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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.
Artigo em Alemão | MEDLINE | ID: mdl-32960295

RESUMO

BACKGROUND: Identification of child abuse is a daily challenge in medical work. The estimated number of unreported cases of child abuse and neglect is high. OBJECTIVES: The aim of this study was to investigate the effectiveness of the redesigned clinical child protection program of a major German pediatric hospital and to improve programs in other hospitals for children and physicians through presentation of the advantages of the new structure. METHODS: All cases of child protection at the Altona Children's Hospital were retrospectively analyzed before and after restructuring of the clinic's child protection program for a two-year period each, and a comparison was made. The child protection program was restructured and the new program subsequently managed by a fulltime coordinator. RESULTS: The prevalence of both suspected and substantiated cases of child abuse was significantly higher after restructuring of the child protection program. Before the change, 24 cases were investigated, of which 23 were substantiated; afterward, 124 cases were investigated and 89 were substantiated. Despite the high number of false-positive suspected cases, stigmatization of the families during the clarification progress was avoided by using a very sensitive approach, and the family was not confronted until the suspicion was affirmed. CONCLUSION: The presented concept of child protection in medical clinics seems to facilitate a higher detection rate of child abuse cases. The reduction in the number of undetected cases and thereby prevention of possible escalation of abuse, as well as the decline in the immense social follow-up costs, justifies the increased personnel costs.


Assuntos
Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/prevenção & controle , Criança , Bem-Estar da Criança , Família , Alemanha/epidemiologia , Humanos , Estudos Retrospectivos
4.
Artigo em Alemão | MEDLINE | ID: mdl-32970170

RESUMO

BACKGROUND: The Robert Koch Institute (RKI) annually publishes an estimate of the number of new HIV diagnoses and the total number of people diagnosed with HIV in Germany. So far, only medication prescription data have served as secondary data as a basis for such estimates. OBJECTIVES: In this study, we used billing data from the outpatient sector to estimate the number of patients with newly diagnosed HIV, the overall number of patients with HIV, and the HIV test rates in those with statutory health insurance in Germany. MATERIALS AND METHODS: We analyzed billing data from the outpatient sector for all persons covered by statutory health insurance between 2009 and 2018. We designed annual cohorts of patient for the years 2011 to 2017 and analyzed the number of HIV diagnoses, the number of HIV-related care services, and HIV testing rates. RESULTS: Every year, about 6000 new patients with HIV are treated in outpatient care. The total number of patients with HIV in 2011 was about 59,300 (0.106%), which increased to 80,800 (0.141%) in 2017. The average increase in the total number of patients per year of about 3600 was significantly below the estimated number of newly treated patients for each year. CONCLUSION: The results may provide an indication of patients receiving HIV care in the outpatient sector. The secondary data provide the possibility of developing another epidemiological data source for population-based representation of the administrative prevalence of HIV. To clarify over-representation, there is a need for further research on patients who are using outpatient care for the first time.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Pacientes Ambulatoriais , Assistência Ambulatorial , Alemanha/epidemiologia , Humanos , Prevalência
5.
Viruses ; 12(9)2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32962125

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a global health emergency. To improve the understanding of the systemic component of SARS-CoV-2, we investigated if viral load dynamics in plasma and respiratory samples are associated with antibody response and severity of coronavirus disease 2019 (COVID-19). SARS-CoV-2 RNA was found in plasma samples from 14 (44%) out of 32 patients. RNAemia was detected in 5 out of 6 fatal cases. Peak IgG values were significantly lower in mild/moderate than in severe (0.6 (interquartile range, IQR, 0.4-3.2) vs. 11.8 (IQR, 9.9-13.0), adjusted p = 0.003) or critical cases (11.29 (IQR, 8.3-12.0), adjusted p = 0.042). IgG titers were significantly associated with virus Ct (Cycle threshold) value in plasma and respiratory specimens ((ß = 0.4, 95% CI (confidence interval, 0.2; 0.5), p < 0.001 and ß = 0.5, 95% CI (0.2; 0.6), p = 0.002). A classification as severe or a critical case was additionally inversely associated with Ct values in plasma in comparison to mild/moderate cases (ß = -3.3, 95% CI (-5.8; 0.8), p = 0.024 and ß = -4.4, 95% CI (-7.2; 1.6), p = 0.007, respectively). Based on the present data, our hypothesis is that the early stage of SARS-CoV-2 infection is characterized by a primary RNAemia, as a potential manifestation of a systemic infection. Additionally, the viral load in plasma seems to be associated with a worse disease outcome.


