The COVID-19 Pandemic Enhanced the Decade-Long Trend of the Decreasing Utilization of Antibiotics.

PURPOSE/INTRODUCTION: A decline in antibiotic (AB) prescriptions was reported during the coronavirus 2019 (COVID-19) pandemic. Therefore, we investigated AB utilization during the COVID-19 pandemic using data from a large database in Germany. METHODS: AB prescriptions in the Disease Analyzer database (IQVIA) were analyzed for each year between 2011 and 2021. Descriptive statistics were used to assess developments in relation to age group, sex, and antibacterial substances. Infection incidence rates were also investigated. RESULTS: In total, 1,165,642 patients received antibiotic prescriptions during the entire study period (mean age: 51.8; SD: 18.4 years; 55.3% females). AB prescriptions started to decline in 2015 (505 patients per practice), and this development persisted until 2021 (2020: 300 patients per practice and 2021: 266 patients per practice). The sharpest drop was observed in 2020 and occurred in both women and men (27.4% and 30.1%). In the youngest age group (≤30), the decrease was -56%, while in the age group >70, it was -38%. The number of patients with prescriptions for fluoroquinolones dropped the most, falling from 117 in 2015 to 35 in 2021 (-70%), followed by macrolides (-56%) and tetracyclines (-56%). In 2021, 46% fewer patients were diagnosed with acute lower respiratory infections, 19% fewer with chronic lower respiratory diseases, and just 10% fewer with diseases of the urinary system. CONCLUSION: AB prescriptions decreased more in the first year (2020) of the COVID-19 pandemic than infectious diseases did. While the factor of older age influenced this trend negatively, it remained unaffected by the factor of sex and the selected antibacterial substance.

Predictive Attributes for Developing Long COVID-A Study Using Machine Learning and Real-World Data from Primary Care Physicians in Germany.

(1) In the present study, we used data comprising patient medical histories from a panel of primary care practices in Germany to predict post-COVID-19 conditions in patients after COVID-19 diagnosis and to evaluate the relevant factors associated with these conditions using machine learning methods. (2) Methods: Data retrieved from the IQVIATM Disease Analyzer database were used. Patients with at least one COVID-19 diagnosis between January 2020 and July 2022 were selected for inclusion in the study. Age, sex, and the complete history of diagnoses and prescription data before COVID-19 infection at the respective primary care practice were extracted for each patient. A gradient boosting classifier (LGBM) was deployed. The prepared design matrix was randomly divided into train (80%) and test data (20%). After optimizing the hyperparameters of the LGBM classifier by maximizing the F2 score, model performance was evaluated using several test metrics. We calculated SHAP values to evaluate the importance of the individual features, but more importantly, to evaluate the direction of influence of each feature in our dataset, i.e., whether it is positively or negatively associated with a diagnosis of long COVID. (3) Results: In both the train and test data sets, the model showed a high recall (sensitivity) of 81% and 72% and a high specificity of 80% and 80%; this was offset, however, by a moderate precision of 8% and 7% and an F2-score of 0.28 and 0.25. The most common predictive features identified using SHAP included COVID-19 variant, physician practice, age, distinct number of diagnoses and therapies, sick days ratio, sex, vaccination rate, somatoform disorders, migraine, back pain, asthma, malaise and fatigue, as well as cough preparations. (4) Conclusions: The present exploratory study describes an initial investigation of the prediction of potential features increasing the risk of developing long COVID after COVID-19 infection by using the patient history from electronic medical records before COVID-19 infection in primary care practices in Germany using machine learning. Notably, we identified several predictive features for the development of long COVID in patient demographics and their medical histories.

Routine care for people with newly diagnosed type 2 diabetes before and during the SARS-CoV-2 pandemic - results from the German Disease Analyzer database.

