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1.
Euro Surveill ; 25(17)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32372753

RESUMEN

Using data on coronavirus disease (COVID-19) cases in Germany from the Robert Koch Institute, we found a relative increase with time in the prevalence in 15-34 year-olds (particularly 20-24-year-olds) compared with 35-49- and 10-14-year-olds (we excluded older and younger ages because of different healthcare seeking behaviour). This suggests an elevated role for that age group in propagating the epidemic following the introduction of physical distancing measures.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Distribución por Edad , Betacoronavirus , Niño , Brotes de Enfermedades , Alemania/epidemiología , Humanos , Persona de Mediana Edad , Prevalencia , Distancia Social , Adulto Joven
2.
Artículo en Alemán | MEDLINE | ID: mdl-32125462

RESUMEN

BACKGROUND: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA. MATERIAL AND METHODS: Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex. RESULTS: In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated. CONCLUSION: The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.


Asunto(s)
Asma/diagnóstico , Adulto , Factores de Edad , Edad de Inicio , Asma/epidemiología , Niño , Enfermedad Crónica , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Masculino , Encuestas y Cuestionarios
3.
Artículo en Alemán | MEDLINE | ID: mdl-32157352

RESUMEN

BACKGROUND: Data on self-reported cardiovascular and metabolic diseases are available for the first 100,000 participants of the population-based German National Cohort (GNC, NAKO Gesundheitsstudie). OBJECTIVES: To describe assessment methods and the frequency of self-reported cardiovascular and metabolic diseases in the German National Cohort. MATERIALS AND METHODS: Using a computer-based, standardized personal interview, 101,806 participants (20-75 years, 46% men) from 18 nationwide study centres were asked to use a predefined list to report medical conditions ever diagnosed by a physician, including cardiovascular or metabolic diseases. For the latter, we calculated sex-stratified relative frequencies and compared these with reference data. RESULTS: With regard to cardiovascular diseases, 3.5% of men and 0.8% of women reported to have ever been diagnosed with a myocardial infarction, 4.8% and 1.5% with angina pectoris, 3.5% and 2.5% with heart failure, 10.1% and 10.4% with cardiac arrhythmia, 2.7% and 1.8% with claudicatio intermittens, and 34.6% and 27.0% with arterial hypertension. The frequencies of self-reported diagnosed metabolic diseases were 8.1% and 5.8% for diabetes mellitus, 28.6% and 24.5% for hyperlipidaemia, 7.9% and 2.4% for gout, and 10.1% and 34.3% for thyroid diseases. Observed disease frequencies were lower than reference data for Germany. CONCLUSIONS: In the German National Cohort, self-reported cardiovascular and metabolic diseases diagnosed by a physician are assessed from all participants, therefore representing a data source for future cardio-metabolic research in this cohort.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Metabólicas/epidemiología , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Masculino , Autoinforme , Encuestas y Cuestionarios
4.
Artículo en Alemán | MEDLINE | ID: mdl-32185449

RESUMEN

BACKGROUND: Infectious diseases continue to play an important role for disease perception, health-economic considerations and public health in Germany. In recent years, infectious diseases have been linked to the development of non-communicable diseases. Analyses of the German National Cohort (GNC) may provide deeper insights into this issue and pave the way for new targeted approaches in disease prevention. OBJECTIVES: The aim was to describe the tools used to assess infectious diseases and to present initial data on infectious disease frequencies, as well as to relate the GNC assessment tools to data collection methods in other studies in Germany. METHODS: As part of the baseline examination, questions regarding infectious diseases were administered using both an interview and a self-administered touchscreen questionnaire. Data from the initial 101,787 GNC participants were analysed. RESULTS: In the interview, 0.2% (HIV/AIDS) to 8.6% (shingles) of respondents reported ever having a medical diagnosis of shingles, postherpetic neuralgia (in cases where shingles was reported), hepatitis B/C, HIV/AIDS, tuberculosis or sepsis if treated in hospital. In the questionnaire, 12% (cystitis) to 81% (upper respiratory tract infections) of respondents reported having experienced at least one occurrence of upper or lower respiratory tract infections, gastrointestinal infections, cystitis or fever within the past 12 months. OUTLOOK: The cross-sectional analyses of data and tools presented here - for example on determinants of susceptibility to self-reported infections - can be anticipated from the year 2021 onward. Beyond that, more extensive research into infectious disease epidemiology will follow, particularly once analyses of GNC biological materials have been performed.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Estudios de Cohortes , Estudios Transversales , Alemania/epidemiología , Humanos , Autoinforme , Encuestas y Cuestionarios
5.
Artículo en Alemán | MEDLINE | ID: mdl-32189044

