We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan–Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. Of 1175 symptomatic participants included in the present analysis, 636 (54.1

Neuroprognostication after cardiac arrest (CA) is critical for guiding treatment decisions. However, concerns about self-fulfilling prophecy related to withdrawal of life-sustaining therapy (WLST) complicate outcome prediction. This study evaluated the accuracy of guideline-recommended prognostic markers within 14 days after CA for predicting poor 12-month outcomes in patients without WLST during the first four weeks after CA. This prospective multicenter observational study enrolled adults who remained comatose 72 h after CA across eight German hospitals between 2014 and 2017. Patients with WLST during the first four weeks, stroke, pre-existing disorders of consciousness, or terminal malignancy were excluded, leaving 101 patients for analysis. Prognostic markers assessed included pupillary light and corneal reflexes (PLR + CR), EEG, somatosensory evoked potentials (SEP), neuron-specific enolase (NSE) concentration, and the best Coma Recovery Scale–Revised (CRS-R) score. Poor outcome was defined as a modified Rankin Scale score of 4–6 at 12 months. Poor outcomes occurred in 67.3

Background:The COVID-19 pandemic has a lasting impact on health care utilization, as both the acute infection and post COVID condition (PCC) can lead to increased demand for medical services due to ongoing symptoms. Objective:The aim of this study is to systematically examine health care utilization among individuals after acute SARS-CoV-2 infection in Bavaria, Germany, with a particular focus on PCC. The study combines claims data analysis with qualitative interviews to improve the understanding of objective care pathways and patients' subjective experiences within the health care system. Methods:The research project 'SOLongCOVID' employs a mixed-methods design consisting of two subprojects: (1) a retrospective cohort study using claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB) to analyze care pathways through state sequence analysis, (2) a qualitative study based on semistructured interviews and focus groups with patients with PCC concerning their subjective care experiences. A synthesis process involving a focus group discussion will combine the information from the two subprojects, providing a comprehensive understanding of the care processes of patients with PCC. Results:The study was funded by the German Federal Joint Committee Innovation Fund in October 2024. Statutory health insurance claims data cover the period from 2019 to 2022, and qualitative interview data collection is planned from May 2025 to August 2026. As of manuscript submission, study preparation and ethics approvals have been completed, and 14 participants have been recruited for the qualitative interviews. Study findings are anticipated to be published from July 2026 to August 2027. Conclusions:The results are expected to enhance the understanding of existing barriers and challenges and to support evidence-based recommendations for improving care pathways for patients with specific care needs.

To evaluate a multidisciplinary therapy program with a neurological focus for individuals with post-COVID-19 condition, aiming to reduce symptom burden and improve functioning. Non-experimental prospective before–after study. Individuals diagnosed with post-COVID-19 condition, defined as experiencing persistent signs and symptoms for more than 12 weeks after initial SARS-CoV-2 infection. We conducted a 2 week multidisciplinary rehabilitation program at the Schoen Clinic Bad Aibling, Germany. The intervention included multi-professional therapies. Assessments were conducted at six time points: baseline at the start of the 2-week control period, pre- and post-intervention, and at 2, 8, and 24 weeks post-intervention. Mixed-effects regression models were used to analyze changes over time. Outcome measures included health-related quality of life (HRQoL; EQ-5D-5L), fatigue, anxiety, depression, symptom severity, breathing difficulties, cognitive function, functional disability, and performance measures. A total of 47 participants (60 https://drks.de/search/en/trial/DRKS00029415