AIM: To investigate whether the SARS-CoV-2 pandemic affected care for people with newly diagnosed type 2 diabetes in Germany. METHODS: The Disease Analyzer database (IQVIA, Germany) contains routine data on diagnoses and treatments (ICD-10 and ATC codes) from patients followed in selected physician practices across Germany. We compared 21,747 individuals with a first diagnosis of type 2 diabetes between January 2018 and September 2019 with 20,513 individuals with a first diabetes diagnosis between March 2020 and November 2021. RESULTS: In March and April 2020, the number of new diagnoses of diabetes decreased by 18.3% and 35.7%, respectively, compared to March and April of the previous two years. The previous diabetes incidence level was reached again in June 2020. Mean pre-treatment glucose levels were higher during the pandemic than before (fasting plasma glucose: +6.3 mg/dl (95% confidence interval: 4.6-8.0)). In the first six months after diabetes diagnosis, the mean number of GP visits, specialist referrals and HbA1c measurements decreased. CONCLUSION: We observed a decrease in diabetes incidence in the early phase of the pandemic and slightly higher pretreatment blood glucose levels during the pandemic than before. Care for newly diagnosed diabetes was slightly worse during the pandemic than before.

Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study.

BACKGROUND: There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. OBJECTIVE: The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. METHODS: This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). RESULTS: The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). CONCLUSION: This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.

[Dementia Screening and Test Psychology in German General and Specialist Practices under Conditions of the Corona Pandemic]. / Demenz-Screening- und testpsychologische Untersuchungen in deutschen Haus- und Facharztpraxen unter Bedingungen der Corona Pandemie.

OBJECTIVE: To analyse changes in frequencies of test psychology examinations (TPE) relevant to detect change in dementia diagnosis in general (GP) and neuropsychiatric (NP) practices during the Covid 19 pandemic. METHODS: Cross-sectional study analysis comparing the number of patients aged ≥ 70 with at least one TPE in 908 GP and 107 NP-practices in 2018-2019 (prepandemic) and 2020-2021 (pandemic) using descriptive statisics and correlations. RESULTS: While there was a large decrease in TPE between 2018-2019 and 2020-2021 (- 18.4%) conducted in NP-practices, it remained stable in GP-practices (+ 2.6%). In both GP and NP, there was a strong correlation between the number of patients tested and newly diagnosed with dementia. CONCLUSION: TPE in performing in GP practices appears less susceptible to a pandemic-related decline in the provision compared to NP practices. Further research is needed to reveal the reasons for these differences.

Increase in depression and anxiety disorder diagnoses during the COVID-19 pandemic in children and adolescents followed in pediatric practices in Germany.

The coronavirus pandemic and related restrictions impacted the daily lives of children and youth, partly due to the closure of schools and the absence of outdoor activities. The aim of this study was to investigate, quantify, and critically discuss the effect of the pandemic and related restrictions on consultations pertaining to depression and anxiety disorders in children and adolescents. This retrospective cross-sectional study was based on medical record data from the Disease Analyzer database (IQVIA) and included all children and adolescents aged 2-17 years with at least one visit to one of 168 German pediatric practices between April 2019 and December 2019 (n = 454,741) or between April 2020 and December 2020 (n = 417,979). The number of children and adolescents with depression and anxiety disorder diagnoses per practice and the prevalence of these diagnoses were compared for April 2020-December 2020 versus April 2019-December 2019. The number of children and adolescents with depression and anxiety diagnoses per practice increased in April 2020-December 2020 compared to the same period in 2019 (anxiety: + 9%, depression: + 12%). The increase was much greater in girls than in boys (anxiety: + 13% vs. + 5%; depression + 19% vs. + 1%). The prevalence of anxiety disorder increased from 0.31 to 0.59% (p < 0.001), and that of depression from 0.23 to 0.47% (p < 0.001). The biggest increases were observed for girls (anxiety from 0.35 to 0.72% (+ 106%, p < 0.001), depression from 0.28 to 0.72% (+ 132%, p < 0.001). This study shows an increase in the number of pediatric diagnoses of depression and anxiety disorders in the pandemic year 2020 compared to the previous year.

Is Dementia Associated with COVID-19 Mortality? A Multicenter Retrospective Cohort Study Conducted in 50 Hospitals in Germany.