RESUMEN

BACKGROUND: Musculoskeletal diseases and symptoms are very common in the general population. They lead to high healthcare costs and pose a significant burden to the national economy. OBJECTIVES: Based on data from the population-based German National Cohort (GNC), frequencies of musculoskeletal symptoms and diseases are reported, including back pain, osteoporosis, osteoarthritis, and arthritis. MATERIALS AND METHODS: Data were collected from March 2014 to March 2017 in adults aged 20-75 years during the first half of the baseline survey of the GNC. The sample comprised 101,779 interviewed subjects, including 9370 subjects who underwent clinical musculoskeletal examinations. The interview included questions about specific musculoskeletal disorders. A clinical examination of the hand provided information about palpable swollen joints and pressure-sensitive joints. Resting pain of the knees and hips was also assessed by a clinical examination. Frequencies were standardized to the German standard population of the year 2011. RESULTS: Having ever been diagnosed with recurrent back pain (22.5%) or osteoarthritis (20.6%) were the most common complaints reported in the interview; osteoporosis (2.9%) and rheumatoid arthritis (1.9%) were stated more seldom. According to the hand examination, 6.0% of all participants experienced pain in at least one finger joint. Resting pain was present in at least one knee among 8.2% and in at least one hip among 5.1% of the participants as assessed during the clinical examination. Women were more likely to report musculoskeletal disorders and symptoms than men. The proportion of adults affected by musculoskeletal diseases increased strongly with age. CONCLUSION: Musculoskeletal disorders and symptoms occur frequently. The burden of complaints and diagnoses is comparable to previous population-based surveys.


Asunto(s)
Enfermedades Musculoesqueléticas/epidemiología , Adulto , Anciano , Dolor de Espalda/epidemiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/epidemiología , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
6.
J Med Microbiol ; 69(3): 396-401, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32125266

RESUMEN

Introduction. Transmission of Enterobacterales in neonatal intensive care units (NICU) can cause outbreaks of colonization and invasive infections among neonates. Two clusters of nosocomial transmission of Klebsiella pneumoniae identified by MALDI-ToF mass-spectrometry were suspected at two NICUs in July and August 2016.Aim. To assess the potential transmission of K. pneumoniae among neonates.Methodology. Whole-genome sequencing (WGS) was performed of K. pneumoniae isolates obtained through targeted surveillance of patients and environmental sampling.Results. WGS data revealed that patient and environmental isolates represented two species, K. pneumoniae and K. variicola. Core-genome multi-locus sequence typing (cgMLST) of the isolates identified three separate transmission clusters, in Hospital A a cluster of K. pneumoniae isolates in 12 children and two environmental samples and a second cluster of K. variicola isolates in five children. In Hospital B a cluster of K. pneumoniae isolates from three children and five unrelated isolates of K. pneumoniae and two unrelated isolates of K. variicola were found.Conclusion. K. variicola can cause hospital outbreaks of colonization and infection similar to other Klebsiella spp.Preliminary results from this study were presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases, April 22-25, 2018, Vienna, Austria.


Asunto(s)
Infección Hospitalaria , Brotes de Enfermedades , Genoma Bacteriano/genética , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/genética , Klebsiella/genética , Técnicas de Tipificación Bacteriana , Alemania/epidemiología , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Klebsiella/efectos de los fármacos , Klebsiella/aislamiento & purificación , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/transmisión , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Tipificación de Secuencias Multilocus , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Secuenciación Completa del Genoma
7.
Angiology ; 71(5): 452-464, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32166953

RESUMEN

This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk (p < .001) in patients with any DVT, an 88% higher mortality (p < .001) for femoral DVT, a 23% higher risk (p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.


