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1.
J Environ Manage ; 301: 113895, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34634724

RESUMO

Copper leached from recreational vessel antifouling paints can pose a threat to aquatic organisms. To date, leaching rates have mainly been studied in seawater and brackish water. The aim of this study was to investigate the copper input from antifouling paints to freshwater using field and laboratory studies. Therefore, a large sailing area in Berlin was sampled. According to a risk assessment, the use of copper containing antifouling paints in Berlins is predicted to have no significant impact on aquatic organisms. An exception was found in sport boat marinas where, in dependence on the boat number, the sediment copper concentrations were up to 2 times higher than the German environmental quality standard for sediments. The most important result revealed by the laboratory batch tests is that the copper leaching rate in freshwater is much lower compared to seawater and brackish water. The dissolution of copper from antifouling paints into freshwater is overestimated up to now. Nevertheless, the leached copper from antifouling paints is the second largest anthropogenic copper source in the urban area of Berlin and the third largest anthropogenic copper source in German freshwaters.


Assuntos
Incrustação Biológica , Poluentes Químicos da Água , Berlim , Incrustação Biológica/prevenção & controle , Cobre/análise , Água Doce , Pintura , Poluentes Químicos da Água/análise
2.
Euro Surveill ; 26(43)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34713798

RESUMO

BackgroundDetailed information on symptom duration and temporal course of patients with mild COVID-19 was scarce at the beginning of the COVID-19 pandemic.AimWe aimed to determine the longitudinal course of clinical symptoms in non-hospitalised COVID-19 patients in Berlin, Germany.MethodsBetween March and May 2020, 102 confirmed COVID-19 cases in home isolation notified in Berlin, Germany, were sampled using total population sampling. Data on 25 symptoms were collected during telephone consultations (a maximum of four consultations) with each patient. We collected information on prevalence and duration of symptoms for each day of the first 2 weeks after symptom onset and for day 30 and 60 after symptom onset.ResultsMedian age was 35 years (range 18-74), 57% (58/102) were female, and 37% (38/102) reported having comorbidities. During the first 2 weeks, most common symptoms were malaise (94%, 92/98), headache (71%, 70/98), and rhinitis (69%, 68/98). Malaise was present for a median of 11 days (IQR 7-14 days) with 35% (34/98) of cases still reporting malaise on day 14. Headache and muscle pain mostly occurred during the first week, whereas dysosmia and dysgeusia mostly occurred during the second week. Symptoms persisted in 41% (39/95) and 20% (18/88) of patients on day 30 and 60, respectively.ConclusionOur study shows that a significant proportion of non-hospitalised COVID-19 cases endured symptoms for at least 2 months. Further research is needed to assess the frequency of long-term adverse health effects in non-hospitalised COVID-19 patients.


Assuntos
COVID-19 , Adolescente , Adulto , Idoso , Berlim , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Adulto Jovem
3.
J Neural Transm (Vienna) ; 128(11): 1635-1640, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34655340

RESUMO

Hallervorden-Spatz disease (HSD) has been recently renamed to pantothenate kinase-associated neurodegeneration (PKAN) and neurodegeneration with brain iron accumulation (NBIA), mainly due to the unethical behavior of Julius Hallervorden in the National Socialist (NS) euthanasia program of the Nazi Third Reich. The role of the second name giver in the NS euthanasia program is less clear. Hugo Spatz was the director of the Kaiser Wilhelm Institute for Brain Research in Berlin-Buch during World War II (WWII), renamed to Max Planck Institute after 1945. After the war, he headed the Max Planck Institute for Brain Research in Frankfurt am Main. The present study investigates the potential involvement of Hugo Spatz in the NS euthanasia program. In the present study, we compared a list of euthanasia victims from the German Federal Archive Berlin (30.146 cases published after the reunification of Germany, BArch R179) with the files of the collection of specimens from 1940 until 1945 of Hugo Spatz as listed in the Archive of the Max Planck Society Berlin-Dahlem (n = 305). Furthermore, the old term HSD and the new terms PKAN and NBIA were systematically searched in PubMed from 1946, through January 2019 to evaluate the renaming process from HSD to PKAN/NBIA. Following Hugo Spatz's death in 1969 growing evidence indicated that he may have taken part in the NS euthanasia program. This study identifies 4 euthanized victims in the patient files of Hugo Spatz from 1940 to 1945, suggesting involvement of Hugo Spatz in the NS euthanasia program. This further strengthens the argument that the former HSD should be exclusively referred to as PKAN or NBIA.