BACKGROUND: Dementia has been identified as a major predictor of mortality associated with COVID-19. OBJECTIVE: The objective of this study was to investigate the association between dementia and mortality in COVID-19 inpatients in Germany across a longer interval during the pandemic. METHODS: This retrospective study was based on anonymized data from 50 hospitals in Germany and included patients with a confirmed COVID-19 diagnosis hospitalized between March 11, 2020 and July, 20, 2022. The main outcome of the study was the association of mortality during inpatient stays with dementia diagnosis, which was studied using multivariable logistic regression adjusted for age, sex, and comorbidities as well as univariate logistic regression for matched pairs. RESULTS: Of 28,311 patients diagnosed with COVID-19, 11.3% had a diagnosis of dementia. Prior to matching, 26.5% of dementia patients and 11.5% of non-dementia patients died; the difference decreased to 26.5% of dementia versus 21.7% of non-dementia patients within the matched pairs (n = 3,317). This corresponded to an increase in the risk of death associated with dementia (OR = 1.33; 95% CI: 1.16-1.46) in the univariate regression conducted for matched pairs. CONCLUSION: Although dementia was associated with COVID-19 mortality, the association was weaker than in previously published studies. Further studies are needed to better understand whether and how pre-existing neuropsychiatric conditions such as dementia may impact the course and outcome of COVID-19.

The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany.

Background: The COVID-19 pandemic and the imposed lockdowns severely affected routine care in general and specialized physician practices. Objective: To describe the long-term impact of the COVID-19 pandemic on the physician services provision and disease recognition in German physician practices and perceived causes for the observed changes. Design: Observational study based on medical record data and survey data of general practitioners and specialists' practices. Participants: 996 general practitioners (GPs) and 798 specialist practices, who documented 6.1 million treatment cases for medical record data analyses and 645 physicians for survey data analyses. Main measures: Within the medical record data, consultations, specialist referrals, hospital admissions, and documented diagnoses were extracted for the pandemic (March 2020-September 2021) and compared to corresponding pre-pandemic months in 2019. The additional online survey was used to assess changes in practice management during the COVID-19 pandemic and physicians' perceived main causes of affected primary and specialized care provision. Main results: Hospital admissions (GPs: -22% vs. specialists: -16%), specialist referrals (-6 vs. -3%) and recognized diseases (-9 vs. -8%) significantly decreased over the pandemic. GPs consultations initially decreased (2020: -7%) but compensated at the end of 2021 (+3%), while specialists' consultation did not (-2%). Physicians saw changes in patient behavior, like appointment cancellation, as the main cause of the decrease. Contrary to this, they also mentioned substantial modifications of practice management, like reduced (nursing) home visits (41%) and opening hours (40%), suspended checkups (43%), and delayed consultations for high-risk patients (71%). Conclusion: The pandemic left its mark on primary and specialized healthcare provision and its utilization. Both patient behavior and organizational changes in practice management may have caused decreased and non-compensation of services. Evaluating the long-term effect on patient outcomes and identifying potential improvements are vital to better prepare for future pandemic waves.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of neck and low back pain in outpatient practices in Germany.

Little is known about how COVID-19 has impacted the diagnosis of neck and low back pain in outpatient practices in Germany. Thus, this study aimed to compare the number of new diagnoses of neck and low back pain in German general and orthopedic practices between 2020 and 2021 and 2019. This retrospective study included patients aged ≥ 18 years with at least one visit to one of 915 general and 145 orthopedic practices in Germany in March - December 2019 (N = 2,842,145), March - December 2020 (N = 2,810,179), or March - December 2021 (N = 3,214,419). The number of patients newly diagnosed with neck and low back pain per general and orthopedic practice was compared between March - December 2020 and March - December 2019, and between March - December 2021 and March - December 2019 using Wilcoxon signed-rank tests. Analyses were conducted in general and orthopedic practices separately and were also stratified by sex and age. There was a decrease in new diagnoses of neck and low back pain in general and orthopedic practices between 2020 and 2019, and between 2021 and 2019. This decrease reached statistical significance for neck pain in general practices in 2020 (-12.4 %) and 2021 (-6.1 %), and for low back pain in general practices in 2020 (-9.3 %). Similar findings were obtained in sex- and age-stratified analyses. The COVID-19 pandemic had a negative impact on the diagnosis of neck and low back pain in general and orthopedic practices in Germany. More data from other settings and countries are warranted to confirm or refute these results.

