Deutsches Arzteblatt international最新文献

{"title":"Fewer Premature Births After Assisted Reproduction.","authors":"Heribert Kentenich","doi":"10.3238/arztebl.m2026.0063","DOIUrl":"10.3238/arztebl.m2026.0063","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 10","pages":"261-262"},"PeriodicalIF":8.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Mellitus and Osteoporosis After Organ Transplantation: Frequency, Clinical Features, and Treatment.","authors":"Theresia Sarabhai, Annie Mathew, Jassin Rashidi-Alavijeh, Katharina Willuweit, Anja Gallinat, Dagmar Führer","doi":"10.3238/arztebl.m2026.0019","DOIUrl":"10.3238/arztebl.m2026.0019","url":null,"abstract":"<p><strong>Background: </strong>Organ transplantation is an effective treatment option, often the last remaining one, for terminal organ failure. 22-32% of transplant recipients, however, develop metabolic-endocrine complications that markedly impair transplant function and overall survival. We provide an evidence-based narrative review of the clinical features, diagnostic evaluation, and treatment of post-transplantation diabetes mellitus (PTDM) and osteoporosis.</p><p><strong>Methods: </strong>This review is based on pertinent publications that were retrieved by a selective search in PubMed, MEDLINE, and the Cochrane Library (01/1995-09/2025), including systematic reviews, clinical studies, randomized controlled trials, register data analyses, observational studies, and guidelines.</p><p><strong>Results: </strong>Post-transplantation diabetes affects 9-40% of organ recipients in the first year after transplantation, corresponding to a two- to threefold risk elevation compared to the general population. Its incidence and course are organ-specific and characterized by further risk factors, including a 3.3-fold elevation of the risk of cardiovascular events. Studies have shown that, alongside insulin and metformin, newer antidiabetic agents such as GLP-1 receptor agonists and SGLT2 inhibitors also improve glycemic control, reduce cardiovascular events, and, as far as can be determined, do not endanger the transplant. Transplantation-associated osteoporosis affects 23-67% of transplant recipients, causing the most marked bone loss in the first 6-18 months after transplantation. Approximately 20% of the affected patients sustain fractures. Bisphosphonate, denosumab, and teriparatide have been found to be treatment options. Treatment should be initiated as early as possible.</p><p><strong>Conclusion: </strong>Thorough screening and timely, specialist-coordinated interdisciplinary care in specialized transplantation centers are decisive for the recognition and risk-adapted, evidence-based treatment of PTDM and transplantation-associated osteoporosis.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"281-288"},"PeriodicalIF":8.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADHD in Children, Adolescents, and Adults: Incidence, Prevalence, and Treatment. An Analysis of Routine Health Insurance Data.","authors":"Felix Betzler, Jana Knop, Martina Grönig, Patrick Timpel, Vukašin Višković, Daniel Schöttle","doi":"10.3238/arztebl.m2026.0032","DOIUrl":"10.3238/arztebl.m2026.0032","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in children and adolescents, with symptoms often persisting into adulthood. We studied epidemiology and health care provision for ADHD in Germany by analyzing recent billing data.</p><p><strong>Methods: </strong>Anonymized billing data from 2017 to 2023 were examined. Patients with ≥ 2 outpatient or one inpatient ADHD diagnosis were included. Application of the inclusion and exclusion criteria yielded 78 919 ADHD cases for analysis.</p><p><strong>Results: </strong>The administrative prevalence of ADHD in 2023 was 3.6% in children/adolescents and 0.6% in adults. In 2023, 40.9% of children and adolescents with ADHD received no treatment, 47.8% were treated with drugs alone, 4.2% were treated with psychotherapy alone, and 7.1% received multimodal therapy. 44.4% of adults with ADHD received no treatment, 38% were treated with drugs alone, 7.6% were treated with psychotherapy alone, and 10% received multimodal therapy. Over the period of observation, the prevalence of ADHD and the frequency of drug treatment, psychotherapy, and multimodal therapy rose slightly.</p><p><strong>Conclusion: </strong>This secondary data analysis characterizes the care of ADHD in Germany. In 2023, the administrative prevalence was much lower in adults than in children and adolescents. Over the period of observation, there was a continuous rise in the provision of psychotherapeutic services-especially behavioral therapy-while the percentage of patients treated with neither drugs nor psychotherapy fell; yet overall rates of treatment are still low, particularly for psychotherapy.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 10","pages":"275-280"},"PeriodicalIF":8.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Quality of Outpatient Health Care: An Evaluation of Common Mental and Physical Conditions in Childhood and Adolescence (the QualiPäd Study).","authors":"Christian J Bachmann, Claudia Mehl, Teresa Müller, Peter Hibbert, Monika Heinzel-Gutenbrunner, Fakhrah M Iqbal, Max Geraedts","doi":"10.3238/arztebl.m2026.0031","DOIUrl":"10.3238/arztebl.m2026.0031","url":null,"abstract":"<p><strong>Background: </strong>Most medical care for the approximately 14 million children and adolescents in Germany is provided on an outpatient basis, but data on the quality of care is lacking. We studied the quality of outpatient care for children and adolescents with common mental or physical conditions.