Deutsches Arzteblatt international最新文献

{"title":"Undiagnosed Thoracic Aortic Aneurysms: Prevalence, Risk Factors, Screening Modalities.","authors":"Sven Peterss, Michael Czihal, Evaldas Girdauskas, Thorsten Klink, Mario Lescan, Jost Steinhäuser","doi":"10.3238/arztebl.m2026.0095","DOIUrl":"10.3238/arztebl.m2026.0095","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of thoracic aortic aneurysms (TAA) varies from 0.01 to 10 per 100 000 people depending on the healthcare sector. Undiagnosed TAA can cause highly lethal complications, such as acute aortic dissection. In this article, we discuss the opportunities for stratified early detection.</p><p><strong>Methods: </strong>To assess the benefits and risks of screening in high-risk groups and in the population at large, the prevalence of TAA, as well as the sensitivity, radiation exposure, and burden of various diagnostic techniques, were determined or estimated on the basis of a selective literature review, and the identified correlations were discussed with experts and compared with the current guidelines. The prevalence and risk of TAA in patients with certain concurrent diseases were calculated from data on 394 113 adults (2000–2023) from the SHRN primary care database.</p><p><strong>Results: </strong>Suitable screening methods include computed tomography, magnetic resonance imaging, and, to a limited extent, transthoracic echocardiography. The use of these techniques and the choice among them must be considered individually for each patient. Population-wide screening is not recommended according to current data. Diagnostic testing may be reasonable for persons at elevated risk of TAA (high pretest probability), e.g., those with a family history of TAA or aortic dissection and those with a genetic predisposition, or persons with a bicuspid aortic valve (adjusted odds ratios 43.95 [9.84. 196.5] to 91.8 [18.7; 450.0], depending on age and sex), an abdominal aortic aneurysm (OR 25.6 [13.9; 47.2] to 31.1 [15.9; 60.7]), or giant cell arteritis (OR 4.99 [0.52; 47.5] to 25.3 [3.10; 206.3]).</p><p><strong>Conclusion: </strong>Early detection measures are reasonable for specific patient groups; current treatment guidelines reflect this only to a limited extent. In the future, the sensitivity and specificity of the diagnostic tests used should be estimated more precisely in studies conducted for this purpose, and TAA should be documented as a cause of death in Germany, as in other countries.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"505-511"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210522","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":"Polypharmacy Among 200 000 Subjects of the Population-Based German National Cohort Study (NAKO), Aged 19-74: A Baseline Analysis.","authors":"Jonas Peltner, Miriam Degen, Tom Berger, Nina Ebert, Beate Fischer, Kathrin Guenther, Manuela Harries, Volker Harth, Ulrike Haug, Margit Heier, André Karch, Verena Katzke, Thomas Keil, Jasmin Kiekert, Lilian Krist, Berit Lange, Michael Leitzmann, Jakob Linseisen, Claudia Meinke-Franze, Rafael Mikolajczyk, Ilais Moreno Velásquez, Nadia Obi, Phil Pendt, Anette Peters, Tobias Pischon, Thomas Reinhold, Oliver Riedel, Börge Schmidt, Ben Schöttker, Stefan Willich, Kerstin Wirkner, Matthias Wuttke, Britta Haenisch","doi":"10.3238/arztebl.m2026.0096","DOIUrl":"10.3238/arztebl.m2026.0096","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is associated with adverse events, reduced quality of life, and increased mortality, but populationbased studies including both prescribed and over-the-counter medications are scarce.</p><p><strong>Methods: </strong>We analyzed baseline data from the German National Cohort (NAKO), Germany’s largest population-based cohort study (recruitment 2014–2019; participants aged 19–74 years at baseline). We estimated the proportion of participants with polypharmacy (defined as reporting regular use of ≥ 5 prescribed and over-the-counter medications) and hyperpolypharmacy (≥ 10 medications), stratified by sex and age. Determinants of polypharmacy were estimated using logistic regression.</p><p><strong>Results: </strong>Among 203 765 participants (mean age 49.8 years, 50.4% female), 6869 women (6.7%; 95% confidence interval [6.5; 6.8]) and 8126 men (8.0% [7.9; 8.2] reported regular use of ≥ 5 medications. Regular use of ≥ 10 medications was reported by 505 women (0.5% [0.45; 0.54]) and 722 men (0.7% [0.67;0.77]). Polypharmacy and hyperpolypharmacy increased with age. Diabetes and chronic cardiovascular conditions were strong determinants. Use of cardiovascular medications was most frequently reported.</p><p><strong>Conclusion: </strong>Polypharmacy was common in NAKO, particularly among older participants, men, and persons with cardiovascular disease. Because medication appropriateness could not be assessed, future studies should examine inappropriate polypharmacy and evaluate risk factors and strategies for deprescribing.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"487-492"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210514","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":"Epidural Analgesia in Labor: A Nationwide Evaluation of Utilization in Germany.","authors":"Armin N Flinspach, Florian J Raimann, Thomas Jasny, Benjamin Friedrichson, Susan Bitok, Lea V Blum, Vanessa Neef, Peter Kranke, Kai Zacharowski, Jan A Kloka","doi":"10.3238/arztebl.m2026.0089","DOIUrl":"10.3238/arztebl.m2026.0089","url":null,"abstract":"<p><strong>Background: </strong>Lumbar epidural anesthesia (LEA) is considered the gold standard for the treatment of pain during vaginal delivery. Despite procedural advances and high maternal satisfaction in surveys, the extent of LEA utilization in Germany and its trend over time remain unclear.</p><p><strong>Methods: </strong>We carried out a nationwide retrospective cross-sectional analysis of routine administrative data reported by German hospitals from 1 January 2014 to 31 December 2023. Births were identified by ICD-10 and OPS codes. The data set included all women in Germany who were admitted to a hospital for childbirth. The data analysis was descriptive, with subgroup stratification by mode of delivery. The primary endpoint was the use of LEA for delivery.