The long-term impact of the COVID-19 pandemic on primary and specialized care provision and disease recognition in Germany

Background The COVID-19 pandemic and the imposed lockdowns severely affected routine care in general and specialized physician practices. Objective To describe the long-term impact of the COVID-19 pandemic on the physician services provision and disease recognition in German physician practices and perceived causes for the observed changes. Design Observational study based on medical record data and survey data of general practitioners and specialists' practices. Participants 996 general practitioners (GPs) and 798 specialist practices, who documented 6.1 million treatment cases for medical record data analyses and 645 physicians for survey data analyses. Main measures Within the medical record data, consultations, specialist referrals, hospital admissions, and documented diagnoses were extracted for the pandemic (March 2020–September 2021) and compared to corresponding pre-pandemic months in 2019. The additional online survey was used to assess changes in practice management during the COVID-19 pandemic and physicians' perceived main causes of affected primary and specialized care provision. Main results Hospital admissions (GPs: −22% vs. specialists: −16%), specialist referrals (−6 vs. −3%) and recognized diseases (−9 vs. −8%) significantly decreased over the pandemic. GPs consultations initially decreased (2020: −7%) but compensated at the end of 2021 (+3%), while specialists' consultation did not (−2%). Physicians saw changes in patient behavior, like appointment cancellation, as the main cause of the decrease. Contrary to this, they also mentioned substantial modifications of practice management, like reduced (nursing) home visits (41%) and opening hours (40%), suspended checkups (43%), and delayed consultations for high-risk patients (71%). Conclusion The pandemic left its mark on primary and specialized healthcare provision and its utilization. Both patient behavior and organizational changes in practice management may have caused decreased and non-compensation of services. Evaluating the long-term effect on patient outcomes and identifying potential improvements are vital to better prepare for future pandemic waves.

Is there an association between depression, anxiety disorders and COVID-19 severity and mortality? A multicenter retrospective cohort study conducted in 50 hospitals in Germany.

BACKGROUND: The aim of this retrospective cohort study was to investigate associations between depression and anxiety disorder and the risk of COVID-19 severity and mortality in patients treated in large hospitals in Germany. METHODS: This retrospective study was based on anonymized electronic medical data from 50 public healthcare service hospitals across Germany. Multivariable logistic regression models were used to study associations between depression, anxiety and mechanical ventilation and mortality due to COVID adjusted for age, sex, time of COVID-19 diagnosis, and pre-defined co-diagnoses. RESULTS: Of 28,311 patients diagnosed with COVID-19, 1970 (6.9%) had a diagnosis of depression and 369 (1.3%) had a diagnosis of anxiety disorder prior to contracting COVID-19. While multivariable logistic regression models did not indicate any association between depression diagnosis and the risk of mechanical ventilation, depression was associated with a decreased risk of mortality (OR: 0.71; 95% CI: 0.53-0.94). There was no association between anxiety disorders and risk of mortality, but there was a strong positive association between anxiety disorders and the risk of mechanical ventilation (OR: 2.04; 95% CI: 1.35-3.10). CONCLUSION: In the present study, depression and anxiety disorder diagnoses were not associated with increased COVID-19 mortality. Anxiety disorder was strongly associated with an increased risk of mechanical ventilation. Further studies are needed to clarify how depression and anxiety disorders may influence COVID-19 severity and mortality.

Prevalence of and factors associated with COVID-19 diagnosis in symptomatic patients followed in general practices in Germany between March 2020 and March 2021.

AIMS: This study aimed to investigate the prevalence of and the factors associated with the diagnosis of coronavirus disease 2019 (COVID-19) in symptomatic patients followed in general practices in Germany between March 2020 and March 2021. METHODS: Symptomatic patients tested for COVID-19 and followed in one of 962 general practices in Germany from March 2020 to March 2021 were included in this study. Covariates included sex, age, and comorbidities present in at least 3% of the population. The association between these factors and the diagnosis of COVID-19 was analyzed using an adjusted logistic regression model. RESULTS: A total of 301,290 patients tested for COVID-19 were included in this study (54.7% women; mean [SD] age 44.6 [18.5] years). The prevalence of COVID-19 was 13.8% in this sample. Male sex and older age were positively and significantly associated with COVID-19. In terms of comorbidities, the strongest positive associations with COVID-19 were observed for cardiac arrhythmias, depression, and obesity. There was also a negative relationship between the odds of being diagnosed with COVID-19 and several conditions such as chronic sinusitis, asthma, and anxiety disorders. CONCLUSIONS: Approximately 14% of symptomatic patients tested for COVID-19 were diagnosed with COVID-19 in German general practices from March 2020 to March 2021.

