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2.
Artigo em Inglês | MEDLINE | ID: mdl-33022993

RESUMO

The COVID-19 pandemic represents a worldwide threat to mental health. To optimize the allocation of health care resources, research on specific vulnerability factors, such as health anxiety, intolerance of uncertainty, and distress (in)tolerance, and particularly their effect on the time course of SARS-CoV-2 related anxiety appears crucial for supporting high risk groups suffering from elevated mental distress during the pandemic. N = 887 participants (78.4% female; Mage = 38.15, SD = 17.04) completed an online survey in Germany (April to mid-May 2020), comprising measures of SARS-CoV-2 related anxiety, health anxiety, safety and preventive behavior, intolerance of uncertainty, and distress intolerance. Higher levels of health anxiety pre and during COVID-19 were associated with an initially intensified increase (b = 1.10, p < 0.001), but later on a more rapid dampening (b = -0.18, p < 0.001) of SARS-CoV-2 related anxiety. SARS-CoV-2 related preventive behavior was intensified by both pre (b = 0.06, p = 0.01) and during (b = 0.15, p < 0.001) COVID-19 health anxiety, while reassurance behavior only was associated with health anxiety during COVID-19 (b = 0.14, p < 0.001). Distress intolerance and intolerance of uncertainty did not moderate the relationship between health anxiety and SARS-CoV-2 related anxiety and behavior. The results suggest detrimental effects of health anxiety on the emotional and behavioral response to virus outbreaks.


Assuntos
Infecções por Coronavirus/psicologia , Pandemias , Pneumonia Viral/psicologia , Adulto , Ansiedade/epidemiologia , Atitude Frente a Saúde , Infecções por Coronavirus/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Angústia Psicológica , Incerteza
3.
Dtsch Med Wochenschr ; 145(20): 1464-1468, 2020 10.
Artigo em Alemão | MEDLINE | ID: mdl-33022727

RESUMO

Vaccination practices in Germany are driven by scientific developments and a complex regulatory environment. Some important developments in 2019/20 are described here: Work-related vaccination recommendations for measles, rubella, and chickenpox have been streamlined and expanded. In addition, measles vaccination or documentation of immunity is now mandatory for employment at and attendance of many institutions, specifically including day care centers and schools. Owing to the shift of pneumococcal serotypes since the introduction of conjugate vaccines the US ACIP no longer recommends these for the routine administration to healthy persons of older age. Reduced series of 2 or even 1 dose of an HPV vaccine may be sufficient, however definitive RCT data are not yet available. After years of development and clinical studies the first vaccine against Ebolavirus disease has been licensed by EMA in November and by FDA in December 2019. More than 150 SARS-CoV-2 vaccine candidates are being developed with massive financial support, several phase 1/2 trials have started. A licensed vaccine may actually be available in 2021 and thus dramatically faster compared to any other modern vaccine development.


Assuntos
Vacinação em Massa , Vacinas , Adulto , Ensaios Clínicos como Assunto , Infecções por Coronavirus/prevenção & controle , Alemanha , Humanos , Esquemas de Imunização , Vacinas Virais
5.
Z Gastroenterol ; 58(10): 982-1002, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33036052

RESUMO

The COVID-19 pandemic is a global outbreak of new onset infections with the SARS-CoV-2 virus. To date, more than 3.4 million people have been infected throughout the world. In Germany, approximately 450,000 patients suffer from inflammatory bowel disease; these patients generally require continuous expert care and support. Against the background of a rapidly accumulating knowledge base on SARS-CoV-2, 68 expert authors of the current DGVS guidelines for Crohn's disease and ulcerative colitis took part in a virtual meeting to compile up-to-date, practice-orientated recommendations aimed at improving the care of patients with IBD. These recommendations address the risk of infection, including the risk for specific patient groups, the possible course of the disease, and consequences for pharmacological and surgical therapies of the underlying disease, as well as general measures for infection prevention and adjuvant prophylactic and therapeutic options.