</p><p><strong>Methods: </strong>In pediatric, general medical, and child/adolescent psychiatric practices in the German federal state of Hesse, patient records of children and adolescents diagnosed with attention deficit/hyperactivity disorder, depression, conduct disorder, asthma, atopic dermatitis, otitis media, or tonsillitis were randomly selected, and data were extracted for the calculation of quality indicators. The quality indicators had been generated before the start of the study with a modified RAND/UCLA method. The extracted data were used to determine the extent to which the quality indicators were fulfilled. Potential influencing factors were examined as well. Study registration: DRKS00022408.</p><p><strong>Results: </strong>In the overall sample (1156 patients; 55.2% male, average age 8.9 years, 20 513 diagnostic/therapeutic episodes evaluated), 45.5% of quality indicators were met (mental disorders: 38.7%, physical diseases: 50.9%). The highest degree of adherence was found for tonsillitis (78.8%) and conduct disorders (72.5%), and the lowest for depressive disorders (21.2%) and asthma (34.0%). No consistent picture emerged with regard to the influencing factors examined.</p><p><strong>Conclusion: </strong>The quality of outpatient care for children and adolescents in Germany is-with limited comparability, because of methodological and health system factors-comparable to that in the USA and lower than that in Australia. Potential for improvement was identified for some disorders. The assessment of quality of care proved to be feasible; in future, this could be done routinely on the basis of electronic secondary data.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 10","pages":"270-274"},"PeriodicalIF":8.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single or Double Embryo Transfer for Infertility: An Evaluation of Registry Data From Over 22 000 Treatment Cycles.","authors":"Jan-Steffen Krüssel, Markus Kimmel, Ute Czeromin, Verona Blumenauer, Sylvia Bartnitzky, Nicole Sänger, Daniel Fehr, Christoph Grewe, Markus Simon Kupka, Sascha Tauchert, Holger Aust, Andreas Tandler-Schneider","doi":"10.3238/arztebl.m2026.0025","DOIUrl":"10.3238/arztebl.m2026.0025","url":null,"abstract":"<p><strong>Background: </strong>Single embryo transfer (SET) is considered the most effective method for reducing multiple pregnancies in assisted reproduction. Nevertheless, couples in Germany often opt for double embryo transfer (DET) in the hope of achieving a higher success rate. The aim of this study was to evaluate the effectiveness of two consecutive SETs compared to one DET.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of data from 133 German fertility clinics. Treatment cycles between January 2017 and December 2022 were analyzed. The parameters examined were the clinical pregnancy rate (CPR) and the live birth rate (LBR), the type of birth (single or multiple), the number of children born, the percentage of premature births, and birth weight.</p><p><strong>Results: </strong>The rates of clinical pregnancy and live birth after fresh transfer were higher after DET than after SET (49.2% vs. 45.1% and 38.4% vs. 35.2%, respectively), but more women achieved a live birth with two SETs than with one DET (5111 of 11 205 [45.6%] vs. 4304 of 11 205 [38.4%] after DET). The number of children born per 1000 women was higher after DET (503) than after two cycles of SET (464), but DET resulted in significantly more multiple births (30.3% vs. 1.7%), fewer singleton births (26.8% vs. 37.4%), more premature births (46.5% vs. 18.1%), lower birth weight (2924.8 ± 756.8 g vs. 3264.4 ± 487.0), and significantly more very premature births.</p><p><strong>Conclusion: </strong>Two consecutive SETs lower the risks associated with DET with a comparable success rate in terms of the number of babies born.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 10","pages":"263-269"},"PeriodicalIF":8.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13291626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Popliteal Artery Entrapment Syndrome.","authors":"Simon Häfner, Jens Putzbach, Daniel Halt","doi":"10.3238/arztebl.m2025.0212","DOIUrl":"10.3238/arztebl.m2025.0212","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 9","pages":"252"},"PeriodicalIF":8.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin Prescribing in Accordance With the Guidelines for Type II Diabetes: An Analysis of Billing Data of a German Statutory Health Insurance Carrier, the Allgemeine Ortskrankenkasse (AOK) Hessen.","authors":"Bernardo Mertes, Nadine Zeise, Sybille Gödde, Guido Kramer, Christof Kloos, Andreas Klinge, Til Uebel","doi":"10.3238/arztebl.m2026.0009","DOIUrl":"10.3238/arztebl.m2026.0009","url":null,"abstract":"<p><strong>Background: </strong>From 2014 onward, the German National Disease Management Guideline (NDMG) for Type II diabetes has recommended a stepwise escalation of insulin therapy, starting with less complex forms of treatment. Hardly any data have been available to date on which insulin therapies were actually prescribed and billed.