Asunto(s)
Úlcera de la Pierna/epidemiología , Pierna/irrigación sanguínea , Síndrome Postrombótico/epidemiología , Trombosis de la Vena/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Úlcera de la Pierna/mortalidad , Masculino , Persona de Mediana Edad , Síndrome Postrombótico/mortalidad , Prevalencia , Trombosis de la Vena/mortalidad
8.
BMC Med Genet ; 21(1): 62, 2020 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-32220223

RESUMEN

BACKGROUND: To examine the association between lipoprotein(a) (Lp(a)) levels, LPA (rs10455872 and rs3798220) and IL1F9 (rs13415097) single nucleotide polymorphisms (SNPs) with coronary artery calcification (CAC), an important predictor for coronary artery disease (CAD). METHODS: We used data from 3799 (mean age ± SD: 59.0 ± 7.7 years, 47.1% men) Heinz Nixdorf Recall study participants. We applied linear regression models to explore the relation between the log-transformed Lp(a) levels and LPA and IL1F9 SNPs with loge (CAC + 1). The association between the SNPs and log-transformed Lp(a) levels was further assessed using linear regression. The models were adjusted for age and sex (Model 1) and additionally for Lp(a) levels (Model 2). RESULTS: We observed a statistically significant association between log-transformed Lp(a) levels and CAC (Model 1: beta per log-unit increase in Lp(a) levels = 0.11; 95% confidence interval [95% CI] [0.04; 0.18], p = 0.002). Furthermore, the LPA SNP rs10455872 showed a statistically significant association with CAC (Model 1: beta per allele = 0.37 [0.14; 0.61], p = 0.002). The association between rs10455872 and CAC was attenuated after adjustment for Lp(a) levels (Model 2: beta per allele = 0.26 [- 0.01; 0.53], p = 0.06). Both LPA SNPs also showed a statistically significant association with Lp(a) levels (Model 1: betars10455872 per allele: 1.56 [1.46; 1.65], p < 0.0001 and betars3798220 per allele: 1.51 [1.33; 1.69], p < 0.0001)). The Mendelian randomization analysis showed that Lp(a) is a causal risk factor for CAC (estimate per log-unit increase in Lp(a) levels (95% CI), p: 0.27 [0.11; 0.44], p = 0.001). The IL1F9 SNP did not show any statistically significant association with Lp(a) levels or with CAC. CONCLUSIONS: We provide evidence for the association of LPA rs10455872 with higher levels of Lp(a) and CAC in our study. The results of our study suggest that rs10455872, mediated by Lp(a) levels, might play a role in promoting the development of atherosclerosis leading to cardiovascular disease events.


Asunto(s)
Enfermedad de la Arteria Coronaria , Lipoproteína(a)/sangre , Lipoproteína(a)/genética , Polimorfismo de Nucleótido Simple , Calcificación Vascular , Anciano , Alelos , Aterosclerosis/sangre , Aterosclerosis/epidemiología , Aterosclerosis/genética , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/genética , Vasos Coronarios/patología , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Estudio de Asociación del Genoma Completo , Genotipo , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Calcificación Vascular/sangre , Calcificación Vascular/epidemiología , Calcificación Vascular/genética
9.
J Cancer Res Clin Oncol ; 146(5): 1197-1204, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32130481

RESUMEN

OBJECTIVE: To assess the association of public health parameters with the regional variation in the initial treatment for prostate cancer. METHODS: We used data from German epidemiologic cancer registries for the years 2009-2013. Presence of a certified cancer center, a radiotherapy and/or urology institution, the district-specific GDP, and population density were used as predictors. Patients with indication for adjuvant treatment were excluded (T3b). Only districts with defined quality criteria were eligible. We used general linear mixed models (equivalent to logistic regression) with a covariance matrix weighted by the Euclidean distances between districts. Models were adjusted for age, grading, and TNM stage. We performed sensitivity analyses by imputing missing data with multiple imputation and considering extreme case scenarios. We applied inverse probability weighting to account for missing values. RESULTS: When radiotherapy/surgery is compared to neither treatment, the probability for the latter was higher in East than in West Germany (OR 1.7, 95% CI 1.43-2.02). The same was true for districts with both, a radiotherapy and urologic treatment facility (OR 1.43, 1.19-1.72). Analyzing radiotherapy vs. surgery, the probability for prostatectomy was inversely associated with the presence of a radiotherapy unit when compared to districts with neither treatment facility (OR 0.52, 95% CI 0.38-0.73). Patients treated in East Germany were more likely to receive a surgical treatment (OR 1.34, 95% CI 1.08-1.66). Sensitivity analyses revealed no relevant change of effect estimates. CONCLUSION: Treatment differs between East and West Germany and is associated with the presence of a radiotherapy or urology clinic.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Alemania/epidemiología , Humanos , Modelos Logísticos , Masculino , Estadificación de Neoplasias , Prostatectomía/estadística & datos numéricos , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/patología , Radioterapia/estadística & datos numéricos , Sistema de Registros
11.
BMC Infect Dis ; 20(1): 233, 2020 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-32192436

