[Test Concept of the City of Cologne for Critical Infrastructure (KRITIS) during the First Wave of the COVID-19 Pandemic]. / Testkonzept der Stadt Köln für die Kritische Infrastruktur (KRITIS) in der ersten Welle der Corona-Pandemie.

BACKGROUND: At the beginning of the COVID-19 pandemic, the Public Health Department of the City of Cologne established preferential testing for critical infrastructure (KRITIS) personnel. The aim of this study was to retrospectively analyze this concept. METHODS: Test results as well as demographic and job-related data from March to April 2020 were collected and descriptively analyzed using a specially developed software. KRITIS personnel who tested positive were systematically interviewed over the phone. RESULTS: 1521 individuals were tested, of whom 896 (59%) were from the healthcare sector, particularly from the nursing professions (35%). Testing and consultation services were also utilized by employees of non-profit organizations (8%), administration (7%), fire department (11%), and police (4%). KRITIS personnel who tested positive suspected increased risk from contacts at the workplace (58%), mostly without adequate protection (85%). Of those surveyed, 83% rated the KRITIS concept as 'good' or 'very good'. Processes at the testing center were rated as 'good' or 'very good' by 89%, while 47% rated phone support as 'good' or 'very good', and 30% as 'sufficient' or poor. Free comments showed that frequent phone contact from the Public Health Department was perceived as positive and even more often as negative interindividually. Communication and advice were positively highlighted, while lack of competence and coordination were criticized. The respondents criticized the comparatively lower provision of testing services for family members, for example, due to limited resources. CONCLUSION: With the KRITIS concept, the Public Health Department of Cologne developed and implemented an offer for system-relevant professional groups that was intensively used and mostly assessed as positive. This concept can be used as a blueprint for other pandemics.

[From the practice of monitoring SARS-CoV-2 test sites in the city of Cologne]. / Aus der Praxis der Überwachung der SARS-CoV-2-Teststellen im Stadtgebiet Köln.

In spring 2021, a law for the nationwide opening of test centers in Germany was passed. The local health department fulfilled the task of monitoring the test centers that subsequently opened throughout Cologne regarding the infectious and hygienic risks. Inspections were carried out using structured checklists. A retrospect evaluation of the identified deficiencies was run for the period between March 15 and July 31, 2021. In 84% of the cases, hygienic deficiencies were found when the test sites were inspected for the first time. 35% of the test sites were closed immediately, most of them temporarily. These first results provide information on frequent and important hygienic problems of the rapid set up of test sites and important advice for avoiding those and thus protecting employees and test persons.

[Basic Knowledge of Hygiene in Voluntary Disaster Control Using - German Red Cross in the Rhein-Erft District as an Example]. / Hygienisches Grundwissen im ehrenamtlichen Katastrophenschutz ­Am Beispiel des Deutschen Roten Kreuzes im Rhein-Erft-Kreis .

Full-time workers in the rescue service are often exposed to a risk of infection. The volunteers of the German disaster control (Katastrophenschutz; KatS) are exposed to a similar risk of infection when they are deployed. The aim of this study was to investigate the hygiene status of the two operational units of the German Red Cross (Deutsches Rotes Kreuz; DRK) in the Rhein-Erft District (Rhein-Erft-Kreis; REK). The 66 volunteers of the two operational units (Einsatzeinheiten; EE) "NRW BM 05" and "NRW BM 02" were assessed by means of a written questionnaire. The results showed that they had good general knowledge of hygiene.There were, however, deficits in the knowledge of specific diseases and some multi-resistant pathogens. In general, perceived risk varied greatly, and was often above 5 on a scale from 1-10, where "1" stands for no perceived risk and "10" for high perceived risk. Thus, there is a certain "concern" about getting an infection in action. Appropriate training courses are needed to optimize this situation in the future.

Health care provision for refugees in Germany - one-year evaluation of an outpatient clinic in an urban emergency accommodation.

