KUKA (Germany)

The impact of demographic change has far-reaching consequences for the entire healthcare system. One of the areas particularly affected is palliative and hospice care. To meet the demand for palliative and hospice care services, adequate capacity planning in inpatient and outpatient settings is essential. However, the available capacities per one million inhabitants in Germany vary significantly within the individual regions. For an improved assessment of care needs, we propose a simulation-based analysis, carried out both retrospectively for 2019 and prospectively for 2039 for the southern German region of Swabia, and calculate the required capacities of hospices and specialized outpatient palliative care. We focus on cancer patients, as this group represents the largest proportion of patients requiring palliative and hospice care. Driven by demographic change and the increasing incidence of cancer in older age groups, the number of patients requiring palliative care is expected to increase substantially. Accordingly, our results indicate a marked rise in the demand for hospice and specialized outpatient palliative care for cancer patients up to the year 2039. This projected trend underscores the growing care needs within this patient population in the coming decades. Our study introduces a simulation-based framework for estimating demand for hospice and specialized outpatient palliative care. By offering a quantitative, mathematical-statistical perspective, the approach complements existing qualitative research and supports informed decision making in palliative care planning.

On 15 October 2025, the revised S3 guideline on schizophrenia (living) was published and transferred to the MAGICapp evidence ecosystem and will be updated annually in the future. This narrative review summarizes essential innovations and explains their development. New and revised recommendations and MAGICapp background information were extracted and summarized. The guideline is now fully integrated into MAGICapp and annually updated. Key changes include adowngrading of the recommendation for antipsychotic monotherapy, asubstantial expansion of guidance on adverse effect monitoring and management and astrengthened emphasis on evidence-based psychotherapeutic interventions, such as metacognitive training and systemic therapy. Additionally, 4 new recommendations (digital/technology-assisted interventions, mindfulness-based procedures, acceptance and commitment therapy [ACT], trauma-focussed therapy for post-traumatic stress disorder [PTSD]) were implemented and 12 were removed. All chapters were comprehensively revised.

Since their discovery in the 18th century, artificial sweeteners have been an important part of modern-day nutrition. The same applies to sugar consumption, which has increased massively in the last few decades. That is why the World Health Organization (WHO) recommends limiting free sugar intake to less than 10% of total daily energy intake, with additional benefits likely at levels below 5% per day. This high consumption led to the fact that diabetes is now one of the most frequent comorbidities in the world, with around 529 million people suffering from this disease. Patients need to be careful with their diet, which raises the question of whether artificial sweeteners should be mandatory in a diabetic nutrition plan. To answer this question, a systematic review following PRISMA guidelines and a meta-analysis were conducted. Overall, 22 studies were included in this review. The results of the studies were ambivalent, and no general statement could thus be made. We found the same results in the meta-analysis, where Hedges' g was used as an effect size. Artificial sweeteners were associated with higher insulin (g = 0.50, 95% CI, 0.19-0.82) and higher HbA1c (g = 0.30, 95% CI, 0.06-0.54) in common-effects models; however, these associations were not relevant in random-effects models, and heterogeneity was substantial. No consistent effects were observed for other outcomes. Based on current evidence, the routine use of artificial sweeteners in diabetic diets cannot be recommended.

<h2>Abstract</h2> Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) in children and adolescents are rare and biologically heterogeneous. Due to their low incidence, therapeutic strategies are largely adapted from adult protocols, underscoring a critical need for paediatric-specific evidence. Surgical resection remains the mainstay of curative treatment for localized disease and should be prioritized before the initiation of systemic therapy whenever feasible. This review synthesizes current knowledge on systemic therapies in paediatric GEP-NENs, including somatostatin analogues (SSAs), peptide receptor radionuclide therapy (PRRT), chemotherapy, small molecules (e.g., everolimus, sunitinib), and immune checkpoint inhibitors (ICIs). While SSAs remain the mainstay for well-differentiated, somatostatin receptor (SSTR)-positive tumours, emerging data support the safety and potential efficacy of PRRT in paediatric populations, despite limited prospective evidence. Chemotherapy continues to play a role in high-grade or progressive disease, although responses are variable. Supportive therapies, including high-dose proton pump inhibitors (PPIs), are also important in managing functional tumours and can significantly alleviate clinical symptoms in advanced disease. Novel approaches, including SSTR antagonists, α- and β-emitting radiopharmaceuticals, and oncolytic virotherapy (e.g., SVV-001), are under active investigation in adults and may inform future paediatric protocols. Resistance mechanisms—particularly to SSAs—highlight the dynamic nature of tumour evolution and the need for individualized strategies. These insights underscore the importance of molecular profiling and imaging-based SSTR assessment to guide therapeutic selection, particularly in refractory or complex paediatric cases. Future efforts should prioritize international collaboration, the design of rational combination regimens, and the integration of radiomics, genomics, and biomarker-driven approaches to advance precision medicine in paediatric GEP-NENs.