RESUMEN

BACKGROUND: This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. METHODS: Adult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up. RESULTS: Overall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001). CONCLUSIONS: SAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.


Asunto(s)
Procedimientos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/mortalidad
12.
Artículo en Alemán | MEDLINE | ID: mdl-32060573

RESUMEN

BACKGROUND: Addiction is associated with health-related and social risks. The interministerial harmonized Lower Saxon concept on drug prevention was most recently revised in 2008 and is predominantly implemented by drug counselling services, drug prevention specialists, the police, self-help groups, corporate addiction prevention, child welfare, and local prevention committees. OBJECTIVE: The study aimed at providing the necessary information for an intended enhancement of the Lower Saxon concept on drug prevention. METHOD: Descriptive analysis of the ratings of a sample of 459 stakeholders involved in preventive activities who completed an online questionnaire on the current performance of Lower Saxon drug prevention. RESULTS AND DISCUSSION: Moderate levels of success have been rated in terms of the achievement of selected preventive goals as well as certain quality standards. An additional need for drug prevention was described for several target groups, including children living in families with a drug-addicted family member, youth aged between 13 and 17, refugees, children with poor educational background, people suffering from mental illness, trainees and university students, as well as the unemployed. In comparison to other institutions, German employment offices, job centers, and churches were nominated to a lesser extent as being responsible for executing drug prevention. Participants saw great potential in a more consistent implementation of current regulations on advertisement, access, and consumption as well as for additional situation-based-prevention. In addition, stakeholders felt restricted in their preventive work due to financial constraints and a lack of recourse in terms of evaluation and documentation. Disregarding their various institutional backgrounds participants had a common agreement when evaluating the questions. Differences led back to their deferring public service obligations.


Asunto(s)
Trastornos Relacionados con Sustancias/epidemiología , Familia , Alemania/epidemiología , Humanos , Trastornos Mentales , Encuestas y Cuestionarios
13.
Z Gastroenterol ; 58(3): 234-240, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32018316

RESUMEN

OBJECTIVES: Angiodysplasia (AD) is a common source of gastrointestinal bleeding. Yet, little is known about factors forwarding bleeding in these vascular malformations. The presented study aims to determine risk factors for bleeding that occurs only in patients with symptomatic, but not with asymptomatic, AD. METHODS: Case-control study in patients with AD and either a positive or a negative history of gastrointestinal bleeding in Munich, Germany. Groups were compared by clinical, laboratory, and endoscopic features. RESULTS: 80 patients with (58, f 31, med. age 72) or without bleeding AD (22, f 12, med. age 61) were included. Bleeding from AD was significantly associated with the total number of AD (OR 1.4 (95 % CI 1.1-1.7) p = 0.01) and closure time in PFA/collagen-epinephrine test (OR 1.0 (95 % CI 1.0-1.0) p < 0.01). The total number of AD correlated significantly with age (r = 0.36; p = 0.01). AD were mainly detected in the upper small intestine (> 30 %). Although patients with aortic stenosis suffered not significantly more frequently from bleeding from AD, they demonstrated a loss of high molecular multimers of VWF. CONCLUSIONS: The amount of AD is clearly correlated to the age of the patient. A higher number of ADs and inhibition of primary hemostasis increase the risk of bleeding.