Assuntos
Anticorpos Antivirais/sangue , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , RNA Viral/sangue , Idoso , Betacoronavirus/genética , Betacoronavirus/imunologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/patologia , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/patologia , RNA Viral/análise , Sistema Respiratório/virologia , Índice de Gravidade de Doença , Carga Viral , Viremia/sangue , Viremia/patologia , Viremia/virologia
6.
BMC Infect Dis ; 20(1): 678, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32942990

RESUMO

BACKGROUND: Tuberculosis (TB) control is a primary global health priority but the goal to eliminate TB is being threatened by the increase in incidence of multidrug-resistant tuberculosis (MDR-TB). With this series of seven MDR-TB cases in migrant patients with identical Mycobacterium tuberculosis strains we aim to illustrate the challenges encountered during therapy and follow-up: language barriers, access to care for migrant patients, depression due to isolation, adverse reactions to the treatment, management of pediatric TB, further contact tracing. We also discuss best practices for the management of complex MDR-TB cases in settings with low overall TB incidence focusing on modern diagnostic assays and an individualized and an interdisciplinary therapeutic approach. METHODS: We describe a case series of seven consecutively diagnosed MDR-TB patients, six of them treated at our tertiary care hospital between May 2018 and March 2020. Epidemiologic data was gained by semi-structured patient interviews and reconstruction of the migration route. The origin of the cluster was confirmed by genotyping of the TB-strains. RESULTS: Six related patients were diagnosed with pulmonary MDR-TB between May and August 2018. All had a positive Interferon-Gamma-Release Assay (IGRA), in five patients sputum microscopy was positive for acid-fast bacilli (AFB). The genetic and phenotypical drug susceptibility test did not match with MDR-TB strains from an East-African origin. The index patient was identified through genetical fingerprinting. By changing the therapy to a modern MDR-TB regime and using an interdisciplinary and culture-sensitive approach, all patients improved clinically and radiologically. CONCLUSION: Human migration plays an important role for the global spread of MDR-TB in low incidence countries. Early case detection and adequate treatment are key to prevention of outbreaks. Especially language barriers and complex migration routes make genotyping of TB-strains a crucial tool to identify cases clusters, the potential index patient and transmission dynamics. We are fortunate enough to experience times in which new TB-antibiotics were made available and in which molecular assays revolutionized TB-diagnostics. We need to take advantage of that and develop personalized therapies for patients suffering from drug resistant TB.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto , Antituberculosos/efeitos adversos , Pré-Escolar , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Fenótipo , Gravidez , Escarro/microbiologia , Sudão , Migrantes , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Adulto Jovem
7.
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
8.
Nutrients ; 12(9)2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32927735