BACKGROUND: In 2015, Germany recorded the highest rates of refugees since the early 1990s. Access to medical care is a legally regulated fundamental element of aid for refugees. In practice, there are several hurdles such as language barriers and legal regulations. In response to the massively increased need, special outpatient services for refugees were started in several German cities. In Cologne, an outpatient clinic (OPD) was established in the largest emergency accommodation centre for refugees supported by the Cologne municipality and operated by the German Red Cross and physicians from the Association of Statutory Health Insurance Physicians. This study reports experiences of the first year of the OPD regarding structure, processes and utilization. METHODS: Employing mixed methods, between May and December 2015 cross sectional pseudonymized data from patients' contacts were collected, coded in the International Classification of Primary Care (ICPC) and evaluated. Infrastructure, equipment, process organisation and function of the OPD were assessed during five participatory observations and triangulated with results of a self-administered questionnaire for staff and four qualitative interviews with key informants. RESULTS: During the observation period a total of 2205 persons (67% male) stayed in the emergency accommodation and 984 patient contacts (51% male) were registered, mainly by young persons from Western Balkan countries and Syria. Medical treatment was sought primarily for acute respiratory-, loco-motor-system- and skin symptoms followed by chronic physical diseases. Headache, back and neck pain and acute respiratory infection were the most frequent diagnoses. Questionnaires and interviews among staff revealed language barriers and psycho-trauma as the most frequently reported challenges. Equipment and staffing was adequate, but patient documentation was not systematic, leading to loss of information. CONCLUSION: To facilitate refugees' appropriate access to health care, the OPD was seen as functional for this refugee accommodation centre. Need was recognised for standardized, data protective documentation and a health passport for clients for medical information. Psychological support for refugees needs expansion taking legal circumstances and coverage of costs into consideration. To improve patient communication employees working with refugees should be offered an introduction to culturally sensitive understanding of health and illness.

[Environmental medical syndromes]. / Umweltmedizinische Syndrome.

Environmental medical syndromes comprise sick building syndrome (SBS), multiple chemical sensitivity (MCS)/idiopathic environmental intolerances (IEI), electromagnetic hypersensitivity, chronic fatigue syndrome (CFS), burnout, fibromyalgia, and the candida syndrome. There is also some overlap described in the literature. There is still no established knowledge of etiology, pathology, pathophysiology, diagnostics, therapy, prevention and prognosis. These syndromes are thought to result from a complex interaction of physical, chemical and/or (micro)biological environmental stresses, individual dispositions, psychological influencing factors, perceptual and processing processes, variants of somatization disorders, culturally or socially caused distress, or simply iatrogenic causation. Examination and treatment methods must be developed or existing ones scientifically validated. However, all uncertainties in the assessment of these syndromes do not absolve the physician from taking patients seriously and helping them as best as possible.

Analysis of whole blood samples with low gas flow inductively coupled plasma-optical emission spectrometry.

Low gas flow ICP-OES with a total argon consumption below 0.7 L/min is introduced for the analysis of trace elements in blood samples to investigate the influence of samples containing an organic solvent in a demanding matrix on the performance of this plasma for the first time. Therefore, gadolinium was determined in human plasma samples and mercury in red blood cells, human plasma, and precipitated plasma protein fraction. Limits of detection (LOD) were determined to be in the low microgram per liter range for the analytes and the accuracy of the method was assessed by comparison with a conventional Fassel-type torch-based ICP-OES. It was proven that the low gas flow ICP-OES leads to comparable results with the instrument based on the Fassel-type torch.

Indoor Mold.

BACKGROUND: According to self-reported frequencies, every fifth or sixth dwelling in Germany is affected by dampness and/or mold. This carries a potential risk to health. METHODS: This review is based on pertinent publications retrieved by a selective literature search and inquiry in the GENESIS database, on the AWMF guideline on the medical clinical diagnosis of indoor mold exposure, as updated in 2023, and on the relevant contents of other current guidelines. Based on this research, we present an algorithm for the evaluation of health problems that may be due to mold in indoor environments. RESULTS: A rational diagnostic work-up begins with history-taking and physical examination, with attention to risk factors-above all, immune compromise and atopy. If there is evidence of atopy, targeted allergy diagnostics should be performed, consisting of a skin prick test and/or measurement of specific IgE antibodies, supplemented whenever indicated by provocative testing and cellular test systems. If the patient's immune response is compromised, the immediate cessation of mold exposure has absolute priority. Any suspected invasive fungal infection should be evaluated with radiological, microbiological, serological, and immunological testing. Indoor measurements of mold fungi, microbial volatile organic compounds (MVOC), and/or mycotoxins are generally not indicated as part of the medical evaluation; nor are blood or urine tests for particular mold components or metabolites. CONCLUSION: Mold in indoor environments should be dealt with by rapid exposure elimination for patients at risk, the rational diagnostic evaluation of any symptoms and signs of disease, and patient education about the possibilities and limitations of diagnostic testing and the generally limited utility of measurements in the affected interior spaces.