Asunto(s)
Angiodisplasia/etiología , Hemorragia Gastrointestinal/etiología , Anciano , Angiodisplasia/epidemiología , Estudios de Casos y Controles , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
14.
Pneumologie ; 74(4): 210-216, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32053839

RESUMEN

BACKGROUND: In patients with end-stage renal disease (ESRD), pulmonary hypertension (PH) is a frequent complication with different etiologies and a 17 - 56 % prevalence rate. We evaluated the impact of fluid retention measured by bioimpedance on the prevalence of PH in this patient cohort. METHODS: All patients with ESRD at the dialysis center of the Medical Clinic II of the University Hospital Gießen were invited to participate in the study and undergo non-invasive PH screening. If the screening suggested PH, patients underwent bioimpedance spectroscopy for measurement of fluid retention followed by adjustment of fluid levels to normovolemia as far as possible. Thereafter a second non-invasive screening was performed in this patient cohort after reaching normovolemia. If signs for PH persisted, patients underwent right heart catheterization for further assessment. RESULTS: 52 patients agreed to participate in the study. After the first noninvasive screening, PH was suspected in 12 patients (23 %). After adjustment of fluid levels to reach normovolemia, PH was suspected only in 4 patients (7.7 %) with confirmation in 2 patients by right heart catheterization (3.8 %). DISCUSSION: In patients with ESRD, PH is frequently associated with fluid retention as shown by bioimpedance spectroscopy. After adjustment of fluid to normal levels, PH was confirmed by invasive test in nearly 4 % of cases.


Asunto(s)
Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Fallo Renal Crónico/complicaciones , Alemania/epidemiología , Insuficiencia Cardíaca , Humanos , Hipertensión Pulmonar/diagnóstico , Fallo Renal Crónico/terapia , Prevalencia , Diálisis Renal
15.
J Cancer Res Clin Oncol ; 146(4): 1065-1077, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32076823

RESUMEN

PURPOSE: Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome emerging from a deregulated immune response due to various triggers. In adults, systematic data are sparse, which is why recommendations on diagnosis and management have been adopted from pediatric guidelines. A nationwide clinical registry with associated consulting service as collaborative initiative of HLH-specialized pediatricians and hematologists was initiated to better characterize HLH in adults. METHODS: Patients with proven or suspected HLH were registered by 44 institutions. Both HLH-2004 diagnostic criteria and the HScore (www.saintantoine.aphp.fr/score/) were used to confirm HLH diagnosis. Data referring to underlying disease, treatment, outcome, clinical presentation and laboratory findings were recorded. RESULTS: The study included 137 patients and provides the first systematic data on adult HLH in Germany. Median age was 50 years with a wide range (17-87 years), 87 patients (63.5%) were male. Most common triggering diseases were infections in 61 patients (44.5%) and malignancies in 48 patients (35%). Virtually all patients had elevated ferritin concentrations, and 74% had peak concentrations greater than 10,000 µg/l. At time of analysis, 67 of 131 patients (51%) had died. Patients with malignancy-associated HLH had the shortest median survival (160 days), however no statistically significant difference between subgroups was observed (p = 0.077). Platelets under 20*109/l and low albumin concentrations (< 20 g/l) were associated with poor overall and 30-day survival. CONCLUSION: Close multidisciplinary case consultation and cooperation is mandatory when treating adult HLH patients. Early contact with reference centers is recommended, especially in relapsing or refractory disease.


Asunto(s)
Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Linfohistiocitosis Hemofagocítica/patología , Masculino , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Adulto Joven
16.
J Cancer Res Clin Oncol ; 146(4): 1033-1050, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32107625