RESUMO

Infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses an enormous challenge to health care systems throughout the world. Without causal treatment, identification of modifiable prognostic factors may help to improve outcomes. To explore possible associations of vitamin D (VitD) status with disease severity and survival, we studied 185 patients diagnosed with coronavirus disease 2019 (COVID-19) and treated at our center. VitD status at first presentation was assessed retrospectively using accredited laboratory methods. VitD deficiency was defined as serum total 25-hydroxyvitamin D level < 12 ng/mL (<30 nM). Primary endpoint was severe course of disease (i.e., need for invasive mechanical ventilation and/or death, IMV/D). Within a median observation period of 66 days (range 2-92), 23 patients required IMV. A total of 28 patients had IMV/D, including 16 deaths. Ninety-three (50%) patients required hospitalization (inpatient subgroup). A total of 41 (22%) patients were VitD deficient. When adjusted for age, gender, and comorbidities, VitD deficiency was associated with higher risk of IMV/D and death (HR 6.12, 95% CI 2.79-13.42, p < 0.001 and HR 14.73, 95% CI 4.16-52.19, p < 0.001, respectively). Similar correlations were observed in the inpatient subgroup. Our study demonstrates an association between VitD deficiency and severity/mortality of COVID-19, highlighting the need for interventional studies on VitD supplementation in SARS-CoV-2 infected individuals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Deficiência de Vitamina D/mortalidade , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/virologia , Feminino , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/virologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/virologia
10.
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
11.
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
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.
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
14.
Euro Surveill ; 25(36)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32914746

RESUMO

We investigated data from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected 0-19 year olds, who attended schools/childcare facilities, to assess their role in SARS-CoV-2 transmission after these establishments' reopening in May 2020 in Baden-Württemberg, Germany. Child-to-child transmission in schools/childcare facilities appeared very uncommon. We anticipate that, with face mask use and frequent ventilation of rooms, transmission rates in schools/childcare facilities would remain low in the next term, even if classes' group sizes were increased.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Coronavirus/isolamento & purificação , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Instituições Acadêmicas , Adolescente , Betacoronavirus , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/epidemiologia , Alemanha/epidemiologia , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Pneumonia Viral/epidemiologia , Adulto Jovem
15.
PLoS One ; 15(9): e0239027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931510

RESUMO

INTRODUCTION: After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. MATERIAL AND METHODS: An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. RESULTS: 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits. CONCLUSION: The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.


Assuntos
Infecções por Coronavirus/patologia , Pessoal de Saúde/psicologia , Pneumonia Viral/patologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Internet , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Robóticos , Inquéritos e Questionários , Doenças Urológicas/cirurgia , Urologistas/psicologia
16.
Artigo em Alemão | MEDLINE | ID: mdl-32876717

RESUMO

BACKGROUND: Data sources for the systematic and ongoing analysis of prevalence of microvascular complications of diabetes mellitus are limited in Germany. For the first time, we estimated the complications prevalence based on claims data of all statutory health insurance (SHI) providers according to the Data Transparency Act. METHODS: Health claims data of the reporting years 2012 and 2013 were analyzed. The reference population was identified as insured persons with a diabetes diagnosis according to the international classification of disease. Diabetes was defined as documentation of at least two confirmed diabetes diagnoses in an outpatient setting or one diagnosis in an inpatient setting (ICD codes E10-E14). Complications were defined based on the following ICD codes: nephropathy (N08.3), retinopathy (H36.0), polyneuropathy (G63.2), diabetic foot syndrome (DFS; E10-14.74, E10-14.75), chronic kidney disease (N18.-), and treatment with dialysis (Z49.1, Z49.2, Z99.2). Results were compared to prevalence estimates based on routine data and registries in Germany and abroad. RESULTS: In 2013, diabetes was documented for 6.6 million persons with SHI (2012: 6.5 million). In 2013, chronic kidney disease (15.0%) was the most frequent complication, followed by diabetic polyneuropathy (13.5%), nephropathy (7.6%), retinopathy (7.0%), DFS (6.1%), and treatment with dialysis (0.56%). While results for diabetic retinopathy, nephropathy, and polyneuropathy are lower than prevalence estimates from other type 2 diabetes studies, they are comparable for chronic kidney disease, treatment with dialysis, and DFS. CONCLUSION: Continuous analysis of health claims data is highly valuable for the diabetes surveillance. However, detailed analyses are required for verification and harmonization of case definitions and documentation practice.


