HR = 4.13) events. In women affected by recurrent preeclampsia, risks were even higher to develop cardiovascular disease (HR = 1.53) or hypertension (HR = 6.01). In the following years after delivery, general practitioners were seen frequently, whereas cardiologists were consulted rarely (0.3 and 2.4%). Conclusion Women affected by preeclampsia experience an increased risk of developing chronic hypertension and cardiovascular disease, especially those with recurrent preeclampsia. Future medical guidelines should take this potential risk into account.

Zusammenfassung Ziel der Studie Videokonsultationen haben sich international im Strafvollzug bewährt und wurden 2018 im Rahmen eines Modellprojekts erstmals in 5 Justizvollzugsanstalten (JVA) in Baden-Württemberg angeboten. Ziel der Evaluation war es, die Akzeptanz der Videokonsultationen bei Patient/-innen zu erfassen. Methodik Die gemischt-methodische Evaluation beinhaltete Begehungen der JVA, Interviews, Fragebögen und eine Behandlungsdatenanalyse. Ergebnisse Von Juni bis Dezember 2018 fanden 305 Videokonsultationen statt. Zu den häufigsten Beratungsanlässen zählten Gefühle der Angst/Unruhe, Schlafstörungen, Kopfschmerzen und Drogenabusus. Die Einbindung des Personals vor Ort und die Schulung der beteiligten Ärzt/-innen waren wichtige Faktoren für eine vertrauensvolle Kommunikation. Schlussfolgerung Die Videokonsultationen wurden als Ergänzung zur bestehenden Versorgung gut akzeptiert. Die begrenzte Eignung in Notfallsituationen und die eingeschränkte körperliche Untersuchung stellten Limitationen dar.

Objective:The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.Design:Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.Setting:Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).Participants:CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.Results:Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.Conclusions:The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.

Video consultations have proven themselves in international penal systems. Amidst a lack of medical staff, video consultations were offered in five correctional facilities in Baden-Württemberg in 2018 as part of a pilot project. This evaluation study aimed at assessing the acceptance of video consultations among patients.The mixed-methods evaluation consisted of site visits, interviews, questionnaires and an analysis of medical treatment data.A total of 305 video consultations were conducted between June and December 2018. Among the most frequent reasons for encounter were feeling anxious/nervous/tense, sleep disturbance, headache and drug abuse. Including familiar medical staff and offering training for the involved physicians were important factors that enabled a trusting communication.Video consultations were seen as a useful addition to existing health care. However, they were considered less suitable for both emergencies and physical examinations.Videokonsultationen haben sich international im Strafvollzug bewährt und wurden 2018 im Rahmen eines Modellprojekts erstmals in 5 Justizvollzugsanstalten (JVA) in Baden-Württemberg angeboten. Ziel der Evaluation war es, die Akzeptanz der Videokonsultationen bei Patient/-innen zu erfassen.Die gemischt-methodische Evaluation beinhaltete Begehungen der JVA, Interviews, Fragebögen und eine Behandlungsdatenanalyse.Von Juni bis Dezember 2018 fanden 305 Videokonsultationen statt. Zu den häufigsten Beratungsanlässen zählten Gefühle der Angst/Unruhe, Schlafstörungen, Kopfschmerzen und Drogenabusus. Die Einbindung des Personals vor Ort und die Schulung der beteiligten Ärzt/-innen waren wichtige Faktoren für eine vertrauensvolle Kommunikation.Die Videokonsultationen wurden als Ergänzung zur bestehenden Versorgung gut akzeptiert. Die begrenzte Eignung in Notfallsituationen und die eingeschränkte körperliche Untersuchung stellten Limitationen dar.

Background: Having recovered from the Coronavirus Disease of 2019 (COVID-19), a considerable number of patients is still experiencing long-term sequelae, referred to as Post-COVID-19. Prevalence and clinical characteristics differ widely in studies reported so far, depending on the respective study design. The present study contributes to the understanding of Post-COVID-19 by investigating prevalence, clinical characteristics and possible risk factors in a population-based cohort. Methods: We designed a total population sampling in three German counties by inviting all patients ≥18 years of age with confirmed COVID-19 between 03/2020 and 09/2020 (n= 4,632). Participants completed a self-developed questionnaire on COVID-19 related symptoms, including validated instruments for the assessment of comorbidity and health-related quality of life (HrQoL). Potential predictors for Post-COVID-19 were identified by multiple ordinal regression analysis. Findings: The response rate was 41%, and a total of 1,732 patients were included in the study, with 198 (11%) hospitalized for acute COVID-19. The prevalence for symptoms persisting ≥12 weeks was 66.7% (n=128) and 39.4% (n=598), for hospitalized and non-hospitalized patients, respectively. The most frequent long-term symptoms were fatigue (40.6%), physical exhaustion (40.5%) and difficulty concentrating (30%). HrQoL was significantly poorer in patients with persisting symptoms. The strongest risk factors for Post-COVID-19 were female sex, level of comorbidity and severity of acute COVID-19. Interpretation: This population-based survey indicates that long-term symptoms are a frequent burden following COVID-19 which will pose major challenges to health care systems. Research into effective therapies and health care structures is urgently needed. Trial Registration: This study was registered in the German Clinical Trials Register (reference DRKS00023069). Funding: Special grant COVID-19 - Ministry of Science, Research and Art of Baden-Wuerttemberg. Declaration of Interest: All authors declare no conflicts of interest. Ethical Approval: The study was approved by the ethics committee of the university hospital Tuebingen (reference 698/2020BO)