Walkability beschreibt die Gehfreundlichkeit einer Nachbarschaft und ist ein zentrales Konzept zur Förderung von Mobilität, körperlicher Aktivität und sozialer Teilhabe im Alter. Bestehende Ansätze bilden die spezifischen Bedürfnisse älterer Menschen bislang nur unzureichend ab, insbesondere bei funktionellen Einschränkungen. Der Beitrag zeigt, wie Walkability im höheren Lebensalter konzeptionell weiterentwickelt, funktionssensitiv erfasst und in einem urbanen Kontext empirisch untersucht werden kann. Vorgestellt wird ein Operationalisierungsframework für Walkability im höheren Lebensalter, das auf Vorarbeiten der Autor:innen und einer Delphi-Konsensstudie basiert. Es umfasst die Dimensionen Wohnumfeld und Verkehrsinfrastruktur, Erreichbarkeit von Zielen und Begegnungsorten sowie Attraktivität und Sicherheit der Umgebung. Zentrales Merkmal ist die systematische Berücksichtigung der Interaktion zwischen funktionellem Status und Umweltanforderungen. Am Beispiel des geplanten WALK-Projekts in München wird die praktische Anwendung der Indikatoren in einer kommunalen Mixed-Methods-Studie beschrieben. Kombiniert werden qualitative Interviews, Walk- -Talk-Begehungen, Expert:innenbefragungen und GIS(geografische Informationssystem)-basierte Analysen. Ziel ist es, Barrieren und Förderfaktoren des alltäglichen Gehens älterer Menschen zu identifizieren und daraus Empfehlungen für eine gesundheitsfördernde, alterssensible Stadtentwicklung abzuleiten.

Walkability describes how supportive a neighbourhood is for walking and is a key concept for promoting mobility, physical activity and social participation in older age. However, existing approaches do not adequately reflect the specific needs of older adults, especially in the presence of functional limitations. This article outlines how walkability can be further conceptualised, measured in a function-sensitive way and empirically examined in an urban context.The paper presents an age-specific operationalization framework for walkability based on the authors' previous work and a Delphi consensus study. It includes three dimensions: residential environment and transport infrastructure, accessibility of destinations and meeting places, and attractiveness and safety of the environment. A central feature is the systematic consideration of the interaction between functional status and environmental demands.Using the planned WALK project in Munich as an example, the article illustrates how these indicators can be applied in a municipal mixed-methods study. The design combines qualitative interviews, walk-and-talk assessments, expert interviews and GIS-based analyses. The aim is to identify barriers and facilitators of everyday walking among older adults and to derive recommendations for health-promoting, age-sensitive urban planning.

Bithermal caloric irrigation of the horizontal semicircular canals is a key method of neurotological diagnostics, allowing the detection of peripheral vestibular hypofunction in the low-frequency range. Current diagnostic criteria for unilateral vestibulopathy (UVP), bilateral vestibulopathy (BVP), and presbyvestibulopathy (PVP) rely on gender-neutral absolute or relative metrics. Here, we analyzed all bithermal water caloric examinations performed in the German Center for Vertigo and Balance Disorders (DSGZ) between 07/2018 and 01/2024 and calculated the total caloric reactivity (TR). Patient age and sex were collected as covariates. For UVP, BVP, and PVP diagnoses, international diagnostic criteria were applied. In total, 11,332 patients (6219 females, mean age 55.97±17.52 years) were included. Females displayed a higher TR (mean difference: 6.41°/s, p <0.001). The frequency of UVP, BVP, and PVP diagnoses based on absolute cut-off values showed a significant male predominance (UVP: n = 1144, 548 females, odd ratio [OR] −0.32, p <0.001; BVP: n = 305, 138 females, OR −0.40, p <0.001; PVP: n = 813, 378 females, OR −0.37, p <0.001). However, the rate of UVP based on relative asymmetries showed no sex differences ( n = 2971, 1595 females, OR −0.08, p = 0.06). Diagnostic criteria for UVP, BVP, or PVP, which utilize absolute caloric excitability cut-offs, might need to be updated to address sex-specific differences of caloric excitability.

Vestibular migraine (VM) and Menière’s disease (MD) are spontaneous episodic vestibular syndromes and often present with overlapping features, making clinical differentiation challenging. This study aimed to (1) identify key features distinguishing VM from MD and (2) investigate discrepancies between expert diagnosis and International Classification of Vestibular Disorders (ICVD) criteria for VM. We analyzed data from patients diagnosed with VM or MD at the tertiary dizziness center of LMU Munich. Diagnostic classification was based on ICVD criteria and expert judgment. Symptoms, vestibulo-ocular reflex (VOR) function, and demographics were compared. A conditional inference tree identified key differentiators. For ‘suspected VM’ cases not meeting ICVD criteria, reasons for diagnostic discrepancy were analyzed. We included 290 patients: 188 with VM and 88 with MD. VM was more common in women (72