Assuntos
Diabetes Mellitus Tipo 2 , Pé Diabético , Alemanha/epidemiologia , Humanos , Seguro Saúde , Prevalência
17.
Artigo em Alemão | MEDLINE | ID: mdl-32897408

RESUMO

BACKGROUND: Estimating the number of persons tested for HIV in Germany is challenging. HIV testing can be reimbursed by statutory health insurance (SHI) under certain circumstances. This study aimed to use SHI physician claims data to determine the number of persons tested in the outpatient sector. METHODS: The Central Research Institute for Ambulatory Health Care in Germany (Zi) aggregated a dataset of persons tested for HIV among all SHI insurees. Descriptive analysis differentiated between screening and confirmatory HIV tests. Time trends were explored using linear regression. Insurees with confirmatory tests were compared to newly diagnosed HIV (ndHIV) cases. RESULTS: Between 2010 and 2015, 1.7% of insurees were annually screened by SHI physicians. Screening tests increased significantly between 2010 and 2015. Among persons screened, 82.5% were women and of those 81.2% had a screening test during pregnancy. Confirmatory tests were performed on 16,034 insurees (0.3% with screening test; 51.2% men). A total of 18,446 (82.8% men) ndHIV cases were notified between 2010 and 2015. CONCLUSIONS: For the first time, the number of persons with HIV tests in the SHI sector was estimated. The high number of screened women is due to tests during pregnancy. The higher number of ndHIV cases indicates an unknown number of persons tested at other testing sites.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Pacientes Ambulatoriais , Assistência à Saúde , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Programas Nacionais de Saúde
18.
Artigo em Alemão | MEDLINE | ID: mdl-32940746

RESUMO

BACKGROUND: According to estimates, between 337,000 and 650,000 people in Germany live without a permanent residence. They are highly deprived in terms of health. Studies on the health situation are rare and methodologically heterogeneous. Previous reviews have focused on mental illness. OBJECTIVES: The aim of this paper is to provide an overview of current research on somatic diseases of homeless people in Germany. METHODS: Based on a systematic literature review for the years 2009-2019, the methodological approaches, sample access, recruitment, and health aspects reported in the studies are compared. RESULTS: By means of a systematic literature search, eight peer-reviewed journal articles were identified. Often the term "homelessness" was not operationalised. The average age of homeless participants was between 40.9 years and 67 years, and the proportion of women was between 0 and 35.3%. Frequently the sample was taken from accommodation and medical services for homeless people. One recruitment strategy was "respondent-driven sampling" in conjunction with incentives. The respondents most frequently reported cardiovascular diseases (17%-37.2%), musculoskeletal diseases (≥20%), and respiratory diseases (7%-24%). Depending on the recruitment site, infectious diseases were common (tuberculosis, hepatitis B and C). CONCLUSION: Somatic health studies of homeless people are often selective. Older men with lower educational backgrounds living in large German cities appear to be overrepresented, and there is no uniform use of the term "homelessness." Compared with representative population data for Germany, increased risks of somatic illness were observed; cohort characteristics can explain these to a limited extent. Biographical and intersectional approaches are needed to capture multiple and cumulative exposure situations in homelessness.


Assuntos
Pessoas em Situação de Rua , Transtornos Mentais/epidemiologia , Tuberculose , Adulto , Idoso , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Masculino
19.
Z Gastroenterol ; 58(9): 855-867, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947631

RESUMO

BACKGROUND: The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS: 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS: Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€â€Š10,653 vs. €â€Š5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€â€Š473 vs. €â€Š488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€â€Š10,307 vs. €â€Š6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€â€Š443 vs. €â€Š499, p = 0.18). ACLF increased treatment revenues to €â€Š10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€â€Š483 vs. €â€Š480, p = 0.29). CONCLUSION: SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.


Assuntos
Insuficiência Hepática Crônica Agudizada/economia , Infecções Bacterianas/economia , Infecção Hospitalar/economia , Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Peritonite/economia , Insuficiência Hepática Crônica Agudizada/terapia , Infecções Bacterianas/terapia , Infecção Hospitalar/complicações , Infecção Hospitalar/terapia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Tempo de Internação , Cirrose Hepática/complicações , Peritonite/tratamento farmacológico , Estudos Retrospectivos
20.
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
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