Characteristics of patients with a lipoprotein(a) assessment – a health insurance claims database analysis

Abstract Background Elevated lipoprotein(a) [Lp(a)] has been established as marker of cardiovascular [CV] risk, however, it is not commonly assessed. Purpose The aim of the study was to characterize patients who underwent their first Lp(a) testing regarding sociodemographic characteristics and clinical outcomes. Methods A retrospective analysis was performed on data from 4 million individual patients in a local database that provides complete, longitudinal, anonymized claims data. The data are representative of the German population in terms of age and gender. Lp(a) billing codes documented in the ambulatory setting were used to identify adult patients in 2015 to 2018 (index quarter defined as the first Lp(a) test in the respective year). These patients must not have had any Lp(a) test in the year prior to the index quarter. Patient data needed to be available for at least 1 year before and 1 year after the Lp(a) test or until death, whichever came first. Patients were followed for a maximum of four years. Results Within the four-year period, 36.609 patients (0.83% of the analysis set) had an Lp(a) test, of whom the majority (58%) were women. 50% of the women (median age 49 years) and 32% of the men (median age 56 years) were younger than 50 years. The most prevalent comorbidities (based on International Classification of Diseases, version 10, German modification) at index were: dyslipidemia (E78) 46%, essential hypertension (I10) 46%, dorsalgia (M54) 25%, overweight/obesity (E66) 18%, chronic ischemic heart disease (I25) 16%, type 2 diabetes mellitus (E11) 15%, other coagulation defects (D68) 14%, depressive episodes (F32) 14%; disorders of refraction and accommodation (H52) 13%, somatoform disorders (F45) 13%, other non-toxic goiter (E04) 13%, other hypothyroidism (E03) 13%, and chronic kidney disease (N18) 11%. The rates of cardiovascular events and procedures are listed in the table below. Conclusions Lp(a) tests are rarely performed in Germany. Women are more often tested than men, and in women this is done at a younger age. The data suggest that CV events/ CV hospitalizations frequently trigger the first Lp(a) assessment. The population tested displayed a high prevalence of cardiovascular comorbidities. The data identify an opportunity to better characterize the CV risk by testing Lp(a) once in a lifetime independent of prior CV events as recommended by current European Society of Cardiology/European Atherosclerosis Society guidelines. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The analysis has been funded by Novartis Pharma GmbH, Nuremberg.

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ACTUAL PROBLEMS OF PREVENTION OF SUICIDE IN THE ARMED FORCES OF THE RUSSIAN FEDERATIO

Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations ◽

10.25016/2541-7487-2019-0-4-50-58 ◽

2019 ◽

pp. 50-58

Author(s):

V. K. Shamrei ◽

K. V. Dnov ◽

V. I. Evdokimov

Keyword(s):

Mental Disorders ◽

Early Detection ◽

Behavioral Disorders ◽

Military Personnel ◽

Military Service ◽

Somatoform Disorders ◽

Armed Forces ◽

International Classification Of Diseases ◽

Addictive Disorders ◽

The Military

Relevance. The level of suicides, according to several authors, is one of the most significant indicators of mental health in society, including in the armies of the world.Intention. To analyze suicides and their existing prevention system in the Russian Federation population and Armed Forces in 2007–2018.Methodology. Mental disorders and behavioral disorders (F00–F99 by Chapter V, the International Classification of Diseases of the 10th revision) were analyzed according to 3/MED Form in the military units, where ≥ 80 % of the military personnel served. The longterm trends of the main statistical indicators of suicides and mental disorders among military personnel compared to the Russian population have been established.Results and Discussion. In 2007–2018, the level of suicides in the Russian Armed Forces was (12.00 ± 1.35) per 100 thousand military personnel and was 1.7 times lower than in the population of Russia (20.12 ± 1.56) per 100 thousand (p < 0.001). The level of suicides seems to decrease among the military personnel of the Russian Armed Forces. When analyzing the longterm incidence of mental disorders and the level of suicides in the personnel of the Armed Forces of Russia, no significant correlation was found. At the same time, in a cohort of officers and ensigns, a statistically significant correlation was established between the level of suicides and the general incidence of the Chapter V diseases (r = 0.87; p < 0.01), including stressrelated neurotic and somatoform disorders (F40–F48; r = 0.72; p < 0.01), mental and behavioral disorders associated with the use of psychoactive substances (F10–F19; r = 0.89; p < 0.001). In the military conscripts, there was a correlation between the level of suicides and general morbidity related to Chapter V diseases (r = 0.72; p < 0.05), including personality and behavior disorders in adulthood (F60–F69; r = 0.81; p < 0.01) and organic, including symptomatic, mental disorders (F00– F09; r = 0.76; p < 0.05). It was revealed that among the officers and military personnel under the contract, family and domestic causes of suicide prevailed in contrast to the draft servicemen. Meanwhile somatic and mental diseases as a predominant cause of suicide accounted for a relatively small proportion.Conclusion. Psychoprophylactic measures should be aimed at early detection of servicemen prone to suicidal behavior, effective assistance in resolving militaryprofessional difficulties and domestic problems, as well as at improving their adaptation to military service. Special attention should be paid to the early detection of people with addictive disorders, especially alcohol abusers.