PurposeLung cancer (LC) is a leading cause of cancer-related mortality, with smoking being a major risk factor. Despite the benefits of smoking cessation, many LC patients continue to smoke, potentially impacting their quality of life (QoL). This study aimed to explore factors influencing QoL among LC patients, with a focus on smoking status and mental health.MethodsA cross-sectional study was conducted at the University Hospital of Augsburg from December 2021 to December 2023. A total of 56 LC patients were categorized into active smokers (AS), ex-smokers (ES), or never-smokers (NS). Participants completed validated questionnaires assessing QoL, depression, anxiety, stress, borderline personality disorder symptoms, and pain. Statistical analyses, including one-way ANOVA and Pearson’s correlation, were employed to examine group differences and the relationship between QoL and mental health factors.ResultsNo significant differences in overall QoL were observed among AS, ES, and NS. However, mental health indicators—including depression, anxiety, stress, and borderline personality disorder symptoms—were significantly negatively correlated with QoL across all groups. Pain was also a key factor affecting QoL. These findings suggest that while smoking cessation is critical for improving prognosis in LC patients, mental health and pain management are more pivotal in determining QoL.ConclusionThis study emphasizes the need for a holistic approach to LC patient care, addressing both physical and mental health. Future research should focus on longitudinal studies to better understand the long-term effects of smoking and other influencing factors on QoL in this patient population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00406-025-02086-w.

ObjectivesRoughly one in eight individuals presents with psychiatric disorders which were proposed to significantly affect oral health. This study compared oral health of 112 patients (mean 28 years), 31 with schizophrenia spectrum disorders (SSD) or 33 with major depression/bipolar disorders (MDD/BD) to 52 healthy controls (HCG).Materials and methodsOral health parameters, including caries experience (decayed-missed-filled teeth/surfaces-index DMFT/DMFS), the presence of plaque (plaque-index PI) and periodontal health (bleeding on probing BOP, periodontal probing depths PPD%), were evaluated by examiners blinded to psychiatric diagnoses. Descriptive statistics summarized demographic and clinical data. Group differences and associations with dental outcomes were analyzed using Chi-square or Mann-Whitney-U tests. Logistic regression identified predictors of oral health.ResultsPatients with SSD or MDD/BD resented with significantly oorer oral health than HCG regarding DMFT (SSD = 9; MDD/BD = 10; HCG = 2), DMFS (SSD = 10; MDD/BD = 12; HCG = 1), PI (SSD = 2; MDD/BD = 2; HCG = 1), BOP (SSD = 20%; MDD/BD = 17%; HCG = 3)% and PPD% (SSD = 1%; MDD/BD = 0%; HCG = 0%) and smoked more often. Differences regarding dental anxiety were not significant (p = 0.112). Subgroup analysis showed no differences between SSD and MDD/BD.ConclusionsSSD and MDD/BD and smoking are key contributors to poor dental health shown by significantly worse DMFT, DMFS and PI, BOP. Probably this might additionally be enhanced by concomitant medication, with multiple psychiatric medication being associated with poorer oral health regarding DMFT, PI and BOP.Clinical relevanceRoutine dental care and personalized oral hygiene training to address disease-specific risks are desirable for individuals with SSD or MDD/BD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-025-06463-6.

Fundamental knowledge gaps still exist in the exposome, especially regarding analytical space coverage, mapping and prioritization of a very large number of diverse chemical structures. This review focuses on the contributions of suspect and non-target screening (NTS) to contaminants characterization and toxicity assessment in drinking water. A comprehensive review of publications from 2013-2024 revealed only 172 substances identified with certainty using NTS and in 17 countries. The analytical approaches, their complementarity, effectiveness and use with compound identification frameworks are discussed. The use of ‘intelligent’ tools (including machine learning) to aid with substance identification, prioritization and toxicity assessment is emerging. Strategies for integration of NTS in epidemiology are also considered, including re-use of existing data. NTS holds great potential for chemical exposure assessment from drinking water and its contribution to the exposome.

This letter proposes a decoupled two-level modelbased planning strategy and control for a class of robotic tasks involving impact to be made with desired performance and constraints. The first part solves the problem of planning a robotic arm trajectory from a given state (position and velocity) to another desired one, enabling non-stop trajectory cycles. The second part is an impact-aware model-based plugin; it is specific to each task and links the desired task-space impact objective to a via-point in the joint-space. The two parts are then combined to achieve the entire task. Our approach is assessed with realrobot experiments demonstrating how this strategy can be used to perform tossing, grabbing, and boxing or any combination of them in sorting logistics-industry use-cases.