Assuntos
Colite Ulcerativa , Infecções por Coronavirus , Doença de Crohn , Doenças Inflamatórias Intestinais , Pneumonia Viral , Guias de Prática Clínica como Assunto , Betacoronavirus , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Alemanha , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
6.
Dtsch Arztebl Int ; 117(33-34): 545-552, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32865489

RESUMO

BACKGROUND: In this study, we investigate the number of emergency room consultations during the COVID-19 pandemic of 2020 in Germany compared to figures from the previous year. METHODS: Case numbers from calendar weeks 1 through 22 of the two consecutive years 2019 and 2020 were obtained from 29 university hospitals and 7 non-university hospitals in Germany. Information was also obtained on the patients' age, sex, and urgency, along with the type of case (outpatient/inpatient), admitting ward, and a small number of tracer diagnoses (I21, myocardial infarction; J44, COPD; and I61, I63, I64, G45, stroke /TIA), as well as on the number of COVID-19 cases and of tests performed for SARS-CoV-2, as a measure of the number of cases in which COVID-19 was suspected or at least included in the differential diagnoses. RESULTS: A total of 1 022 007 emergency room consultations were analyzed, of which 546 940 took place in 2019 and 475 067 in 2020. The number of consultations with a positive test for the COVID-19 pathogen was 3122. The total number of emergency room consultations in the observation period was 13% lower in 2020 than in 2019, with a maximum drop by 38% coinciding with the highest number of COVID-19 cases (calendar week 14; 572 cases). After the initiation of interpersonal contact restrictions in 2020, there was a marked drop in COVID-19 case numbers, by a mean of -240 cases per week per emergency room (95% confidence interval [-284; -128]). There was a rise in case numbers thereafter, by a mean of 17 patients per week [14; 19], and the number of cases of myocardial infarction returned fully to the level seen in 2019. CONCLUSION: In Germany, the COVID-19 pandemic led to a significant drop in medical emergencies of all kinds presenting to the nation's emergency departments. A recovery effect began to be seen as early as calendar week 15, but the levels seen in 2019 were not yet reached overall by calendar week 22; only the prevalence of myocardial infarction had renormalized by then. The reasons for this require further investigation.


Assuntos
Infecções por Coronavirus/epidemiologia , Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Alemanha/epidemiologia , Humanos
7.
F1000Res ; 9: 232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32864101

RESUMO

Since the first identified case of COVID-19 in Wuhan, China, the disease has developed into a pandemic, imposing a major challenge for health authorities and hospitals worldwide. Mathematical transmission models can help hospitals to anticipate and prepare for an upcoming wave of patients by forecasting the time and severity of infections. Taking the city of Heidelberg as an example, we predict the ongoing spread of the disease for the next months including hospital and ventilator capacity and consider the possible impact of currently imposed countermeasures.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Betacoronavirus , Cidades/epidemiologia , Alemanha/epidemiologia , Humanos , Pandemias
8.
Z Psychosom Med Psychother ; 66(3): 272-286, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32876561

RESUMO

Validation of the Short-Form-Health-Survey-12 (SF-12 Version 2.0) assessing health-related quality of life in a normative German sample Objectives: Convergent and divergent validation of the Short-Form-Health-Survey-12 assessing HRQoL by analyzing its associations with depressiveness (PHQ-9), social support (OSS-3) and satisfaction with life (SWLS). Methods: A normative German sample (N = 2.524) was analyzed using correlation, regression as well as confirmatory factor analysis and structural equation modelling for ordinal data. Results: The SF-12-scale Mental Health is associated most strongly with the validation criteria (PHQ: r[scales/constructs] = -.73/-.88, OSS-3: r = .35/.55, SWLS: r = .47/.62). Mental Health (ß = .36) and Social Support (OSS-3; ß = .25) allow to explain a significant amount of variance of the SWLS (R2 = .28). On construct level Emotional Role Functioning (ß = .28) proved to be significant additionally. Conclusions: The SF-12 scales are associated with the validation criteria as expected. The SF- 12 proved to be suitable for modelling core components of HRQoL within a biopsychosocial framework aiming at predicting satisfaction with life.