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Study of psychiatric disorders among nepalese patients working abroad and their family members

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v6i4.6718 ◽

2012 ◽

Vol 6 (4) ◽

pp. 1-6

Author(s):

B Yengkokpam ◽

SK Shah ◽

GR Bhantana

Keyword(s):

Psychiatric Disorders ◽

Psychotic Disorders ◽

Somatoform Disorders ◽

Bipolar Affective Disorder ◽

Family Members ◽

International Classification Of Diseases ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Classification Of Diseases ◽

Icd 10

This study was carried out among the patients working abroad and their family members, having various psychiatric disorders. 80 patients attending psychiatry OPD between the age of 15 to 65 years both male and female in the period of July 2009 to July 2010 were included. The results were tabulated as per the diagnostic criteria of International Classification of Diseases (ICD-10). Out of total 80 patients, 41 were males and 39 were females, whose husbands were working abroad. 30 cases were of depression,out of which 16 were males and 14 were females.18 cases were having anxiety disorders out of which 5 were males and 13 were females. 12 cases were suffering from psychotic disorders out of which 10 were males and 2 were females.7 cases were having dissociative disorders with 1 male and 6 females.4 cases were having somatoform disorders with 2 males and 2 females.1 male and 1 female were suffering from mania.1 male and 1 female were suffering from bipolar affective disorder. 2 males were alcohol dependent and 2 males were having obsessive compulsive disorder. 1 male was having organic psychosis. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6718

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Caregiver Burden and Disability in Somatoform Disorder: An Exploratory Study

Indian Journal of Psychological Medicine ◽

10.1177/0253717620957563 ◽

2020 ◽

pp. 025371762095756

Author(s):

Esther Chinneimawi ◽

Padmavathi Nagarajan ◽

Vikas Menon

Keyword(s):

Caregiver Burden ◽

Somatoform Disorders ◽

Statistical Significance ◽

International Classification Of Diseases ◽

Somatoform Disorder ◽

Chi Square ◽

Disability Score ◽

Chi Square Test ◽

The Mean ◽

Student’S T

Background: Very few Indian studies have explored disability among patients with somatoform disorder and the burden experienced by their caregivers. We aimed to assess the levels of disability among patients with somatoform disorder and the levels of burden among their caregivers and compare these parameters against patients with schizophrenia. Methods: Participants included adults with a diagnosis of somatoform disorders (F45.0–F 45.9) ( n = 28) or schizophrenia (F20.0–F20.9) ( n = 28) diagnosed as per the International Classification of Diseases, Tenth Revision ( ICD-10), clinical descriptions, and diagnostic guidelines, as well as their caregivers. The WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent Student’s t-test or chi-square test was used to compare relevant sociodemographic and clinical parameters. Results: Out of 56 patients, the mean (±SD) age of the sample was 38.6 (±10.5) years. Females constituted a slender majority of the sample ( n = 29, 51.8%). The mean disability score of patients with somatoform disorders was slightly higher (83.6 ±20.9) than that of patients with schizophrenia (82.3 ±16.7). Similarly, the mean burden score of caregivers of patients with somatoform disorders was nominally higher (18.96 ±9.9) than that of caregivers of patients with schizophrenia (15.7 ±9.7). Neither of these differences approached statistical significance (P > 0.05). Conclusion: Patients with somatoform disorders experience considerable levels of disability, and their caregivers go through various levels of burden in their daily life that is comparable to schizophrenia.

