Deutsches Arzteblatt international最新文献

{"title":"Tobacco and Nicotine Consumption and the Motivation to Stop Smoking in Smokers With and Without Coronary Heart Disease: A Comparative Analysis of Two Cross-Sectional Studies.","authors":"Stephanie Klosterhalfen, Sabrina Hoppe, Daniel Kotz, Ute Mons, Sabrina Kastaun","doi":"10.3238/arztebl.m2026.0057","DOIUrl":"10.3238/arztebl.m2026.0057","url":null,"abstract":"<p><strong>Background: </strong>Smoking worsens the prognosis of patients with coronary heart disease (CHD). Only limited population-based data are available on smoking cessation and its characteristics in people with CHD. We compared smokers with and without CHD.</p><p><strong>Methods: </strong>We analyzed pooled data from nine waves (June 2023-August 2024) of two representative cross-sectional surveys in Germany (DEBRA and OptiCor). We included adults aged 35 years and above who provided information on their smoking behavior and CHD status (n = 11 069; 994 [9%] with CHD). The endpoints included smoking status, tobacco dependence, motivation to quit smoking, and attempts to do so, as well as the use of electronic inhalation products (e-cigarettes, tobacco heaters). Regression models with CHD as an independent variable were adjusted for age, sex, education, and income.</p><p><strong>Results: </strong>People with CHD were less likely to be current smokers (23.8%, 95% confidence interval [21.2; 26.6], versus 29.3% [28.5; 30.2]), but they were more likely to be former smokers (32.2% [29.3; 35.3] versus 18.9% [18.1; 19.6]). Being a smoker with CHD was associated with the use of electronic inhalation products (odds ratio [OR] = 2.53 [1.43; 4.48]), higher motivation to quit smoking (OR = 1.41 [1.02; 1.96]), and greater tobacco dependence (OR = 1.63 [1.05; 2.53]). Among current smokers and those who smoked in the past year, those with CHD were also more likely than those without CHD to have made at least one attempt to quit in the past year (OR = 2.90 [1.98; 4.25]).</p><p><strong>Conclusion: </strong>One-quarter of people with CHD smoke. Despite a greater degree of tobacco dependence, they show higher motivation and make more attempts to quit smoking compared with smokers without CHD. As smoking cessation is crucial in this group, healthcare professionals should consistently assess the smoking status of people with CHD and offer them evidence-based support for smoking cessation.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 12","pages":"327-332"},"PeriodicalIF":8.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833841","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":"Cannabis-Related Hospitalizations Before and After Partial Legalization: An Analysis From Five Psychiatric Clinics in the Rhine-Ruhr Metropolitan Area.","authors":"Udo Bonnet, Norbert Scherbaum, Eugen Davids, Bodo Lieb, Benedikt Bernd Claus, Georg Juckel","doi":"10.3238/arztebl.m2026.0042","DOIUrl":"10.3238/arztebl.m2026.0042","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 12","pages":"339-340"},"PeriodicalIF":8.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535603","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":"Tranexamic Acid for Acute Bleeding in Severely Traumatized Patients: Mortality, Neurological Outcomes, and Thromboembolic Risk.","authors":"Heiko Lier, Marc Maegele, Björn Hossfeld","doi":"10.3238/arztebl.m2026.0046","DOIUrl":"10.3238/arztebl.m2026.0046","url":null,"abstract":"<p><strong>Background: </strong>The optimal use of tranexamic acid (TXA) in trauma care is a matter of intense discussion, particularly with respect to its indications, dosage, temporal window, and thromboembolic adverse effects.</p><p><strong>Methods: </strong>This review is based on publications retrieved by a selective literature search on the indications, effects, mechanism of action, and side effects of TXA (January 2022 to December 2025). Three randomized, controlled trials (RCTs), three observational studies, eight secondary analyses, and 16 meta-analyses were evaluated.</p><p><strong>Results: </strong>TXA administration lowers the mortality of severely traumatized patients (e.g., with a relative risk [RR] of 0.73 [0.56;0.96]). The currently available evidence is inconsistent, and many of the effects found in published studies lie within the range of random fluctuation. The reduction of mortality depends on TXA administration at the earliest possible time in the first 90 minutes after trauma (this temporal window is more important than the question of pre- vs. in-hospital administration), as well as on the nature of the injury, particularly in patients with hemorrhagic shock. Among patients with isolated traumatic brain injury, no consistent effect on mortality has been shown, but there may be an effect on the progression of intracranial bleeding. Multiple studies point to a thromboembolic risk, which is dose-dependent, with a marked rise at 4 g (hazard ratio [HR] 5.33, 95% confidence interval [1.94;14.63]). In patients without shock, the reported absolute risk difference for mortality ranges from -5% to +5%, and that for thromboembolic adverse events from -0.2% to +4%.