ObjectiveThe aim of this world-wide survey was to evaluate the currently applied treatment options for the six most frequent peripheral vestibular disorders: benign paroxysmal positional vertigo (BPPV), acute unilateral vestibulopathy (AUVP)/vestibular neuritis, Menière’s disease (MD), bilateral vestibulopathy (BVP), vestibular paroxysmia (VP) and superior canal dehiscence syndrome (SCDS).BackgroundFor the therapy of vestibular disorders, there are four treatment options: vestibular physical therapy (canalith repositioning maneuvers or balance training), pharmacotherapy, surgery, and psychotherapy. Since there are very few state-of-the-art RCTs, the treatment of vestibular disorders is so far not standardized and various methods are applied with heterogeneous efficacy.Design/methodsA web-based standardized survey questionnaire on the treatment of the six most frequent peripheral vestibular disorders was used to collect data.Results234 replies from five continents, 47 countries, 162 cities and 188 centers were received: (% from all 234 replies; multiple answers possible): BPPV: posterior canal BPPV: 71% Epley, 40% Semont, and 12% others. Horizontal canal BPPV canalolithiasis: 58% Lempert (roll-over) maneuver, 33% Gufoni, 7% prolonged rest, and 9% others. Horizontal canal BPPV cupulolithiasis: 35% Gufoni, 27% Lempert (roll-over) maneuver, 9% Zuma, and 7% head shaking: AUVP: 79% pharmacotherapy, namely 47% glucocorticoids, 39% antiemetics, and 24% betahistine; 67% vestibular physical therapy. MD: 85% pharmacotherapy, namely 65% betahistine, 21% diuretics, 20% steroids, 16% antiemetics, 14% gentamicin; 37% surgery. VP: 65% pharmacotherapy, namely 57% anticonvulsants; 7% surgery. BVP: 77% vestibular physical therapy. SCDS: 50% surgery, namely 38.8% canal plugging, 23.3% capping and 15.5% resurfacing.ConclusionIn this world-wide survey with 234 replies from 188 centers, widely heterogeneous applied treatment options were reported for the six most frequent peripheral vestibular disorders. This study shows in particular that certain drugs are often used despite low or very low evidence. Namely in AUVP, MD and VP well-designed controlled trials with clinically meaningful endpoints are needed.

BackgroundPersistent Postural-Perceptual Dizziness (PPPD) is a frequent chronic functional disorder that manifests with dizziness, unsteadiness, or non-spinning vertigo present for at least 3 months. Characteristic provocation factors are moving or complex visual stimuli and exclusion of organic diseases. To assess the severity and impact of PPPD, Japanese researchers developed the Niigata PPPD Questionnaire (NPQ). The study's aim was to evaluate the concurrent construct validity and reliability [including test-retest reliability, internal consistency, standard error of measurement (SEM), and minimal detectable change (MDC)] of the German version of the NPQ (12 items) and its revised version, NPQ-R, which contains 19 items addressing additional symptoms and symptom behavior.MethodsThe Swiss Reha Rheinfelden and the German Center for Vertigo and Balance Disorders included 265 PPPD patients (mean age 50.2 ± 16.8 years, disease duration 46.3 ± 76.6 months). Patients completed the NPQ and the NPQ-R (twice), the DHI and potentially related constructs: anxiety (ABC-Scale, VSS), depression (HADS), and general health (SF-36) once. To assess the questionnaires' reliability and validity, several statistical measures were calculated, including Spearman's rank correlation coefficients, Intraclass Correlation Coefficients (ICC2, 1), Cronbach's alpha, SEM, and MDC.ResultsOn average, patients scored 29.9 ± 13.2 for NPQ and 52.3 ± 19.6 for NPQ-R. Correlations between NPQ/NPQ-R and (1) disease-specific questionnaires were rs= 0.712 and rs= 0.752 (DHI), rs=0.426 and rs= 0.0.462 (VSS-V), rs= -0.500 and rs= -0.545 (ABC-Scale), (2) anxiety-specific subscales rs = 0.394 and rs = 0.430 (VSS-A) and rs= 0.354 and rs= 0.430 (HADS-A), (3) depression-related subscales rs=0.438 and rs= 0.487 (HADS-D), and (4) general health rs ranged between rs= -0.216 and −0.578 (all SF-36 subscales). Internal consistency, test-retest reliability, SEM and MDC calculated for NPQ/NPQ-R were α = 0.88/α = 0.91, ICC=0.83 (CI 0.77 to 0.0.87), SEM 5.55/8.37, and MDC 15/23 points.ConclusionThe German versions of NPQ and NPQ-R are valid and reliable patient-reported outcome measures for assessing PPPD, demonstrating satisfactory psychometric measurement properties including convergent construct validity and reliability parameters: internal consistency, test-retest reliability, SEM, and MDC as an evaluative measure. The NPQ-R, with its additional subscales addressing associated symptoms and symptom behavior, represents both the patient and clinician perspective on PPPD-specific problems. Therefore, we recommend utilizing the NPQ-R for a comprehensive assessment of PPPD.