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Socioeconomic Characteristics of Patients Undergoing Ambulatory Parathyroidectomy and a Comparison of Institutional Charges

The American Surgeon ◽

10.1177/0003134820951479 ◽

2020 ◽

pp. 000313482095147

Author(s):

Ellie A. Moeller ◽

Tamar Walker ◽

Zahra F. Khan ◽

Joshua P. Parreco ◽

Jessica L. Buicko

Keyword(s):

Logistic Regression ◽

Ambulatory Surgery ◽

Private Insurance ◽

High Volume ◽

International Classification Of Diseases ◽

Ambulatory Setting ◽

Multivariate Logistic Regression ◽

White Ethnicity ◽

Classification Of Diseases ◽

Icd 10

Background Parathyroidectomy is frequently performed as ambulatory surgery. This study seeks to characterize the socioeconomic factors that may impact the patient selection for outpatient parathyroidectomy. Methods The 2016 Florida State Inpatient Database (SID) and the 2016 Florida State Ambulatory Surgery Database (SASD) were queried for all patients undergoing parathyroidectomy using the International Classification of Diseases 10 (ICD-10) procedure codes. Univariable comparison and multivariate logistic regression were performed for outpatient versus inpatient parathyroidectomy using all relevant patient and hospital characteristics from the database. Results Seven hundred and sixteen patients underwent parathyroidectomy in Florida in 2016; 322 parathyroidectomies were performed in the ambulatory setting (45.0%). After multivariate logistic regression, patients over age 65 and parathyroidectomies performed at high-volume centers were more likely to be performed at an outpatient center. Those patients who were black, Hispanic, had a Charlson Comorbidity Index ≥3, Medicare, Medicaid, and Self-pay were associated with a decreased likelihood of having an outpatient procedure. Discussion Access to ambulatory parathyroidectomy is more common in patients with private insurance, white ethnicity, and fewer comorbidities.

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Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS)

Psychological Medicine ◽

10.1017/s0033291703001399 ◽

2004 ◽

Vol 34 (4) ◽

pp. 597-611 ◽

Cited By ~ 659

Author(s):

F. JACOBI ◽

H.-U. WITTCHEN ◽

C. HÖLTING ◽

M. HÖFLER ◽

H. PFISTER ◽

...

Keyword(s):

Mental Disorders ◽

Anxiety Disorders ◽

Somatoform Disorders ◽

Care Utilization ◽

Computer Assisted ◽

German Population ◽

Conditional Response ◽

Health Interview ◽

Co Morbidity ◽

Dsm Iv

Background. The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community.Methods. The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87·6%) can be regarded as representative for the German population aged 18–65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers.Results. 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in ‘pure’, 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder.Conclusions. Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

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Age- and sex-specific first health care use for migraine in 2016 in children and adolescents from prospectively collected health insurance data in Germany

Cephalalgia ◽

10.1177/0333102419844543 ◽

2019 ◽

Vol 39 (9) ◽

pp. 1156-1163 ◽

Cited By ~ 4

Author(s):

Lucia Albers ◽

Rüdiger von Kries ◽

Andreas Straube ◽

Florian Heinen ◽

Mirjam N Landgraf ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Children And Adolescents ◽

Disease Onset ◽

International Classification Of Diseases ◽

Health Care Use ◽

German Population ◽

Health Insurance Data ◽

Classification Of Diseases ◽

Age And Sex

Background Migraine in children and adolescents is associated with significant disability and a high risk of persistence into adulthood. Objective Data on migraine incidence in children and adolescents are few and relatively coarse. To tailor interventions starting shortly after disease onset, detailed information on age- and sex-specific incidence of migraine in children and adolescents is needed. Methods We used health care data prospectively collected by the BARMER statutory health insurance, representing ∼11% of the German population. The incidence of migraine diagnoses (International Classification of Diseases (ICD)-10 code G43) in the year 2016 was assessed in subjects aged 0–19 years, who had been continuously insured with the BARMER between 2005 and 2016 or during their entire lifespan. Results Data from ∼1.2 million children and adolescents were available. The incidence of migraine diagnoses steadily increased with age, reaching ∼1% per year around the age of 10 for both sexes, and 3.49% per year in females and 1.72% per year in males at the age of 19. Incidences in males and females were similar up to the age of 13 and higher in females from there on. The proportion of incident migraine diagnoses specified as “definite” versus “probable” migraine increased with age. Conclusion The present study provides a representative estimation of the first documented health care use for migraine in children and adolescents in Germany within 1-year age bins, separately for boys and girls. These data will be helpful for tailoring early healthcare interventions to reduce disability and prevent migraine chronification.

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Lipid-Management 2020 – medikamentöse Therapie und Lipidapherese im Kontext

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0887-0595 ◽

2020 ◽

Vol 145 (07) ◽

pp. 464-469

Author(s):

Kyrill S. Rogacev ◽

Ulrich Laufs

Keyword(s):

European Society ◽

Medikamentöse Therapie ◽

Lipid Management ◽

Lipoprotein A ◽

European Society Of Cardiology ◽

Klasse Ii

Was ist neu? Medikamentöse Therapie Die aktualisierte Dyslipidämie-Leitlinie der European Society of Cardiology senkt nochmals die LDL-Cholesterinzielwerte. Zur Erreichung dieser Zielwerte werden hochpotente Statine und vermehrt Kombinationspartner wie Ezetimib und PCSK9-Hemmer nötig werden. Lipidapherese Die Bestimmung von Lipoprotein(a) zur kardiovaskulären Risikostratifizierung ist nun eine Klasse-II(a)-Empfehlung. Momentan steht lediglich die Lipidapherese zur Senkung von Lipoprotein(a) zur Verfügung, neue medikamentöse Therapieansätze sind allerdings in der klinischen Erprobung.