</p><p><strong>Results: </strong>Of the 6.6 million deliveries recorded, 4.5 million (68%) were vaginal. LEA was used in 1.2 million deliveries (18.4% of the total), including 922 510 in vaginal deliveries (20.5% of all vaginal deliveries). Women who received LEA were younger on average (median age 30 versus 31 years). LEA utilization was relatively stable throughout the study period. Women undergoing vaginal delivery were more likely to receive LEA if they had documented pre-existing conditions or comorbidities.</p><p><strong>Conclusion: </strong>The level of LEA utilization in Germany is stably low compared to other high-income industrialized countries. Better prenatal maternal education and standardized counseling on pain management options can raise awareness of this method of obstetrical analgesia and increase its use.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 17","pages":"499-504"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210397","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":"A Solitary Fibrous Tumor as a Rare Cause of a Somatostatin Receptor-Positive Pancreatic Lesion.","authors":"Ning Wei, Dietrich Alexander Ruess, Viviana Barrera Penagos","doi":"10.3238/arztebl.m2026.0084","DOIUrl":"10.3238/arztebl.m2026.0084","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"504"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080127","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":"In Reply.","authors":"Peter Albrecht","doi":"10.3238/arztebl.m2026.0108","DOIUrl":"10.3238/arztebl.m2026.0108","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"m1072"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080035","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":"Hearing Impairments in People With Intellectual Disabilities: A Prospective Cohort Study on Prevalence and Healthcare Utilization.","authors":"Philipp Mathmann, Corinna Gietmann, Vincent Jankovic, Werner Brannath, Awa Naghipour, Peter Matulat, Sandra Diekmann, Amélie Hesping, Anja Neumann, Lukas Prein, Karolin Schäfer, Sarah Schlierenkamp, Anna Sophia Schwalen, Katharina Schwarze, Susanne Wasmuth, Heike Weiler-David, Anna Wiegand, Susanna Zielonkowski, Martin Scharpenberg, Katrin Neumann","doi":"10.3238/arztebl.m2026.0099","DOIUrl":"10.3238/arztebl.m2026.0099","url":null,"abstract":"<p><strong>Background: </strong>People with intellectual disabilities (ID, prevalence ca. 1.04%) have an elevated risk of hearing impairments, which, if untreated, can hinder communication, cognitive development, and social participation. In a project called \"HörGeist,\" we studied the prevalence of hearing impairments and the feasibility and utility of an outreach auditory screening, diagnosis, and intervention program for people with ID in their living and working environments.</p><p><strong>Methods: </strong>In an age-stratified cohort study with a total of 1194 subjects, 1053 people with ID (outreach cohort, aged 1–90 years) underwent auditory screening in their living or working environment twice one year apart, and, if indicated, a diagnostic evaluation for a hearing impairment and either an intervention or a referral for outside treatment. To compare utilization, a control cohort of people with ID (141 subjects) was offered screening and auditory diagnostic testing in a clinical setting.</p><p><strong>Results: </strong>Clinically relevant hearing impairments were diagnosed in 44.0% of patients in the outreach cohort; 69.8% of these impairments had not been identified previously. Cerumen obturans affecting hearing was present in 9.9% of the impairments. Approximately one-third of the subjects or their carers overestimated their hearing ability. Screening and diagnostic evaluation yielded a conclusive result in 96.7% of cases. Screening had an estimated 92.3% specificity (95% confidence interval: [89.6; 94.3]) and 96.4% sensitivity ([94.1; 97.8]). None of the subjects in the invited control cohort made use of the auditory screening program. The prevalence of hearing impairments varied depending on sex, age, and type of institution.</p><p><strong>Conclusion: </strong>The prevalence of hearing impairments in people with ID is high, and most cases are unrecognized. A comprehensive outreach program of auditory screening, diagnostic evaluation, and intervention for people with ID appears feasible and justified and would reach more of the affected persons than a simple invitation. It could improve their social participation as well.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"493-498"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216859","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":"Lower Leg Hematoma Requiring Intervention During Piperacillin/Tazobactam Therapy.","authors":"Lino Henkel, Stefan Reuter, Mats Jonas Karlsfeld","doi":"10.3238/arztebl.m2026.0086","DOIUrl":"10.3238/arztebl.m2026.0086","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"514"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080131","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":"Inadequate Infusion Therapy.","authors":"Reiner Klick","doi":"10.3238/arztebl.m2026.0107","DOIUrl":"10.3238/arztebl.m2026.0107","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"m1072"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080051","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":"Acute Sarcoidosis (Löfgren Syndrome) in a Traveler Returning With Fever.","authors":"Philipp Schulz, Pascal Migaud, Hartmut Stocker","doi":"10.3238/arztebl.m2026.0066","DOIUrl":"10.3238/arztebl.m2026.0066","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 18","pages":"514"},"PeriodicalIF":8.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080064","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":"In Reply.","authors":"David Martin","doi":"10.3238/arztebl.m2026.0113","DOIUrl":"10.3238/arztebl.m2026.0113","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 17","pages":"m1071"},"PeriodicalIF":8.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13567712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988372","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}