Correction: Where is the greatest risk of COVID-19 infection? Findings from Germany's largest public health department, Cologne.

[This corrects the article DOI: 10.1371/journal.pone.0273496.].

AWMF mold guideline "Medical clinical diagnostics for indoor mold exposure" - Update 2023 AWMF Register No. 161/001.

None.

In vitro toxicology of ambient particulate matter: correlation of cellular effects with particle size and components.

High concentrations of airborne particulate matter (PM) have been associated with increased rates of morbidity and mortality among exposed populations. Although certain components of PM were suggested to influence these effects, no clear-cut correlation was determined thus far. One of the possible modes of action is the induction of oxidative stress by inhaled PM triggering inflammatory responses. Therefore, the in vitro formation of reactive oxygen species (ROS) in three cell lines in the presence of five subfractions of PM(10), collected in Münster, Germany was investigated. The PM components chloride, nitrate, ammonium, sulfate, 68 chemical elements, and endotoxin were quantified. The highest concentration of endotoxin was found in particles of 0.42-1.2 µm aerodynamic diameters, and therefore probably subject to long-range transport. Intracellular ROS formation in three well established mammalian cell lines (CaCo2, human; MDCK, canine; RAW264.7, mouse) only correlated positively with particle size. The two smallest PM size fractions provoked the highest rise in ROS. However, the latter did not correlate with the concentration of any PM components investigated. The smallest PM size fractions significantly dominated the number of particles. Therefore, the particle number may be most effective in inducing oxidative stress in vitro.

Adherence to stay-at-home orders: awareness, implementation and difficulties of officially ordered quarantine measures in the context of the COVID-19 pandemic in Cologne - a retrospective cohort study.

OBJECTIVES: To estimate the awareness, implementation and difficulty of behavioural recommendations and their correlates in officially ordered domestic isolation and quarantine during the COVID-19 pandemic. DESIGN: Online retrospective cohort survey conducted from 12 December 2020 to 6 January 2021 as part of the Cologne-Corona Counselling and Support for Index and Contact Persons During the Quarantine Period study. SETTING: Administrative area of the city of Cologne, Germany. PARTICIPANTS: 3011 infected persons (IPs) and 5822 contacts over 16 years of age who were in officially ordered domestic isolation or quarantine between 28 February 2020 and 9 December 2020. Of these, 60.4% were women. OUTCOME MEASURES: Self-developed scores were calculated based on responses about awareness and implementation of 19 behavioural recommendations to determine community-based and household-based adherence. Linear regression analyses were conducted to determine factors influencing adherence. RESULTS: The average adherence to all recommendations, including staying in a single room, keeping distance and wearing a mask, was 13.8±2.4 out of 15 points for community-based recommendations (CBRs) and 17.2±6.8 out of 25 points for household-based recommendations (HBRs). IPs were significantly more adherent to CBRs (14.3±2.0 points vs 13.7±2.6 points, p<0.001) and HBRs (18.2±6.7 points vs 16.5±6.8 points, p<0.001) than were contact persons. Among other factors, both status as an IP and being informed about the measures positively influenced participants' adherence. The linear regression analysis explained 6.6% and 14.4% (corr. R²) of the adherence to CBRs and HBRs. CONCLUSIONS: Not all persons under official quarantine were aware of the relevant behavioural recommendations. This was especially true in cases where instructions were given for measures to be taken in one's own household. Due to the high transmission rates within households, HBRs should be communicated with particular emphasis.

Impact of physical activity on COVID-19-related symptoms and perception of physical performance, fatigue and exhaustion during stay-at-home orders.