Assuntos
Inquéritos Epidemiológicos/normas , Qualidade de Vida , Alemanha/epidemiologia , Humanos , Psicometria , Reprodutibilidade dos Testes
9.
J Environ Manage ; 263: 110418, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32883482

RESUMO

Social media data are increasingly utilised as a low-cost alternative to visitor surveys in characterising nature-based recreation. However, the information available on individual users is limited and typically does not include provenance, restricting the potential applications and impact of the data. Here we investigate a methodology to estimate social media visitors' home locations at various spatial scales and apply it to the entire network of national parks in Germany. We compare predicted visitor provenance to representative onsite survey data and explore group-specific spatial and temporal patterns of recreation as characterised by users' geotagged photographs. Results show that photograph metadata can be used to assign home locations with accuracies between 62 and 89% depending on spatial scale implemented. Said social media-based predictions are reasonably well representative of the surveyed visitor structure in German national parks with Flickr visitor-days composed of 19% local, 62% non-local German and 19% international visits.


Assuntos
Parques Recreativos , Mídias Sociais , Conservação dos Recursos Naturais , Alemanha , Recreação , Inquéritos e Questionários
10.
Clin Interv Aging ; 15: 1427-1437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884251

RESUMO

Purpose: Demographic change and lack of specialized workforces are challenging. Likewise, home visits by general practitioners (GPs) become rarer. If a nursing home resident develops acute symptoms, nurses are often inclined to call the rescue service. Besides patient-related consequences, this might lead to unnecessary hospitalization and far-reaching health economic costs. Due to legal restrictions of remote treatment in Germany, which were recently loosened, telemedicine is still in the early stages. The aim of this study was to employ a holistic telemedical system for nursing homes which facilitates the connection to a GP and thus avoids unnecessary hospitalizations in the case of ambulatory-sensitive illnesses. Materials and Methods: After an inter-professional requirement analysis, the iterative development was started. In addition to an audio-video connection, several point of care measurements were integrated. Finally, first field tests were performed in a nursing home in a rural area in Germany. Results: One nursing home was equipped with telemedical system based on the results of the requirement analysis and tele-medically connected to a GP. Over a period of seven months, 56 routine and emergency teleconsultations took place. Only one of those required a hospital admission. In addition to video telephony, electrocardiography and assessment of vitals such as pulse, blood pressure, oxygen saturation and auscultation of heart and lungs were applied frequently. Conclusion: A telemedical system including integrated medical devices was successfully developed and has turned out to be helpful and even necessary for careful and reliable decision-making by the GP. First test results show high acceptance for elderly care. Involved patients, nurses, and the GP itemize various specific benefits, including economic, personal, and altruistic issues. Another issue that the current COVID-19 crisis brought to light is lowering the risk of contagion; GPs can replace their home visits by using telepresence combined with point of care measures.


Assuntos
Infecções por Coronavirus , Medicina Geral/métodos , Casas de Saúde , Pandemias , Pneumonia Viral , Consulta Remota/métodos , Consulta Remota/organização & administração , Idoso , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Alemanha , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Consulta Remota/instrumentação , Software , Inquéritos e Questionários
11.
Orthopade ; 49(9): 808-814, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32885289

RESUMO

BACKGROUND: The German Arthroplasty Registry, EPRD, has the ability to examine early factors influencing the probability of failure of total hip arthroplasty (THA) and knee arthroplasty (TKA). The study analyses the influence of the overall experience of a hospital, as well as the change in supplier on the revision rate. MATERIALS AND METHODS: A total of 164,903 cementless THA and 155,577 cemented TKA were in follow-up from 656 hospitals from 2012 to 2019. The number of arthroplasties performed per hospital per year was used as a surrogate parameter for institutional experience. This number was subdivided into 250, 251-500 and more than 500 for hip and knee per year and the overall revision rate was analysed. Additionally, the effects of the change of a major supplier of implant systems to a hospital were analysed. At least 70% of the documented implant components for each calendar quarter were used in that hospital to define the company as a major supplier. RESULTS: The overall revision rate for THA was 3.9% for hospitals with up to 250 arthroplasties per year, 3.3% for hospitals with 251-500 arthroplasties per year and 2.9% for hospitals performing over 500 surgeries per year (p < 0.0001). The revision rate for TKA was also significantly different between the three groups with 3.4, 3.3 and 2.7% (p < 0.0001). Changing the supplier of implant systems also showed a significant increase of the revision rate (p < 0.0001 for THA, p = 0.02 for TKA). CONCLUSION: The institutional experience significantly influences short-term results in terms of the revision rate of hip and knee arthroplasty. Changing the implant system even in an experienced hospital has a major impact on the early revision rate and, therefore, needs careful transition.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Alemanha , Humanos , Articulação do Joelho , Sistema de Registros , Reoperação , Estudos Retrospectivos
12.
Dtsch Arztebl Int ; 117(31-32): 528-533, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32900426