</p><p><strong>Conclusion: </strong>For trauma patients with life-threatening hemorrhage, especially those in hemorrhagic shock, it is recommended that TXA be given as early as possible (before arrival in the hospital) in a single dose of 1-2 g (15-30 mg/kg body weight [BW]). When this is done, the benefit appears to be greater than the thromboembolic risk.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 12","pages":"333-338"},"PeriodicalIF":8.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638359","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":"Sedation of Persons With Intellectual Disability and Multiple Disabilities: A Single-Center, Retrospective Evaluation of Clinical Cases.","authors":"Saskia Karina Bücker, Kristin Rolke, Nessia Rachma Dianti, Eva Münster, Jörg Stockmann","doi":"10.3238/arztebl.m2026.0037","DOIUrl":"10.3238/arztebl.m2026.0037","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 12","pages":"341-342"},"PeriodicalIF":8.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535586","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 Period Prevalence and In-Hospital Mortality of Central Pontine Myelinolysis.","authors":"Ludwig Matrisch, Yannick Rau","doi":"10.3238/arztebl.m2026.0049","DOIUrl":"10.3238/arztebl.m2026.0049","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 12","pages":"343-344"},"PeriodicalIF":8.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535528","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":"Transplacental Infection: Frequency, Testing, and Treatment.","authors":"Christoph Härtel, Karl Oliver Kagan, Dorothee Viemann, Michael O Schneider, Martin Enders","doi":"10.3238/arztebl.m2025.0227","DOIUrl":"10.3238/arztebl.m2025.0227","url":null,"abstract":"<p><strong>Background: </strong>Infections transmitted through the placenta are caused by viruses [e.g., cytomegalovirus (CMV) and parvovirus B19 (B19V)], bacteria (e.g., <i>Treponema pallidum spp. pallidum</i>), and protozoa (e.g., <i>Toxoplasma gondii</i>). These infections may have serious consequences for the unborn child. In this article, we discuss current aspects of prevention, testing, and treatment.</p><p><strong>Methods: </strong>This narrative review is based on pertinent publications (1946-1015) retrieved by a selective search in the PubMed/MEDLINE, Cochrane Library, ClinicalTrials.gov, and Google Scholar databases, along with the guidelines of medical societies.</p><p><strong>Results: </strong>The current incidence of transplacental infection in Germany is ca. 1 : 200 (CMV) to 1 : 500 000 neonates (syphilis). The diagnosis is made by the serological demonstration of antibodies. Before the 20^th week of gestation, the rate of vertical transmission is lower, but the potential for permanent harm is markedly higher than in the second half of pregnancy. 5-50% of transplacental infections lead to miscarriage or premature birth. Most infected fetuses are asymptomatic at birth, but there is still a 7-14% risk of sensorineural hearing loss from CMV and a 10-30% risk of retinochoroiditis from toxoplasmosis. Up to 60% of symptomatic neonates have long-term neurocognitive sequelae. Anti-infectious treatment is therefore indicated.</p><p><strong>Conclusion: </strong>The most important preventive measures are hygiene education for pregnant women and prophylaxis against exposure. Anti-infectious treatment of pregnant women can reduce the risk of transmission, and the treatment of symptomatic neonates can improve the outcome.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"312-320"},"PeriodicalIF":8.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117615","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 Proposed Introduction of a Prostate Cancer Screening Program in Germany: Procedure, Necessary Studies before Implementation, Benefits, and Risks.","authors":"Peter Albers, Sigrid Carlsson, Agne Krilaviciute, Petra Seibold, Nikolaus Becker","doi":"10.3238/arztebl.m2026.0040","DOIUrl":"10.3238/arztebl.m2026.0040","url":null,"abstract":"<p><strong>Background: </strong>Both the new German S3 guideline on prostate cancer (2025) and the European Union (2022) recommend risk-adapted early detection of prostate cancer by measurement of the prostate-specific antigen (PSA) level combined with magnetic resonance imaging (MRI).In this article, we describe the available screening instruments and the implications of various different methods that might be used for the introduction of a prostate cancer screening program in Germany.