Type 1 diabetes incidence in children and adolescents during the COVID-19 pandemic in Germany.

AIMS/HYPOTHESIS: The aim of this study was to analyze the incidence of type 1 diabetes in children and adolescents (<20 years of age) during the COVID-19 pandemic (3/2020 to 12/2021) in Germany. METHODS: The present study was based on the IQVIA longitudinal prescription database (LRx), All persons (age ≤ 20 years) with new insulin prescriptions from 2016 to 2021 (index date) were selected and stratified by age group. Weekly (age-specific) data were used to forecast the prescription incidence for the pandemic period based on pre-pandemic data and to explore the relationship between weekly reported age-specific COVID-19 incidences and type 1 diabetes incidence and rate ratios of observed vs. predicted diabetes incidence respectively. RESULTS: During the pre-pandemic period, there was a stable higher insulin prescription incidence during the winter period and a lower insulin prescription incidence during summer. During the pandemic period, there was less seasonal variation in incidence related to the finding that the observed incidence during summer in 2002 and 2021 was 44 % and 65 %, higher, respectively, than the expected incidence based on pre-pandemic year. We did not find any cross-correlations between the COVID-19 incidence and the type 1 diabetes incidence for any age group. Likewise, there were no cross-correlations between the COVID-19 incidence and the incidence rate ratios of observed incidences to predicted incidences. CONCLUSIONS/INTERPRETATION: During the COVID-19 pandemic, there was less seasonal variation in the incidence of type 1 diabetes (defined by new insulin prescriptions), with higher observed than expected incidences during summer. We found no evidence that the increase in type 1 diabetes incidence during the COVID-19 pandemic relates to direct effects of COVID-19 pandemic.

Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Cervical Cancer Screening in Gynecological Practices in Germany.

Purpose: the aim of this cross-sectional study was to analyze the impact of the COVID-19 pandemic on Cervical Cancer Screening (CCS) in gynecological practices in Germany. Methods: The basis of the analysis was the Uniform Evaluation Standard (EBM) of the Statutory Health Insurance Scheme. This cross-sectional study included all women aged ≥20 years with at least one CCS (clinical and cytological examination) in 223 gynecological practices in Germany during the period 2018-2021. The number of patients with CCS per practice was shown for each year. The average number of patients per year was compared between the pre-pandemic time period (2018, 2019) and the pandemic time period (2020, 2021) using Wilcoxon tests. Analyses were conducted separately for clinical investigations and cytological investigations and were also stratified by age group (20-34, 35-50, >50 years). Results: CCS in gynecological practices significantly decreased in Germany between the pre-pandemic time period of 2018-2019 and the pandemic years of 2020-2021. This decrease was observed in all age groups but was stronger in women aged 20-34 (-25.6%) and weaker in women aged >50 (-15.2%). Conclusions: We found a statistically and clinically relevant decrease of patients receiving CCS in gynecological practices in Germany. This finding is even more exceptional because the new screening algorithm with direct invitations for each patient started in 2020 and was supposed to lead to a higher number of patients in its first years. However, the observed decline in the detection of cervical precancer lesions may lead to increased cervical cancer burden. Risk-based screening strategies and further measures are necessary to adapt to the ongoing COVID-19 pandemic and return to pre-pandemic CCS numbers.

Obesity and lipid metabolism disorders determine the risk for development of long COVID syndrome: a cross-sectional study from 50,402 COVID-19 patients.