Objectives: The measures used to contain the COVID-19 pandemic led to a significant reduction in physical activity. Due to the health benefits of exercise, recommendations were made for lockdown restrictions. Within the CoCo-Fakt study (Cologne-Corona counselling and support for index and contacts during the quarantine period), we aimed to determine how these recommendations were implemented, especially by individuals who were officially quarantined due to an infected persons (IPs) or as close contacts (CPs), and how this affected their physical and psychological condition. Methods: From 12 December 2020 to 6 January 2021, all IPs and CPs registered by Cologne's public health department up to the survey period were surveyed online. Of 10 547 people in the CoCo-Fakt sample, 8102 were integrated into the current analysis. In addition to demographic data, information regarding COVID-19-specific and persistent symptoms or conditions and their association with the amount and type of exercise and screen time before and during the quarantine were collected. Results: Before quarantine, 66.9% of IPs and 69% of CPs were physically active; during quarantine, this decreased by 49.4% in IPs depending on the course of the disease and by 30.6% in CPs. Physically active IPs and CPs felt less exhausted and more fit during their quarantine periods than those who were inactive, with active IPs significantly less likely to report prolonged physical and psychological symptoms than their more sedentary counterparts. Conclusion: Given the acute and long-term positive effects of exercise on quarantined individuals, corresponding recommendations should be communicated to those affected, especially CPs. Recommendations for IPs depend on their health status.

Where is the greatest risk of COVID-19 infection? Findings from Germany's largest public health department, Cologne.

BACKGROUND: SARS-CoV-2 has been spreading worldwide since late 2019. Before vaccines became available, exclusively non-pharmaceutical measures were used to prevent transmission of infection. Despite the fact that vaccinations are now available, it is still important to identify relevant transmission routes in order to contain the COVID-19- or further pandemics. Therefore, this study aims to systematically analyse data from the largest public health department in Germany to determine the significance of the various known and unknown transmission situations in terms of the proportion of infections. METHODS: All infections in Cologne were systematically recorded by the local health department. In addition to clinical data, the transmission situations were recorded and categorised as pertaining to social contact, work contact, travellers, health care workers, users of educational institutions, visitors of community institutions, infection in the context of medical treatment, and unknown infection. FINDINGS: The analysis included 25,966 persons. A transmission situation could be identified in 82.7% of the cases (n = 21,477). Most persons (42.1%) were infected due to social contact, primarily within their own household. Another 22.3% were infected at their place of work; this was particularly common among staff members of medical facilities, nursing homes and educational institutions. In 17.3% of the cases, the transmission situation remained unknown; the cases with unknown transmission situation were slightly more often symptomatic (75.2%) than the cases with known transmission situation (69.4%). INTERPRETATION: Considering that during the study period the leading strains were the wild-type and alpha-variant transmission rather occurred during scenarios involving close contacts than in anonymous situations. Presumably, however, the findings can be transferred to the new variants. Therefore, in order to prevent transmission, besides vaccination regular antigen tests and/or appropriate protective measures remain relevant until this pandemic has subsided.

Changes in Alcohol Consumption, Eating Behaviors, and Body Weight during Quarantine Measures: Analysis of the CoCo-Fakt Study.

INTRODUCTION: Public health measures enacted to reduce COVID-19 transmission have affected individuals' lifestyles, mental health, and psychological well-being. To date, little is known how stay-at-home orders have influenced the eating behaviors, weight development, and alcohol consumption of quarantined persons. The CoCo-Fakt cohort study analyzed these parameters and their association with psychological distress and coping strategies. METHODS: An online survey was conducted of all persons who tested positive for SARS-CoV-2 (infected persons [IP]) between December 12, 2020, and January 6, 2021, as well as their close contacts (contact persons [CP]) registered by the public health department of Cologne. 8,075 of 33,699 individuals were included in the analysis. In addition to demographic data, psychological distress, and coping strategies, information on changes in body weight, eating, and drinking behaviors was collected. RESULTS: IP lost 1.2 ± 4.4 kg during the quarantine period, and CP gained 1.6 ± 4.1 kg. The reasons given by IP for weight change were mainly loss of taste and feeling sick, whereas CP were more likely than IP to eat out of boredom. Higher psychological burden and lower coping strategies were associated with both weight gain and loss. Of the 30.8% of participants who changed their alcohol consumption during the quarantine period, CP in particular drank more alcohol (IP 15.2%; CP 47.7%). Significantly less alcohol was consumed by individuals with higher coping scores. CONCLUSION: In this short but psychologically stressful period of stay-at-home orders, changes in eating and drinking behavior as well as weight development are evident, mainly in high-risk contacts. To avoid possible long-term sequelae, health authorities should take these findings into account during the quarantine period; in particular, general practitioners should consider these findings during follow-up.