RESUMEN

PURPOSE: Several scoring systems have been proposed to predict the outcome of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). However, the application of these scores to a bridging to transplant setting is poorly validated. Evaluation of the applicability of prognostic scores for patients undergoing TACE in palliative intention vs. bridging therapy to liver transplantation (LT) is necessary. METHODS: Between 2008 and 2017, 148 patients with HCC received 492 completed TACE procedures (158 for bridging to transplant; 334 TACE procedures in palliative treatment intention at our center and were analyzed retrospectively. Scores (ART, CLIP, ALBI, APRI, SNACOR, HAP, STATE score, Child-Pugh, MELD, Okuda and BCLC) were calculated and evaluated for prediction of overall survival. ROC analysis was performed to assess prediction of 3-year survival and treatment discontinuation. RESULTS: In patients receiving TACE in palliative intention most scores predicted OS in univariate analysis but only mSNACOR score (p = 0.006), State score (p < 0.001) and Child-Pugh score (p < 0.001) revealed statistical significance in the multivariate analysis. In the bridging to LT cohort only the BCLC score revealed statistical significance (p = 0.002). CONCLUSIONS: Clinical usability of suggested scoring systems for TACE might be limited depending on the individual patient cohorts and the indication. Especially in patients receiving TACE as bridging to LT none of the scores showed sufficiently applicability. In our study Child-Pugh score, STATE score and mSNACOR score showed the best performance assessing OS in patients with TACE as palliative therapy.


Asunto(s)
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carboplatino/administración & dosificación , Carcinoma Hepatocelular/mortalidad , Quimioembolización Terapéutica/estadística & datos numéricos , Estudios de Cohortes , Doxorrubicina/administración & dosificación , Aceite Etiodizado/administración & dosificación , Femenino , Alemania/epidemiología , Humanos , Neoplasias Hepáticas/mortalidad , Trasplante de Hígado/métodos , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del Tratamiento
17.
Infection ; 48(2): 275-284, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32052287

RESUMEN

BACKGROUND: The aim of this study was to analyse temporal changes in the epidemiology of candidemia assessing patient's characteristics, risk factors, diagnostic management, treatment, and outcome in a tertiary care hospital in South Eastern Germany. METHODS: In this retrospective cohort study patients with blood cultures positive for Candida spp. were identified from the microbiological database in the years 2006-2018. A detailed collection of patients' characteristics was obtained for the time periods 2006-2008 and 2016-2018. Risk factors for survival were analysed in a logistic regression analysis. RESULTS: In the years 2006-2018, a total of 465 episodes of candidemia were identified. An increase in candidemia cases was evident in the period of 2016-2018 compared to 2006-2015 and to 2006-2008 in absolute numbers and adjusted to patient-days. C. albicans was responsible for 62.8% of cases in 2006-2008 and 51.2% of all cases in the years 2016-2018, respectively, whereas there was a significant increase of C. glabrata in the latter period (16.3-31.5%). Overall mortality was not significantly different in the two periods. Infectious diseases consultation led to a lower mortality of patients with candidemia and to a higher adherence to guidelines. In multivariate analysis, only complete change or extraction of intravascular indwelling material and female gender were independent predictors for survival. CONCLUSION: We observed an increase in candidemia rates and rates of non-albicans spp. over time. A complete change of all catheters and/or indwelling devices improved survival. ID consultation led to a better guideline adherence.


Asunto(s)
Candida/fisiología , Candidemia/epidemiología , Candidemia/mortalidad , Derivación y Consulta/normas , Anciano , Candida/clasificación , Candida/aislamiento & purificación , Candidemia/diagnóstico , Candidemia/tratamiento farmacológico , Estudios de Cohortes , Femenino , Alemania/epidemiología , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
18.
BMC Infect Dis ; 20(1): 110, 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32033533