</p><p><strong>Methods: </strong>All insulin prescriptions covered by the AOK Hessen in the first two quarters of 2022 that were documented in the database system of the AOK's Scientific Institute were analyzed in this study. A newly developed classification was used to categorize types of insulin therapy.</p><p><strong>Results: </strong>37 498 insulin prescriptions were identified for 185 069 insurees (20,3 %). Long-acting insulin analogs were prescribed in 25 712 cases (68.6%), most commonly either intensified conventional insulin therapy (37.8%) or basally supported oral therapy (30.8%). Classic forms of treatment, such as supplementary insulin therapy (13.1%), conventional insulin therapy (8.3%), or intermediate-acting insulin at night (2.1%), were less frequently prescribed.</p><p><strong>Conclusion: </strong>The NDMG of 2014 and further guidelines that were issued after the end of the period analyzed in this study recommend that insulin therapy should begin with intermediate-acting insulin and/or basally supported oral antidiabetic therapy. The documented prescribing behavior deviates from the guidelines in question and from the guideline issued by the German Federal Joint Committee (G-BA) in 2024. In all but one of the guidelines, intensified conventional insulin therapy is recommended restrictively or only in case of demonstrated absolute insulin deficiency. The analyzed data do not permit any conclusion as to whether insulin was prescribed for proper indications. The care situation indicates that prescribing behavior is partly not in conformity with the guidelines. The analysis had only limited ability to account for complex treatment regimens. There is a need for further research on regional care structures and guideline implementation.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"235-239"},"PeriodicalIF":8.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Artery Pseudoaneurysm Due to Stent Fracture in PAOD.","authors":"Marcus Brugger, Christian Bradaric, Tareq Ibrahim","doi":"10.3238/arztebl.m2026.0021","DOIUrl":"10.3238/arztebl.m2026.0021","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 9","pages":"252"},"PeriodicalIF":8.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measures Following Abnormal Non-Invasive Prenatal Testing (NIPT) for Trisomies 13, 18, and 21: A Retrospective Cohort Study Using Billing Data of the Barmer Health Insurance Company.","authors":"Dagmar Hertle, Danny Wende, Ekkehard Schleußner","doi":"10.3238/arztebl.m2026.0036","DOIUrl":"10.3238/arztebl.m2026.0036","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 9","pages":"248-249"},"PeriodicalIF":8.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shorter Versus Longer Antibiotic Treatment in Children With Community-Acquired Pneumonia: A Systematic Review With Meta-Analyses.","authors":"Alexander Benkendorff, Sibylle Puntscher, Magdalena Flatscher-Thöni, Nikolai Mühlberger, Anne Göhner, Susanne Beck, Anneke Clara Bergt, Laura Krabbe, Thomas L Heise, Lea Gorenflo, Siegbert Rieg, Markus Hufnagel, Claudia Breuer, Angela M Kunzler, Uwe Siebert, Jörg J Meerpohl, Christine Schmucker","doi":"10.3238/arztebl.m2025.0238","DOIUrl":"10.3238/arztebl.m2025.0238","url":null,"abstract":"<p><strong>Background: </strong>Excessive antibiotic use promotes resistance and side effects and increases healthcare costs. Antibiotics are often prescribed to treat community-acquired pneumonia (CAP). The optimal duration of treatment is debated. In this study, we compare the efficacy of shorter and longer antibiotic treatment for CAP in the outpatient setting and evaluate the pertinent economic, environmental, ethical, and societal issues.</p><p><strong>Methods: </strong>Relevant articles published up until 5 February 2024 were identified by searches in the electronic databases MEDLINE, Embase, and CENTRAL as well as in trial registries and in reference lists of systematic reviews, including health technology assessment (HTA) reports. All randomized controlled trials (RCTs) comparing short- and long-term antibiotic treatment in children with outpatient CAP were included in the benefit assessment. A 10% difference was set as the non-inferiority margin.</p><p><strong>Results: </strong>Seven RCTs that studied a total of 8590 children were included. In young children with clinically diagnosed CAP, a three-day course of amoxicillin was non-inferior to 5-, 7-, or 10-day courses with respect to treatment success (relative risk [RR] 0.99; 95% confidence interval [0.96; 1.02]). Shorter treatment was associated with fewer (non-severe) adverse events (0.87, [0.78; 0.96]). Relapses and deaths were rare overall. Where shorter treatment was equally effective, it also had economic and ecological benefits.</p><p><strong>Conclusion: </strong>Three days of antibiotic treatment with amoxicillin may be just as effective as longer treatment, and also better tolerated, in younger children with clinically diagnosed, outpatient, non-severe CAP, and would conserve resources. These findings can be taken into account in the formulation of guideline recommendations.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"240-247"},"PeriodicalIF":8.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}