The potential of spatial information in human biomonitoring by example of two German environmental epidemiology studies.

This study aimed at statistically investigating the association between the internal exposure of children and young adults to uranium (U) and epidemiologically relevant external determinants of exposure. The investigation was performed with data from two studies within the framework of the German health-related environmental monitoring program: The German Environmental Survey for Children (GerES IV) conducted by the Federal Environment Agency (Umweltbundesamt) with data on 1,780 children 3-14 years of age and their home environment and the German Environmental Specimen Bank (ESB, section: human specimens) with data on 2,253 students 20-29 years of age. Both studies provided data on the U levels in human urine for all probands. GerES IV furthermore provided an extensive environmental and demographic database on, e.g., U levels in drinking water. The data from GerES IV and ESB were linked by GIS to spatially relevant exposure information, including background values of U in stream sediments and in upper and lower soils, U levels in mosses and particulate matter in the lower atmosphere, precipitation and elevation as well as forest density. Bivariate correlation analysis and two decision tree models showed moderate but significant associations between U in human urine and U levels in drinking water, stream sediments and upper and lower soils. Future investigations considering additional epidemiologically relevant data sets may differentiate the results. Furthermore, the sample design of future environmental epidemiology studies should take the spatial evaluation of the data into greater account.

COVID-19 Breakthrough Infections and Transmission Risk: Real-World Data Analyses from Germany's Largest Public Health Department (Cologne).

BACKGROUND AND METHODS: Vaccination is currently considered the most successful strategy for combating the SARS-CoV-2 virus. According to short-term clinical trials, protection against infection is estimated to reach up to 95% after complete vaccination (≥14 days after receipt of all recommended COVID-19 vaccine doses). Nevertheless, infections despite vaccination, so-called breakthrough infections, are documented. Even though they are more likely to have a milder or even asymptomatic course, the assessment of further transmission is highly relevant for successful containment. Therefore, we calculated the real-world transmission risk from fully vaccinated patients (vaccination group, VG) to their close contacts (CP) compared with the risk from unvaccinated reference persons matched according to age, sex, and virus type (control group = CG) utilizing data from Cologne's health department. RESULTS: A total of 357 breakthrough infections occurred among Cologne residents between 27 December 2020 (the date of the first vaccination in Cologne) and 6 August 2021. Of the 979 CPs in VG, 99 (10.1%) became infected. In CG, 303 of 802 CPs (37.8%) became infected. Factors promoting transmission included non-vaccinated status (ß = 0.237; p < 0.001), male sex (ß = 0.079; p = 0.049), the presence of symptoms (ß = -0.125; p = 0.005), and lower cycle threshold value (ß = -0.125; p = 0.032). This model explained 14.0% of the variance (corr. R2). CONCLUSION: The number of transmissions from unvaccinated controls was three times higher than from fully vaccinated patients. These real-world data underscore the importance of vaccination in enabling the relaxation of stringent and restrictive general pandemic control measures.

How to manage quarantine-adherence, psychosocial consequences, coping strategies and lifestyle of patients with COVID-19 and their confirmed contacts: study protocol of the CoCo-Fakt surveillance study, Cologne, Germany.