</p><p><strong>Methods: </strong>This narrative review is based on pertinent publications that were retrieved by a literature search from November 2024 to November 2025.</p><p><strong>Results: </strong>Compared to purely PSA-based screening, a PSA-based, risk-adapted screening program lowers the incidence of clinically indolent prostate cancer (ISUP gradation group 1) from approximately 50% to 24% if begun at age 45-50. The cumulative incidence of clinically relevant prostate cancer is 0.6% and thus comparable to the detection rate of breast cancer screening in patients of this age group. Prostate cancer screening starting at an older age increases the number of overdiagnoses leading to unnecessary treatment and is in all likelihood not cost-efficient.</p><p><strong>Conclusion: </strong>Prostate cancer screening that starts at age 45-50 and proceeds on the basis of a risk-adapted concept has a better benefit-to-harm ratio than a screening program introduced all at once over a wide age range (e.g., 50-70) or opportunistic screening (i.e., no organized screening program). Implementation studies and model calculations on cost-efficiency are needed before organized screening can begin.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 11","pages":"303-309"},"PeriodicalIF":8.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638292","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 Effects of New Antidiabetic Drugs on the Course of Peripheral Arterial Occlusive Disease.","authors":"Knut Kröger, Hinrich Böhner, Christian-Alexander Behrendt, Olga von Beckerath","doi":"10.3238/arztebl.m2026.0055","DOIUrl":"10.3238/arztebl.m2026.0055","url":null,"abstract":"<p><strong>Background: </strong>Peripheral arterial occlusive disease (PAOD) and diabetic foot syndrome (DFS) are the leading reasons for lower-limb amputation. The new antidiabetic drugs-GLP-1 receptor agonists (GLP-1-RA) and SGLT-2 inhibitors (SGLT-2-I)-improve glycemic control and lower the risk of cardiovascular events. The differing effects of these two drug classes on PAOD are currently under discussion.</p><p><strong>Methods: </strong>This narrative review is based on pertinent publications retrieved by a selective PubMed search employing the terms \"peripheral arterial disease,\" \"SGLT-2 inhibitors,\" and \"GLP-1 receptor agonists.\"</p><p><strong>Results: </strong>No randomized controlled trials (RCTs) of the use of SGLT-2 inhibitors and GLP-1 receptor agonists have yet been conducted in which amputation served as a primary endpoint; in the published trials, amputation is reported only as an adverse event. The SGLT-2 inhibitors empagliflozin and dapagliflozin, which are approved in Germany, were not associated with a significantly increased risk of amputation in RCTs. In one RCT, the GLP-1 receptor agonist semaglutide led to a median prolongation of maximum walking distance by 26.4 m in patients with PAOD. Evidence suggests that GLP-1 receptor agonists may improve the clinical course of PAOD.</p><p><strong>Conclusion: </strong>The available evidence concerning the effect of GLP-1 receptor agonists and SGLT-2 inhibitors on the course of peripheral arterial occlusive disease (PAOD) and diabetic foot syndrome is limited. At any rate, no evidence suggests that GLP-1-RAs or SGLT-2 inhibitors worsen the course of PAOD or increase the risk of amputation. In the authors' judgment, the cardioprotective and nephroprotective effects of these drugs justify their use in patients with diabetic foot syndrome and PAOD.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 11","pages":"297-301"},"PeriodicalIF":8.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765551","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":"Unilateral Chest Wall Hypoplasia and Ipsilateral Upper Limb Anomalies.","authors":"Binglin Lai","doi":"10.3238/arztebl.m2026.0028","DOIUrl":"10.3238/arztebl.m2026.0028","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 11","pages":"302"},"PeriodicalIF":8.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13353538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535588","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":"Missing Values Below the Detection Limit.","authors":"Anne Lotz, Thomas Behrens","doi":"10.3238/arztebl.m2026.0044","DOIUrl":"10.3238/arztebl.m2026.0044","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 11","pages":"m1063"},"PeriodicalIF":8.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535613","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}