RESUMO

BACKGROUND: The reported high mortality of COVID-19 patients in intensive care has given rise to a debate over whether patients with this disease are being intubated too soon and might instead benefit from more non-invasive ventilation. METHODS: This review is based on articles published up to 12 June 2020 that were retrieved by a selective literature search on the topic of invasive and non-invasive ventilation for respiratory failure in COVID-19. Guideline recommendations and study data on patients with respiratory failure in settings other than COVID-19 are also considered, as are the current figures of the intensive care registry of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin). RESULTS: The high mortality figures among patients receiving invasive ventilation that have been reported in studies from abroad cannot be uncritically applied to the current situation in Germany. Study data on ventilation specifically in COVID-19 patients would be needed to do justice to the special pathophysiology of this disease, but such data are lacking. Being intubated too early is evidently associated with risks for the patient, but being intubated too late is as well. A particularly im - portant consideration is the potential harm associated with prolonged spontaneous breathing, with or without non-invasive assistance, as any increase in respiratory work can seriously worsen respiratory failure. On the other hand, it is clearly unacceptable to intubate patients too early merely out of concern that the medical staff might become infected with COVID-19 if they were ventilated non-invasively. CONCLUSION: Nasal high flow, non-invasive ventilation, and invasive ventilation with intubation should be carried out in a stepwise treatment strategy, under appropriate intensive-care monitoring and with the observance of all relevant anti-infectious precautions. Germany is better prepared that other countries to provide COVID-19 patients with appropriate respiratory care, in view of the high per capita density of intensive-care beds and the availability of a nationwide, interdisciplinary intensive care registry for the guidance and coordination of intensive care in patients who need it.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Infecções por Coronavirus/epidemiologia , Alemanha/epidemiologia , Humanos , Ventilação não Invasiva , Pandemias , Pneumonia Viral/epidemiologia
13.
J Prim Care Community Health ; 11: 2150132720953682, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32865107

RESUMO

INTRODUCTION: COVID-19 is causing an enormous psychological burden for most people. This study aims to assess individual changes in mental health and health status before and after the COVID-19 outbreak, and to explore potential predictors of change. METHODS: A cross-sectional study in Germany (n = 15 037) were conducted. Demographics, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L) were assessed. Additionally, all instruments used were adapted to measure the participants' mental health and health status before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information about COVID-19 were examined. RESULTS: Overall, the participants showed a significant increase in depression and anxiety symptoms, and distress, while health status deteriorated since the COVID-19 outbreak. Impairment in mental health was predicted by COVID-19-related fear. Pre-existing mental illness predicted an increase in depression symptoms and a deterioration in health status. Trust in governmental actions and the subjective level of information predicted less increase in psychological burden. CONCLUSIONS: Our data revealed that there have been changes in mental health and health status at an individual level since the outbreak of COVID-19. In order to maintain mental health, the observed predictors should be addressed.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Surtos de Doenças , Transtornos Mentais/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Medo/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , Adulto Jovem
14.
Biomed Res Int ; 2020: 2721381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884938

RESUMO

Introduction: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. Methods: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of "highly suspicious for COVID-19" and "COVID-19 as differential diagnosis." All respiratory and infectious symptoms were included as at least "differential diagnosis" as an expanded suspicion strategy. Results: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. Conclusion: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Estado Terminal , Diagnóstico Diferencial , Surtos de Doenças , Serviço Hospitalar de Emergência , Reações Falso-Negativas , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , RNA Viral/genética , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Ressuscitação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Triagem
15.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 443-462, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886045

RESUMO

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Cognitivo-Comportamental , Governo , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Pais/psicologia , Adolescente , Adulto , Áustria , Criança , Pré-Escolar , Suscetibilidade a Doenças , Alemanha , Humanos , Lactente , Transtornos Mentais/diagnóstico , Poder Familiar/psicologia
16.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 416-425, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886051

