Patients with interstitial lung diseases (ILD) have impaired health-related quality of life (HRQL). Little is known about the applicability of the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) and the generic EQ-5D-5L in a German setting. We assessed disease-specific (K-BILD) and generic HRQL (EQ-5D experience based value set (EBVS) and Visual Analog Scale (VAS)) in 229 patients with different ILD subtypes in a longitudinal observational study (HILDA). Additionally, we assessed the correlation of the HRQL measures with lung function and comorbidities. In a linear regression model, we investigated predictors (including age, sex, ILD subtype, FVC percentage of predicted value (FVC%pred), DLCO percentage of predicted value, and comorbidities). Among the 229 patients mean age was 63.2 (Standard deviation (SD): 12.9), 67.3% male, 24.0% had idiopathic pulmonary fibrosis, and 22.3% sarcoidosis. Means scores were as follows for EQ-5D EBVS 0.66(SD 0.17), VAS 61.4 (SD 19.1) and K-BILD Total 53.6 (SD 13.8). K-BILD had good construct validity (high correlation with EQ-5D EBVS (0.71)) and good internal consistency (Cronbach’s alpha 0.89). Moreover, all HRQL measures were highly accepted by patients including low missing items and there were no ceiling or floor effects. A higher FVC % pred was associated with higher HRQL in all measures meanwhile comorbidities had a negative influence on HRQL. K-BILD and EQ-5D had similar HRQL trends and were associated similarly to the same disease-related factors in Germany. Our data supports the use of K-BILD in clinical practice in Germany, since it captures disease specific effects of ILD. Additionally, the use of the EQ-5D-5L could provide comparison to different disease areas and give an overview about the position of ILD patients in comparison to general population.

Background: Asthma patients experience impairments in health-related quality of life (HRQL). Interventions are available to improve HRQL. EQ-5D-5L is a common generic tool used to evaluate health interventions. However, there is debate over whether the use of this measure is adequate in asthma patients. Methods: We used data from 371 asthma patients participating in a pulmonary rehabilitation (PR) program from the EPRA randomized controlled trial. We used four time points: T0 randomization, T1 start PR, T2 end PR, T3 3 months follow-up. We calculated floor and ceiling effects, intra-class correlation (ICC), Cohen’s d, and regression analysis to measure the sensitivity to changes of EQ-5D-5 L (EQ-5D index and Visual Analog Scale (VAS)) and the disease-specific Asthma Quality of Life Questionnaire (AQLQ). Furthermore, we estimated the minimally important difference (MID). Based on the Asthma Control Test (ACT) scores, we defined three groups: 1. ACT-A (ACT> 19) controlled asthma, 2. ACT-B (14 < ACT≤19) not well-controlled asthma, and 3. ACT-C (ACT≤14) very poorly controlled asthma. Results: Only the EQ-5D index showed ceiling effects at T2 and T3 (32%). ICC (between T0 and T1) was moderate or good for all measures. Cohen’s d at T2 and T3 was better at differentiating between ACT-A and ACT-B than between ACT-B and ACT-C. The EQ-5D index showed moderate effect sizes (0.63–0.75), while AQLQ showed large effect sizes (0.74–1,48). VAS was responsive to pronounced positive and negative ACT changes in every period, and AQLQ mostly to the positive changes, whereas the EQ-5D index was less responsive. We estimated a MID of 0.08 for the EQ-5D index, 12.3 for VAS, and 0.65 for AQLQ. Conclusion: All presented HRQL tools had good discriminatory power and good reliability. However, EQ-5D-5 L did not react very sensitively to small changes in asthma control. Therefore, we would suggest using supplementary measures in addition to EQ-5D-5 L to evaluate asthma-specific interventions more comprehensively. Trial registration: German Clinical Trial Register, DRKS00007740 (date of registration: 05/15/2015), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007740. The registration took place prospectively.

Risk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization. Data of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals’ general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs. Higher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations. We conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making – especially in case of participation in preventive services.