PURPOSE: Metabolic disorders have been identified as major risk factors for severe acute courses of COVID-19. With decreasing numbers of infections in many countries, the long COVID syndrome (LCS) represents the next major challenge in pandemic management, warranting the precise definition of risk factors for LCS development. METHODS: We identified 50,402 COVID-19 patients in the Disease Analyzer database (IQVIA) featuring data from 1056 general practices in Germany. Multivariate logistic regression analysis was used to identify risk factors for the development of LCS. RESULTS: Of the 50,402 COVID-19 patients included into this analysis, 1,708 (3.4%) were diagnosed with LCS. In a multivariate regression analysis, we identified lipid metabolism disorders (OR 1.46, 95% CI 1.28-1.65, p < 0.001) and obesity (OR 1.25, 95% CI 1.08-1.44, p = 0.003) as strong risk factors for the development of LCS. Besides these metabolic factors, patients' age between 46 and 60 years (compared to age ≤ 30, (OR 1.81 95% CI 1.54-2.13, p < 0.001), female sex (OR 1.33, 95% CI 1.20-1.47, p < 0.001) as well as pre-existing asthma (OR 1.67, 95% CI 1.39-2.00, p < 0.001) and depression (OR 1.27, 95% CI 1.09-1.47, p = < 0.002) in women, and cancer (OR 1.4, 95% CI 1.09-1.95, p = < 0.012) in men were associated with an increased likelihood of developing LCS. CONCLUSION: Lipid metabolism disorders and obesity represent age-independent risk factors for the development of LCS, suggesting that metabolic alterations determine the risk for unfavorable disease courses along all phases of COVID-19.

Covid-19 pandemic: Anxiety experience of resident and hospital psychiatrists

Background: To date, no studies have examined the pandemic-related stress experience of inpatient versus outpatient psychiatrists. Therefore, the aim is to investigate the extent of Covid-19 exposure, anxiety, stress experience, and coping abilities among psychiatrists in private practice compared to physicians in psychiatric and psychosomatic hospitals. Methods: E-mail-based questionnaires with 13 items were used to assess anxiety and stress experience. A total of 105 practicing psychiatrists, and 73 physicians and psychologists from four clinics (including the Clinic for Psychosomatic Medicine and Psychotherapy) were surveyed between early April and mid-May 2020. Results: Compared to hospital psychiatrists, psychiatrists in private practice more often felt severely restricted (52.4 vs. 32.9 % p = 0.010), at risk of infection (35.2 vs. 13.7 %, p < 0.001) and financially threatened (24.7 vs. 6.9 %, p = 0.002). The proportion of well-informed practicing psychiatrists was lower (47.6 vs. 63.0 %, p = 0.043) and the proportion with lack of protective equipment was higher (27.6 vs. 4.1 %, p < 0.001). At the same COVID-19 exposure level (8.6 vs. 8.2 %), office-based psychiatrists were more likely to report high anxiety, although not significantly, compared to hospital psychiatrists (18.1 vs. 9.6 %, p = 0.114). Risk factors for experiencing anxiety in both groups were feeling restricted (OR = 5.52, p = 0.025) and experienced risk of infection (OR = 5.74, p = 0.005). Exposure level, clinic or practice affiliation, age, gender, and other dimensions of threat experience and coping behavior had no influence. Discussion: Psychiatrists in private practice felt more stressed and threatened by the COVID-19 pandemic compared with hospital-based colleagues. The experience of anxiety was dependent on feeling constrained and at risk of exposure, but not on exposure, protective equipment. Objective indicators seem to play less of an important role in the expression of anxiety than subjective experience. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Hintergrund: Bisher gibt es keine Studien, die das Pandemie bedingte Belastungserleben von stationar im Vergleich zu ambulant tatigen Psychiatern untersucht hat. Es soll deshalb das Ausmas der Covid-19-Exposition, die Angst, das Belastungserleben und die Bewaltigungsmoglichkeiten bei niedergelassenen Psychiatern im Vergleich zu Arzten in psychiatrischen und psychosomatischen Kliniken untersucht werden. Methode: Zur Erfassung von Angst- und Belastungserleben wurden E-Mail-gestutzte Fragebogen mit 13 Items genutzt. Insgesamt wurden 105 niedergelassene Psychiater, und 73 Arzte und Psychologen aus vier Klinikern (inkl. Klinik fur Psychosomatische Medizin und Psychotherapie) zwischen Anfang April bis Mitte Mai 2020 befragt. Ergebnis: In ihrem Belastungserleben fuhlten sich niedergelassene im Vergleich zu Krankenhauspsychiatern haufiger stark eingeschrankt (52,4 vs. 32,9 % p = 0,010), infektionsgefahrdet (35,2 vs. 13,7 %, p < 0,001) und finanziell bedroht (24,7 vs. 6,9 %, p = 0,002). Der Anteil gut Informierter niedergelassener Psychiater war geringer (47,6 vs. 63,0 %, p = 0,043) und der Anteil mit fehlender Schutzausrustung hoher (27,6 vs. 4,1 %, p < 0,001). Bei gleichem COVID-19 Expositionsniveau (8,6 vs. 8,2 %) berichteten niedergelassene Psychiater im Vergleich zu Krankenhaus-Psychiatern haufiger, wenn auch nicht signifikant, grose Angst (18,1 vs. 9,6 %, p = 0,114). Risikofaktoren fur ein Angsterleben waren in beiden Gruppen das Gefuhl der Einschrankung (OR = 5,52, p = 0,025) und die erlebte Infektionsgefahr (OR = 5,74, p = 0,005). Keinen Einfluss hatten das Expositionsniveau, die Klinik- bzw. Praxiszugehorigkeit, das Alter, das Geschlecht und andere Dimensionen des Bedrohungserlebens und des Bewaltigungsverhaltens. Diskussion: Niedergelassene Psychiater fuhlten sich im Vergleich zu den Kollegen im Krankenhaus durch die COVID-19 Pandemie mehr belastet und bedroht. Das Erleben von Angst war abhangig vom Gefuhl der Einschrankung und der Expositionsgefahr, nicht jedoch von der Exposition, der Ausstattung mit Schutzmitteln. Fur die Auspragung der Angst scheinen weniger objektive Indikatoren als das subjektive Erleben eine wichtige Rolle zu spielen. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