Bithermal caloric irrigation of the horizontal semicircular canals is a key method of neurotological diagnostics, allowing the detection of peripheral vestibular hypofunction in the low-frequency range. Current diagnostic criteria for unilateral vestibulopathy (UVP), bilateral vestibulopathy (BVP), and presbyvestibulopathy (PVP) rely on gender-neutral absolute or relative metrics. Here, we analyzed all bithermal water caloric examinations performed in the German Center for Vertigo and Balance Disorders (DSGZ) between 07/2018 and 01/2024 and calculated the total caloric reactivity (TR). Patient age and sex were collected as covariates. For UVP, BVP, and PVP diagnoses, international diagnostic criteria were applied. In total, 11,332 patients (6219 females, mean age 55.97±17.52 years) were included. Females displayed a higher TR (mean difference: 6.41°/s, p<0.001). The frequency of UVP, BVP, and PVP diagnoses based on absolute cut-off values showed a significant male predominance (UVP: n = 1144, 548 females, odd ratio [OR] -0.32, p<0.001; BVP: n = 305, 138 females, OR -0.40, p<0.001; PVP: n = 813, 378 females, OR -0.37, p<0.001). However, the rate of UVP based on relative asymmetries showed no sex differences (n = 2971, 1595 females, OR -0.08, p = 0.06). Diagnostic criteria for UVP, BVP, or PVP, which utilize absolute caloric excitability cut-offs, might need to be updated to address sex-specific differences of caloric excitability.

PurposeUntil now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases.MethodsAn online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022.ResultsIn the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases.ConclusionThere are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.

Abstract Background Characterizing clinical phenotypes is important for classifying patients, predicting disease outcomes, and adapting treatment. We aimed to identify distinct clinical phenotypes among hospitalized children and adolescents with SARS-CoV-2 infection and to evaluate variations in prognosis across these phenotypes. Methods The DGPI (German Society of Pediatric Infectious Diseases) registry serves as a nationwide, prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection in Germany. We applied hierarchical clustering and integrated variables such as sex, SARS-CoV-2-related symptoms, pre-existing comorbidities, clinically relevant coinfection, and SARS-CoV-2 risk factors to describe distinct clinical phenotypes. Subsequently, we applied a multinomial logistic regression model to examine the association between these phenotypes and discharge status. Results The DGPI registry encompassed 6983 patients and facilitated the identification of six distinct phenotypes for children and adolescents with SARS-CoV-2. Phenotype A had a similar symptom pattern as the total sample. Predominant symptoms of patients with other phenotypes were gastrointestinal (95.9%, B), asymptomatic (95.9%, C), lower respiratory tract (49.8%, D), lower respiratory tract and ear, nose and throat (86.2% and 41.7%, E), and neurological (99.2%, F). Patients with phenotype C had lower odds of residual symptoms (OR: 0.10 [0.06, 0.15]) than those with phenotype A, whereas patients with phenotype D and E had higher odds of residual symptoms (OR: 1.33 [1.11, 1.59] and 1.91 [1.65, 2.21], respectively) than those with phenotype A. Patients with phenotype D were significantly more likely (OR: 4.00 [1.95, 8.19]) to have an unfavorable outcome, compared to patients with phenotype A. Conclusions We could show that the identified phenotypes could facilitate early risk assessment and aid in tailoring individualized patient management strategies. Key messages • Six distinct clinical phenotypes existed in children and adolescents with SARS-CoV-2 infection. • Phenotypes could assist in risk evaluation and help personalize patient care.