Objectives: Patients with chronic obstructive pulmonary disease (COPD) show impairments in health-related quality of life (HRQL). We aimed to find a disease-specific questionnaire for routine application in large cohorts and to assess its additional explanatory power to generic HRQL tool (EQ-5D-5L). Methods: 1,350 participants of the disease management program COPD received the EQ-5D-5L combined with one of the three disease-specific tools: COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) or St. George’s Respiratory Disease Questionnaire (SGRQ) (450 participants each). We compared metric properties and evaluated the Germany-specific experience-based values (EBVS) and utilities in comparison to the Visual Analogue Scale (VAS). We calculated the additional explanatory power of the identified disease-specific tool on VAS through regression analysis. Results: 344 patients returned the questionnaire. CAT, CCQ, and SGRQ group did not differ regarding baseline characteristics. The questionnaire specific response rates were 33.7% for CAT, 30.5% for CCQ, and 34.6% SGRQ, thereof 94.0%, 94.3%, and 65.6% valid answers, respectively. EBVS was better suited to reflect VAS than utilities. CAT increased the explanatory power by 10%. Conclusion: CAT outperformed CCQ and SGRQ, and it increased the explanatory power of VAS. EBV combined with CAT seems superior to only generic or disease-specific approaches.

Background/Objectives: Cranioplasty (CP) is associated with high complication rates (20–50%), and the optimal choice between patient-specific implants (PSIs) and hand-molded (HM) alternatives remains debated. This systematic review and meta-analysis aims to compare surgical and postoperative outcomes between PSIs and HM implants. Methods: A systematic search was performed in three databases to identify studies reporting surgical site infection (SSI), implant removal, reoperation, operative time or cosmetic outcome for PSIs and/or HM implants. Two-arm studies of the same material were analyzed separately from pooled single- and two-arm studies. Results: 125 observational studies involving 10,034 patients were included. In two-arm comparisons, PSIs reduced implant removal for titanium (OR 0.34, p = 0.053) and PMMA (OR 0.56, p = 0.188), while SSI rates showed no meaningful difference between groups. In one-arm analyses, PSIs demonstrated lower explantation probabilities (titanium 6.1%, PMMA 7.9%) compared with HM alternatives (titanium 9.9%, PMMA 14.2%), alongside shorter operation times and fewer reoperations. Cosmetic outcomes consistently favored PSIs. Conclusions: PSIs demonstrate advantages in efficiency, durability, and esthetics compared with HM implants, supporting their preferential use where resources allow. HM implants remain a cost-effective option in resource-limited settings. Due to the observational nature of the included studies and differences in study populations across arms, the findings should be interpreted with caution.

Depression and anxiety are increasingly recognized as important comorbidities in gastrointestinal (GI) disorders, influencing disease burden and patient outcomes. However, their prevalence in pancreatitis, both in its acute (AP) and chronic (CP) forms, remains underexplored. This systematic review and meta-analysis aimed to quantify the burden of depressive and anxiety symptoms among patients with pancreatitis. We conducted a systematic search (PROSPERO: CRD42023481739) across three databases: MEDLINE, Embase, and CENTRAL, to identify studies reporting on the prevalence of depression and anxiety symptoms in patients with AP or CP, as of November 10, 2023. The random-effects model was used to calculate the pooled proportion rate and pooled means of different anxiety/depression scores, along with 95 % confidence intervals (CI). In total, 44 studies were included. Anxiety was observed in 23 % (CI: 7 %-54 %) of the AP cases, and it was observed in 31 % (CI: 23 %-39 %) of the CP cases. Depressive symptoms were observed in 29 % (CI: 14 %-51 %) of the AP patients, while in CP cases, the prevalence was 39 % (CI: 30 %-48 %). The pooled single-mean analysis of psychological questionnaire data confirms clinically significant levels of both depressive and anxiety symptoms. Mean scores exceeded established cut-off points across all measures: CESD-10 (14.30 [CI: 6.69-21.92]), HADS-depression (8.23 [CI: 4.53-11.94]), SES (49.29 [CI: 44.01-54.57]), HADS-anxiety (8.67 [CI: 6.89-10.46]), and SAS (47.75 [CI: 35.05-60.45]). These findings indicate that many participants experienced symptom levels beyond the normative range. Overall, a low risk of bias was observed; however, several studies were identified as high risk due to reporting limitations. Our findings reveal a notably high prevalence of depression and anxiety in pancreatitis, exceeding global averages and rates seen in other GI disorders. These findings warrant routine psychological screening, ongoing follow-up, and the integration of mental health professionals into multidisciplinary care teams are therefore warranted.