RESUMEN

BACKGROUND: Men who have sex with men (MSM) are disproportionally affected by sexually transmitted infections (STI). STI are often extragenital and asymptomatic. Both can delay diagnosis and treatment. Approval of HIV pre-exposure prophylaxis (PrEP) might have influenced sexual behaviour and STI-prevalence of HIV- MSM. We estimated STI-prevalence and risk factors amongst HIV- and HIV+ MSM in Germany to plan effective interventions. METHODS: We conducted a nationwide, cross-sectional study between February and July 2018. Thirteen MSM-friendly STI-practices screened MSM for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV) using self-collected rectal and pharyngeal swabs, and urine samples. APTIMA™ STI-assays (Hologic™ Inc., San Diego, USA) were used for diagnostics, and samples were not pooled. We collected information on socio-demographics, HIV-status, clinical symptoms, sexual behaviour within the last 6 months, and PrEP use. We combined HIV status and PrEP use for defining risk groups, and used directed acyclic graphs and multivariable logistic regression to identify risk factors for STI. RESULTS: Two thousand three hundred three MSM were included: 50.5% HIV+, median age 39 [18-79] years. Median number of male sex partners within the last 6 months was five. Sex without condom was reported by 73.6%, use of party drugs by 44.6%. 80.3% had a STI history, 32.2% of STI+ MSM reported STI-related symptoms. 27.6% of HIV- MSM used PrEP. Overall STI-prevalence was 30.1, 25.0% in HIV-/PrEP- MSM (CT:7.2%; MG:14.2%; NG:7.4%; TV:0%), 40.3% in HIV-/PrEP+ MSM (CT:13.8%; MG:19.4%; NG:14.8%; TV:0.4%), and 30.8% in HIV+ MSM (CT:10.1%; MG:18.4%; NG:8.6%; TV:0.1%). Being HIV+ (OR 1.7, 95%-CI 1.3-2.2), using PrEP (OR 2.0, 95%-CI 1.5-2.7), having > 5 sex partners (OR:1.65; 95%-CI:1.32-2.01.9), having condomless sex (OR:2.11.9; 95%-CI:1.65-2.86), and using party drugs (OR:1.65; 95%-CI:1.32-2.0) were independent risk factors for being tested positive for at least one STI. CONCLUSIONS: We found a high STI-prevalence in MSM in Germany, especially in PrEP users, frequently being asymptomatic. As a relevant proportion of PrEP users will not use a condom, counselling and comprehensive STI screening is essential and should be low threshold and preferably free of cost. Counselling of PrEP users should also address use of party drugs.


Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/genética , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium/genética , Neisseria gonorrhoeae/genética , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Adolescente , Adulto , Anciano , Chlamydia trachomatis/aislamiento & purificación , Condones , Consejo , Estudios Transversales , Alemania/epidemiología , Gonorrea/diagnóstico , Gonorrea/microbiología , Infecciones por VIH/prevención & control , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Mycoplasma genitalium/aislamiento & purificación , Neisseria gonorrhoeae/aislamiento & purificación , Prevalencia , Factores de Riesgo , Conducta Sexual , Parejas Sexuales , Adulto Joven
19.
Dtsch Arztebl Int ; 117(4): 43-50, 2020 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-32036852

RESUMEN

BACKGROUND: Acute liver failure (ALF) is a life-threatening event associated with high mortality. Currently, only estimates are available for its incidence. The aim of the study was to assess the incidence of ALF in Germany, using the accounting data of the largest statutory health insurance company, which represents 26.5 million people. METHODS: The analysis included patients insured from 1 January 2014 to 31 December 2018. Coding with the International Statistical Classification of Diseases and Related Health Problems and the German operation and procedure codes were used to identify the patients, whose age, sex, liver transplantations (LT), and fatal outcomes were then recorded and extrapolated to the total population. As a validity check, the extrapolated LT results were compared with the LT that were actually performed. RESULTS: The calculated incidence of ALF was 1.13/100 000 person-years, representing 4652 cases. Women were more often affected (52% versus 48%, p < 0.001). The overall rate of mortality within 3 months was 47%. A total of 203 LT were recorded in 176 patients. Men received 41% of the LT, women 59% (p < 0.137). The 1-year overall mortality rate after LT was 20%. The 203 calculated transplantations corresponded to 228 actually performed transplantations. CONCLUSION: The incidence of ALF was higher than previously estimated for Germany, with only a very low rate of LT despite high mortality. When extrapolating ny, it must be borne in mind that those insured by the company concerned do not represent a valid sample.


Asunto(s)
Fallo Hepático Agudo/epidemiología , Femenino , Alemania/epidemiología , Humanos , Fallo Hepático Agudo/mortalidad , Fallo Hepático Agudo/terapia , Trasplante de Hígado/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
20.
Dtsch Arztebl Int ; 117(4): 53-59, 2020 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-32036854

RESUMEN

BACKGROUND: To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany. METHODS: This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses. RESULTS: The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management. CONCLUSION: A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.


Asunto(s)
Fracturas de Cadera/mortalidad , Fracturas de Cadera/terapia , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Masculino , Resultado del Tratamiento
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