The digital transformation of healthcare is rapidly reshaping neurology, particularly in the field of movement disorders, where continuous monitoring, long disease trajectories, and complex multimodal care create a high demand for innovative solutions. Wearable sensors, digital diagnostics, app-based therapeutics, and integrated hybrid care networks and digital supported care pathways promise earlier diagnosis, personalized treatment and care management, and improved long-term outcomes. However, real-world implementation in managed outpatient care remains fragmented and faces major barriers beyond pure technological feasibility. This position paper critically reviews the current state of digital technologies in movement disorder care, identifies key systemic, ethical, and economic roadblocks, and proposes a pragmatic roadmap toward a realistic and ethically sound digital outpatient clinic. We argue that the future digital clinic will not be defined solely by technical progress, but by how consciously healthcare systems integrate digital tools to hybrid care solutions while preserving human-centered, equitable, and evidence-based care.
Self-injury in adolescents is a significant mental health concern. Most school staff have encountered self-injury in the educational setting, yet many report not feeling confident in dealing with self-injury. We delivered nine two-day workshops on suicidal and nonsuicidal self-injury to 199 school staff (83.9
OBJECTIVE:To assess whether pre-existing endometriosis is associated with specific adverse pregnancy and delivery outcomes in primiparous women. DESIGN:Retrospective cohort study. SETTING:Tertiary care university hospital. POPULATION OR SAMPLE:Primiparous women with singleton pregnancies. METHODS:Women with endometriosis were compared with primiparous controls without endometriosis. Primary outcomes were preterm birth and cesarean delivery; placenta previa was examined as a key secondary outcome. Multivariable logistic regression models adjusted for maternal age and mode of conception were used. MAIN OUTCOME MEASURES:Preterm birth, cesarean delivery, placenta previa. RESULTS:Among 16,033 primiparous women, 118 had a diagnosis of endometriosis prior to pregnancy. After adjustment for maternal age and mode of conception, endometriosis was not independently associated with preterm birth (adjusted odds ratio 0.75; 95% confidence interval 0.44-1.28) or cesarean delivery (adjusted odds ratio, 1.17; 95% confidence interval, 0.81-1.71). In contrast, endometriosis was associated with placenta previa (adjusted odds ratio, 5.90; 95% confidence interval, 2.37-14.71). CONCLUSION:In primiparous women, pre-existing endometriosis was independently associated with placenta previa, but not with preterm birth or cesarean delivery. These findings support abnormal early placentation as a potential mechanism linking endometriosis to adverse obstetric outcomes.
Abstract Background Adolescence and early adulthood are crucial periods marked by identity formation and increased vulnerability to mental health issues, with most mental disorders beginning before the age of 25. Today’s youth face amplified risks during a period characterized by multiple societal crises like the COVID-19 pandemic, climate change and economic instability, potentially disrupting age-typical developmental tasks and contributing to rising rates of anxiety and depression. This study aimed to investigate longitudinal patterns of anxiety and depression symptoms across four generational cohorts. Methods This study drew on data from the German subsample of the ongoing “SOSEC – Social Sentiment in Times of Crises” project. In total, 25,143 individuals contributed 112,858 survey entries, responding to items on depression and anxiety symptoms based on modified versions of the PHQ-9 and GAD-2. Generational groups were defined based on year of birth (Generation Z: 1995–2007; Generation Y: 1980–1994; Generation X: 1965–1979; Baby Boomers/Traditionalists: 1925–1964). Linear mixed-effects models were used to examine associations of generation, survey period, gender and employment status with reported symptom levels, including interaction terms and post-hoc comparisons. Results On average, Generation Z reported higher levels of depression and anxiety symptoms compared to older generations across all survey periods (all p < .001). Women reported higher symptom levels than men and employment was associated to lower symptom levels. Conclusions The findings indicate persistently elevated levels of self-reported depression and anxiety symptoms among younger respondents, particularly Generation Z. Associations with employment suggest potential avenues for targeted prevention. Cautious interpretation is warranted, given the observational design and potential confounding factors. These results highlight the importance of monitoring mental health trajectories in young populations during periods of societal stress.
Abstract Background Transoesophageal echocardiography (TOE) is essential for identifying cardiac sources of embolism in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). As randomized controlled trials are missing, recommendations regarding echocardiography after stroke remain vague, and clinical routines and structural resources for performing TOE on stroke units may differ. We here examined structural conditions for performing TOE on certified stroke units in Germany, and evaluated factors that may influence the decision to perform TOEs. Methods In this prospective exploratory cross-sectional survey, a standardized anonymous questionnaire was sent to all clinical leads of certified stroke units in Germany, supported by the German Stroke Society. The questionnaire focused on (a) on general characteristics of stroke units and logistics of TOE examinations and (b) local indication for performing TOEs, with a focus on factors that may influence this decision. Results Data from 248 SUs (stroke units) were included into the analysis (response rate 71.1%). The reported median TOE rate was 23.0% (IQR 18–34). Lower TOE rates were related to increasing numbers of stroke patients (p = 0.048). Most TOEs were performed within 24–48 h after the request (49.6%). Longer waiting times for TOE were associated with level of certification (p < 0.001) and higher numbers of stroke patients (p = 0.002). The presence of a stroke unit cardiologist did not result into shorter waiting times (p = 0.238). In total, 23.8% of the responding stroke units do not have a standardized operating procedure (SOP) for indicating TOE. Though 50% of leads considered quantitative requirements for indicating TOEs, within certain clinical contexts and situations, our findings revealed a broad consensus among stroke unit leads concerning TOE indications. Conclusions Despite limitations, our study provides valuable insights into performing TOE in hospitalized German stroke patients. This may facilitate the optimized use of TOE in hospitals and represent a first step towards the development of future guidelines and SOPs, in particular in the context of limited resources.