[Mental Disorders in German Pediatric Practices Before and During the COVID-19 Pandemic]. / Psychische Störungen in deutschen pädiatrischen Praxen vor und während der COVID-19-Pandemie.

BACKGROUND: Field studies show an increased mental distress in children and adolescents during the COVID-19 pandemic. This health care data based study investigates, whether this corresponds with an increased number of diagnosed mental disorders in pediatric practices during the COVID-19 pandemics. METHODS: Data are based on children aged 2-17 years who visited one of 154 pediatric practices (Disease Analyzer database/IQVIA) at least once. Descriptive analyses were conducted. RESULTS: In 2020 and 2021, significantly more mental disorders were diagnosed compared to the two previous years (chi2 p < 0.001). An increase was particularly evident in affective disorders, although absolute numbers were small with an average increase of 7 patients per practice per year. DISCUSSION: The pandemic-associated increase in mental disorders in children and adolescents is reflected in the physician-diagnosed cases in pediatric practices, but is small in terms of numbers in individual practices.

Prevalence of and Factors Associated With Post-Coronavirus Disease 2019 (COVID-19) Condition in the 12 Months After the Diagnosis of COVID-19 in Adults Followed in General Practices in Germany.

Background: Little is known about the epidemiology of post-coronavirus disease 2019 (COVID-19) condition (PCC) in primary care practices. Therefore, this study aimed to investigate the prevalence of and the factors associated with PCC in the 12 months after the diagnosis of COVID-19 in patients followed in general practices in Germany. Methods: This retrospective cohort study included adults aged ≥18 years who were diagnosed for the first time with COVID-19 (index date) in 1 of 855 general practices in Germany between October 2020 and August 2021 (Disease Analyzer database; IQVIA). The outcome was the occurrence of PCC 91 to 365 days after the index date. Covariates included age, sex, and comorbidities documented in the 12 months before the index date. The association between covariates and PCC was assessed using a multivariable logistic regression model. Results: We included 51 630 patients in this study (mean age, 47.1 [standard deviation, 19.8] years; 54.3% women). The prevalence of PCC was 8.3%. Age >30 years (odds ratios [ORs] ranging from 1.40 for 31-45 years to 2.10 for 46-60 years) and female sex (OR = 1.23) were positively and significantly associated with PCC compared with age 18-30 years and male sex, respectively. There was also a significant relationship of PCC with asthma (OR = 1.38), reaction to severe stress, and adjustment disorders (OR = 1.24), and somatoform disorders (OR = 1.23). Conclusions: Post-COVID-19 condition was found in the 12 months after the diagnosis of COVID-19 in approximately 8% of adults from general practices in Germany. More data from other settings are warranted to confirm these findings.