RESUMO

Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention In Germany, networks and measures of early childhood intervention (ECI) have been implemented nationwide. By specifically targeting families with multiple psychosocial challenges, ECI contributes to the enhancement of families' parenting skills, in order to promote equal opportunities for all children to grow up healthy and safe. In many families supported by ECI measures at least one parent shows symptoms of a mental health disorder, which poses a major challenge to ECI practitioners. Nevertheless, there is a lack of valid scientific knowledge about the proportion of young families living with symptoms of mental disorders, the degree to which parents' psychic burdens affect care in ECI measures and about the cooperation of different care providing systems. The National Center for Early Prevention (NCEP) monitors and evaluates the scaling up of ECI networks and measures in Germany. The present article compiles results of different NCEP studies focusing on parents with mental illness in Early Childhood Intervention. Results are discussed with regard to their relevance for further improving the care systems.


Assuntos
Filho de Pais Incapacitados/psicologia , Transtornos Mentais/prevenção & controle , Pais/psicologia , Medicina Preventiva , Criança , Suscetibilidade a Doenças , Alemanha , Humanos , Transtornos Mentais/reabilitação , Saúde Mental , Poder Familiar/psicologia
17.
Artigo em Alemão | MEDLINE | ID: mdl-32886137

RESUMO

Health reporting normally uses quantitative data collected in a standardized manner. The use of qualitative data, using the methods of qualitative social research, is generally the exception. The present article would like to illustrate the potential benefits of using qualitative methods in health reporting. The focus is on the following questions: What characterizes qualitative methods, what is their theoretical and methodological basis, and what specific contribution can they make in health reporting?Qualitative research is based on the assumption that people generally act on the basis of subjective meanings they attach to objects in their environment and to the action of other people. Qualitative methods often provide better possibilities to investigate these subjective perspectives and action orientations than standardized procedures. Due to their methodological particularities, qualitative methods are suitable for the exploration of health-relevant perceptions, attitudes, and behaviors. The results could help to improve the appropriateness of prevention programs; they can also be the starting point for further quantitative research to test hypotheses.The openness that characterizes qualitative methods presupposes sufficient expertise, but beyond this, accurateness and a rule-governed procedure are necessary, as in quantitative research. Added to this is transparency; the data have to be precisely documented and the analytic method disclosed. Even the results of qualitative research must stand up to critical appraisal.


Assuntos
Projetos de Pesquisa , Alemanha , Pesquisa Qualitativa
18.
PLoS One ; 15(9): e0238559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886696

RESUMO

The novel coronavirus (SARS-CoV-2), identified in China at the end of December 2019 and causing the disease COVID-19, has meanwhile led to outbreaks all over the globe with about 2.2 million confirmed cases and more than 150,000 deaths as of April 17, 2020. In this work, mathematical models are used to reproduce data of the early evolution of the COVID-19 outbreak in Germany, taking into account the effect of actual and hypothetical non-pharmaceutical interventions. Systems of differential equations of SEIR type are extended to account for undetected infections, stages of infection, and age groups. The models are calibrated on data until April 5. Data from April 6 to 14 are used for model validation. We simulate different possible strategies for the mitigation of the current outbreak, slowing down the spread of the virus and thus reducing the peak in daily diagnosed cases, the demand for hospitalization or intensive care units admissions, and eventually the number of fatalities. Our results suggest that a partial (and gradual) lifting of introduced control measures could soon be possible if accompanied by further increased testing activity, strict isolation of detected cases, and reduced contact to risk groups.


Assuntos
Infecções por Coronavirus/epidemiologia , Modelos Teóricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/estatística & dados numéricos , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
19.
BMC Pediatr ; 20(1): 427, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894080

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. METHODS: We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. RESULTS: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. CONCLUSIONS: Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Acesso aos Serviços de Saúde/tendências , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Estudos Retrospectivos
20.
RMD Open ; 6(2)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32878994

RESUMO

OBJECTIVES: Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. METHODS: Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters-for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection-are documented. RESULTS: Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. CONCLUSIONS: In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.


Assuntos
Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Sistema de Registros , Doenças Reumáticas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Psoriásica/complicações , Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Feminino , Alemanha , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Hospitalização , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Polimialgia Reumática/complicações , Polimialgia Reumática/tratamento farmacológico , Prognóstico , Doenças Reumáticas/complicações , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológico , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Adulto Jovem
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