Background Challenging clinical practice guidelines that recommend serum potassium concentration between 4.0–5.0 mEq/L or ≥4.5 mEq/L in patients with acute myocardial infarction, recent studies found increased mortality risks in patients with a serum potassium concentration of ≥4.5 mEq/L. Studies investigating consequences of hypokalemia after acute myocardial infarction revealed conflicting results. Therefore, the aim of this systematic review and meta-analysis was to combine evidence from previous studies on the association of serum potassium concentration with both short and long-term mortality as well as the occurrence of ventricular arrhythmias. Design Systematic review and meta-analysis. Methods A structured search of MEDLINE and EMBASE databases yielded 23 articles published between 1990 and January 2017 that met the inclusion criteria. Study selection, data extraction and quality assessment were carried out by three reviewers. Random effects models were used to pool estimates across the included studies and sensitivity analyses were performed when possible. Results Twelve studies were included in the meta-analysis. Both pooled results from six studies investigating short-term mortality and from five studies examining long-term mortality revealed significantly increased risks in patients with serum potassium concentrations of Conclusions Mortality, both short and long term, and the occurrence of ventricular arrhythmias in patients with acute myocardial infarction seem to be negatively associated with hypokalemic serum potassium concentration. There is evidence for adverse consequences of serum potassium concentrations of ≥4.5 mEq/L. Due to the heterogeneity among existing studies, further research is necessary to confirm the need to change clinical practice guidelines.

BACKGROUND: Conflicting with clinical practice guidelines, recent studies demonstrated that serum potassium concentrations (SPC) of ≥4.5mEq/l were associated with increased mortality in patients with acute myocardial infarction (AMI). This study examined the association between SPC and long-term mortality following AMI in patients recruited from a population-based registry. METHODS: Included in the study were 3347 patients with AMI aged 28-74years consecutively hospitalized between 1 January 2000 and 31 December 2008 and followed up until 31 December 2011. Patients were categorized into five SPC groups (

Background Paradoxically, beneficial effects of overweight and obesity on survival have been found in patients after cardiovascular events such as acute myocardial infarction (AMI). This obesity paradox has not been analyzed in AMI patients with diabetes even though their cardiovascular morbidity and mortality is increased compared to their counterparts without diabetes. Therefore, the objective of this long-term study was to analyze the association between body mass index (BMI) and all-cause mortality in AMI patients with and without diabetes mellitus. Methods Included in the study were 1190 patients with and 2864 patients without diabetes, aged 28-74 years, recruited from a German population-based AMI registry. Patients were consecutively hospitalized between 1 January 2000 and 31 December 2008 with a first ever AMI and followed up until December 2011. Data collection comprised standardized interviews and chart reviews. To assess the association between BMI and long-term mortality from all causes, Cox proportional hazards models were calculated adjusted for risk factors, co-morbidities, clinical characteristics, in-hospital complications as well as medical and drug treatment. Results AMI patients of normal weight (BMI 18.5-24.9 kg/m2) had the highest long-term mortality rate both in patients with and without diabetes with 50 deaths per 1000 person years and 26 deaths per 1000 person years, respectively. After adjusting for a selection of covariates, a significant, protective effect of overweight and obesity on all-cause mortality was found in AMI patients without diabetes (overweight: hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.58-0.93; p=0.009; obesity: HR 0.64, 95% CI 0.47-0.87; p=0.004). In contrast, an obesity paradox was not found in AMI patients with diabetes. However, stratified analyses showed survival benefits in overweight AMI patients with diabetes who had been prescribed statins prior to AMI (HR 0.51, 95% CI 0.29-0.89, p=0.018) or four evidence-based medications at hospital-discharge (HR 0.52, 95% CI 0.34-0.80, p=0.003). Conclusion In contrast to AMI patients without diabetes, AMI patients with diabetes do not experience a survival benefit from an elevated BMI. To investigate the underlying reasons for these findings, further studies stratifying their samples by diabetes status are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0189-0) contains supplementary material, which is available to authorized users.