INTRODUCTION: The current coronavirus (SARS-CoV-2) pandemic has placed unprecedented restrictions on people's lives and routines. To counteract the exponential spread of this virus, a lockdown was implemented in Germany in March 2020. Infected persons and their contacts were also quarantined. Compliance with quarantine measures is essential for containing the spread of the virus and avoiding incalculable consequences in terms of morbidity and mortality. On the other hand, prolonged homestays, particularly quarantining, may lead to fear, panic, anxiety and depression. Hence, determining the psychological response in people during quarantine and their coping strategies is relevant for the counselling and support of affected persons by healthcare workers. METHODS AND ANALYSIS: The CoCo-Fakt-Survey (Cologne-Corona-Beratung und Unterstützung Für Index- und KontAKt-Personen während der Quarantäne-ZeiT; Cologne-Corona counselling and support for index and contacts during the quarantine period-author's translation) will examine a cohort of persons in Cologne quarantined since the beginning of the SARS-CoV-2 outbreak during March 2020. The questionnaire will include demographic data, transmission route, health status, knowledge of and adherence to quarantine measurements, psychological impact on individuals and their family members including children, mental health status, and lifestyle (physical activity/sedentary behaviour, relaxation techniques, nutrition, smoking). All Cologne residents who needed to be quarantined due to a coronavirus infection and the individuals with whom they had contact will be surveyed. ETHICS AND DISSEMINATION: No risks have been identified and no complications are expected. Ethics approval was obtained from the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Human Ethics Research Committee (351/20), and the research will be conducted in accordance with the approved protocol. The results will be disseminated through peer-reviewed journals and social medicine conferences.

Analysis of the contrast agent Magnevist and its transmetalation products in blood plasma by capillary electrophoresis/electrospray ionization time-of-flight mass spectrometry.

To study transmetalation effects of the gadolinium-based contrast agent Magnevist (Gd-DTPA), the first analytical method for the simultaneous determination of Gd-DTPA and its transmetalation products in complex clinical samples was developed. The high separation efficiency of capillary electrophoresis (CE) was employed to separate Gd-DTPA, Fe-DTPA, Cu-DTPA, Zn-DTPA, and the free DTPA (diethylenetriaminepentaacetic acid) ligand. The coupling of CE with electrospray ionization time-of-flight mass spectrometry (ESI-TOF-MS) provided the required sensitivity and excellent selectivity for the analysis of complex samples, such as blood plasma and whole blood. Separation and detection parameters were optimized, and crucial steps for CE/MS method development are pointed out. Limit of detection (LOD) is 5 x 10(-7) mol/L, limit of quantification (LOQ) is 1.7 x 10(-6) mol/L, and the linear range comprises 2 decades, starting at the limit of quantification. To determine recovery rates, precision, and accuracy of the method, blank plasma samples were spiked with Gd-DTPA in three different concentrations. Blood plasma samples from 10 patients with normal renal function, having received Magnevist, were analyzed for Gd-DTPA and possible transmetalation products by CE/ESI-TOF-MS. The method was validated by determination of the total Gd concentration using inductively coupled plasma optical emission spectroscopy (ICP-OES). Transmetalation assays of Magnevist with and without supplementary iron were carried out in incubated whole blood samples.

Quantification and excretion kinetics of a magnetic resonance imaging contrast agent by capillary electrophoresis-mass spectrometry.

A novel method for the analysis of Gadolinium-based contrast agents in complex clinical matrices is presented. Three commonly applied ionic contrast agents for magnetic resonance imaging were separated by CE and detected by ESI-MS. Blank urine samples were spiked with Dotarem (Gd-DOTA, Gadolinium-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid), Magnevist (Gd-DTPA, Gadolinium-diethylenetriaminepentaacetic acid) and Multihance (Gd-BOPTA, Gadolinium-benzyloxymethyl-diethylenetriaminepentaacetic acid) to determine the recovery rates. The figures of merit were determined with LODs as low as 2.0 x 10(-7) mol/L for Gd-DOTA, 5.0 x 10(-7) mol/L for Gd-DTPA and 1.0 x 10(-6) mol/L for Gd-BOPTA. The respective LOQs were 6.6 x 10(-7) mol/L for Gd-DOTA, 1.5 x 10(-6) mol/L for Gd-DTPA and 3.3 x 10(-6) mol/L for Gd-BOPTA. The linear working range comprised two orders of magnitude starting at the LOQ, with regression coefficients of R > or = 0.999 for all investigated analytes. Using this CE-MS method, Gd-DOTA was quantified in seven urine samples obtained at different times after delivery from a volunteer magnetic resonance imaging patient who was treated with Dotarem. Additionally, total Gd concentrations were determined by means of ICP-optical emission spectroscopy to validate the CE-MS data. To compensate for dietary dilution effects of the urine samples, creatinine was determined by HPLC with UV/Vis absorption detection. Gd-DOTA concentrations were normalized to urinary creatinine, illustrating the fast excretion kinetics of Gd-DOTA.