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Migraine and the development of additional psychiatric and pain disorders in the transition from adolescence to adulthood

Cephalalgia ◽

10.1177/03331024211021792 ◽

2021 ◽

pp. 033310242110217

Author(s):

Lucia Gerstl ◽

Natalie Tadych ◽

Florian Heinen ◽

Christine Kainz ◽

Michaela V Bonfert ◽

...

Keyword(s):

Somatoform Disorders ◽

Negative Impact ◽

Psychosocial Problems ◽

International Classification Of Diseases ◽

Control Group ◽

Health Insurance Data ◽

Term Outcome ◽

Long Term Outcome ◽

Classification Of Diseases ◽

Icd 10

Introduction The transition from childhood to adolescence and from adolescence to adulthood are vulnerable phases in life. In these phases, late or insufficient treatment of diseases may lead to chronification and favor development of additional disorders. In adolescents, migraine often has a highly negative impact on school performance and everyday life. The hypothesis of the present study was that adolescents with migraine have a higher risk for developing additional disorders such as psychiatric disorders or other pain syndromes in the course of the disease. Materials and methods In this study, we analyzed health insurance data of 56,597 German adolescents at the age of 15 years in the year 2006. By using the International Classification of Diseases (ICD 10), we determined a group with migraine diagnosis in the year 2006 and a control group without any headache diagnosis in 2006. We then compared both groups regarding the development of additional disorders (based on the ICD 10) during the following 10 years (2007 to 2016). Results Adolescents with migraine had a 2.1 fold higher risk than persons without migraine diagnosis to develop an additional affective or mood disorder, a 1.8 fold higher risk to obtain neurotic, stress-related and somatoform disorders, a 1.8 fold higher risk to subsequently suffer from behavioral syndromes, a 1.6 higher risk to get back pain and a 1.5 fold higher risk for irritable bowel syndrome during the next 10 years. Conclusion Adolescents with migraine are at risk for developing additional disorders later. Considering and addressing the patient’s risks and potential medical and psychosocial problems might improve the long-term outcome significantly.

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2019 Leitlinie Dyslipidämie kompakt

Der Klinikarzt ◽

10.1055/a-1237-3557 ◽

2020 ◽

Vol 49 (07/08) ◽

pp. 320-325

Author(s):

Oliver Weingärtner ◽

Ulf Landmesser ◽

Ulrich Laufs ◽

Winfried März

Keyword(s):

European Society ◽

Apolipoprotein B ◽

Score System ◽

Kardiovaskuläre Ereignisse ◽

Lipoprotein A ◽

European Atherosclerosis Society ◽

European Society Of Cardiology

ZUSAMMENFASSUNGIm August 2019 wurden auf der Jahrestagung des Europäischen Kardiologen Kongresses in Paris (ESC 2019) die neuen Leitlinien für Dyslipidämien der European Society of Cardiology (ESC) und der European Atherosclerosis Society (EAS) vorgestellt. Die aktualisierte Leitlinie behält das Konzept der risikoadaptierten Zielwerte bei, setzt jedoch die zu erreichenden LDL-C-Ziele abhängig vom individuellen Risiko tiefer als bisher. Neben dem vermehrten Einsatz von bildgebenden Verfahren wie Koronar-CT oder Ultraschall der Hals- und Beckengefäße wird das SCORE-System zur Risikostratifizierung empfohlen. Die zusätzliche Bestimmung von Lipoprotein(a) und Apolipoprotein B hilft, Risikopersonen früher zu identifizieren. Ezetimib und PCSK9-Inhibitoren konnten unter laufender Statintherapie eine weitere Risikoreduktion für kardiovaskuläre Ereignisse nachweisen. Die Verringerung des kardiovaskulären Risikos ist abhängig von der absoluten LDL-C-Senkung, der Therapiedauer und dem individuellen kardiovaskulären Ausgangsrisiko. Für Patienten mit sehr hohem Risiko gilt das neue LDL-C-Ziel < 1,4 mmol/l (55 mg/dl) und eine prozentuale Reduktion des LDL-C-Ausgangswerts um ≥ 50 %.

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