Introduction Menière´s Disease (MD) is characterized by vertigo attacks, low-frequency hearing loss (HL) and fluctuating aural symptoms. Current treatment concepts for MD focus on stabilizing the quality-of-life impairing vertigo. Hearing rehabilitation is often secondary. The presented study investigated the impact of hearing loss on health-related quality of life (HRQoL) and functionality in daily life activities.

Abstract Objective Phenotypes are important for patient classification, disease prognostication, and treatment customization. We aimed to identify distinct clinical phenotypes of children and adolescents hospitalized with SARS-CoV-2 infection, and to evaluate their prognostic differences. Methods The German Society of Pediatric Infectious Diseases (DGPI) registry is a nationwide, prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection in Germany. We applied hierarchical clustering for phenotype identification with variables including sex, SARS-CoV-2-related symptoms on admission, pre-existing comorbidities, clinically relevant coinfection, and SARS-CoV-2 risk factors. Outcomes of this study were: discharge status and ICU admission. Discharge status was categorized as: full recovery, residual symptoms, and unfavorable prognosis (including consequential damage that has already been identified as potentially irreversible at the time of discharge and SARS-CoV-2-related death). After acquiring the phenotypes, we evaluated their correlation with discharge status by multinomial logistic regression model, and correlation with ICU admission by binary logistic regression model. We conducted an analogous subgroup analysis for those aged < 1 year (infants) and those aged ⩾ 1 year (non-infants). Results The DGPI registry enrolled 6983 patients, through which we identified six distinct phenotypes for children and adolescents with SARS-CoV-2 which can be characterized by their symptom pattern: phenotype A had a range of symptoms, while predominant symptoms of patients with other phenotypes were gastrointestinal (95.9%, B), asymptomatic (95.9%, C), lower respiratory tract (49.8%, D), lower respiratory tract and ear, nose and throat (86.2% and 41.7%, E), and neurological (99.2%, F). Regarding discharge status, patients with D and E phenotype had the highest odds of having residual symptoms (OR: 1.33 [1.11, 1.59] and 1.91 [1.65, 2.21], respectively) and patients with phenotype D were significantly more likely (OR: 4.00 [1.95, 8.19]) to have an unfavorable prognosis. Regarding ICU, patients with phenotype D had higher possibility of ICU admission than staying in normal ward (OR: 4.26 [3.06, 5.98]), compared to patients with phenotype A. The outcomes observed in the infants and non-infants closely resembled those of the entire registered population, except infants did not exhibit typical neurological/neuromuscular phenotypes. Conclusions Phenotypes enable pediatric patient stratification by risk and thus assist in personalized patient care. Our findings in SARS-CoV-2-infected population might also be transferable to other infectious diseases.

While mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. The expert workshop and the review led to an extensive list of potential indicators, which we hope will be useful in future research. Those indicators were then adapted and rated in a three-stage Delphi expert survey. A fourth additional Delphi round was conducted to assess the relevance of each indicator for the different frailty levels, namely "robust," "pre-frail," and "frail." Between 20 and 28 experts participated in each round of the Delphi survey. The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: "Built environment and transport infrastructure," "Accessibility and meeting places," and "Attractiveness and sense of security." For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.

Abstract Background The choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany. Methods This is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding. Results We included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02–1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41–1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide. Conclusion In a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care.

Einleitung Morbus Menière (MD) ist von Schwindel, Tieftonhörverlust (HL) und fluktuierenden Ohrsymptomen gekennzeichnet. Aktuelle Behandlungskonzepte konzentrieren sich auf die Stabilisierung des beeinträchtigenden Schwindels. Hörrehabilitation wird häufig als zweitrangig eingeordnet. Die vorliegende Studie untersuchte den Einfluss des Hörverlusts auf gesundheitsbezogene Lebensqualität (HRQoL) und Funktionsfähigkeit