Assuntos
Eutanásia , Neurodegeneração Associada a Pantotenato-Quinase , Berlim , Encéfalo , Alemanha , Humanos , Masculino
4.
PLoS One ; 16(10): e0259037, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34710158

RESUMO

Epidemiological simulations as a method are used to better understand and predict the spreading of infectious diseases, for example of COVID-19. This paper presents an approach that combines a well-established approach from transportation modelling that uses person-centric data-driven human mobility modelling with a mechanistic infection model and a person-centric disease progression model. The model includes the consequences of different room sizes, air exchange rates, disease import, changed activity participation rates over time (coming from mobility data), masks, indoors vs. outdoors leisure activities, and of contact tracing. It is validated against the infection dynamics in Berlin (Germany). The model can be used to understand the contributions of different activity types to the infection dynamics over time. It predicts the effects of contact reductions, school closures/vacations, masks, or the effect of moving leisure activities from outdoors to indoors in fall, and is thus able to quantitatively predict the consequences of interventions. It is shown that these effects are best given as additive changes of the reproduction number R. The model also explains why contact reductions have decreasing marginal returns, i.e. the first 50% of contact reductions have considerably more effect than the second 50%. Our work shows that is is possible to build detailed epidemiological simulations from microscopic mobility models relatively quickly. They can be used to investigate mechanical aspects of the dynamics, such as the transmission from political decisions via human behavior to infections, consequences of different lockdown measures, or consequences of wearing masks in certain situations. The results can be used to inform political decisions.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Busca de Comunicante/métodos , Berlim , COVID-19/metabolismo , Telefone Celular/tendências , Simulação por Computador , Alemanha , Desinfecção das Mãos/tendências , Humanos , Máscaras/tendências , Modelos Teóricos , Distanciamento Físico , Dinâmica Populacional/tendências , SARS-CoV-2/patogenicidade , Análise de Sistemas
6.
Euro Surveill ; 26(34)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34448448

RESUMO

BackgroundSchool attendance during the COVID-19 pandemic is intensely debated.AimIn November 2020, we assessed SARS-CoV-2 infections and seroreactivity in 24 randomly selected school classes and connected households in Berlin, Germany.MethodsWe collected oro-nasopharyngeal swabs and blood samples, examining SARS-CoV-2 infection and IgG antibodies by RT-PCR and ELISA. Household members self-swabbed. We assessed individual and institutional prevention measures. Classes with SARS-CoV-2 infection and connected households were retested after 1 week.ResultsWe examined 1,119 participants, including 177 primary and 175 secondary school students, 142 staff and 625 household members. SARS-CoV-2 infection occurred in eight classes, affecting each 1-2 individuals. Infection prevalence was 2.7% (95% confidence interval (CI): 1.2-5.0; 9/338), 1.4% (95% CI: 0.2-5.1; 2/140), and 2.3% (95% CI: 1.3-3.8; 14/611) among students, staff and household members. Six of nine infected students were asymptomatic at testing. We detected IgG antibodies in 2.0% (95%CI: 0.8-4.1; 7/347), 1.4% (95% CI: 0.2-5.0; 2/141) and 1.4% (95% CI: 0.6-2.7; 8/576). Prevalence increased with inconsistent facemask-use in school, walking to school, and case-contacts outside school. For three of nine households with infection(s), origin in school seemed possible. After 1 week, no school-related secondary infections appeared in affected classes; the attack rate in connected households was 1.1%.ConclusionSchool attendance under rigorously implemented preventive measures seems reasonable. Balancing risks and benefits of school closures need to consider possible spill-over infection into households. Deeper insight is required into the infection risks due to being a schoolchild vs attending school.


Assuntos
COVID-19 , SARS-CoV-2 , Berlim , Estudos Transversais , Alemanha/epidemiologia , Humanos , Pandemias , Instituições Acadêmicas
7.
Sci Rep ; 11(1): 16317, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34381086

RESUMO

Diaphragm weakness affects up to 60% of ventilated patients leading to muscle atrophy, reduction of muscle fiber force via muscle fiber injuries and prolonged weaning from mechanical ventilation. Electromagnetic stimulation of the phrenic nerve can induce contractions of the diaphragm and potentially prevent and treat loss of muscular function. Recommended safety distance of electromagnetic coils is 1 m. The aim of this study was to investigate the magnetic flux density in a typical intensive care unit (ICU) setting. Simulation of magnetic flux density generated by a butterfly coil was performed in a Berlin ICU training center with testing of potential disturbance and heating of medical equipment. Approximate safety distances to surrounding medical ICU equipment were additionally measured in an ICU training center in Bern. Magnetic flux density declined exponentially with advancing distance from the stimulation coil. Above a coil distance of 300 mm with stimulation of 100% power the signal could not be distinguished from the surrounding magnetic background noise. Electromagnetic stimulation of the phrenic nerve for diaphragm contraction in an intensive care unit setting seems to be safe and feasible from a technical point of view with a distance above 300 mm to ICU equipment from the stimulation coil.


Assuntos
Nervo Frênico/fisiopatologia , Gestão da Segurança/métodos , Berlim , Diafragma/fisiopatologia , Fenômenos Eletromagnéticos , Humanos , Unidades de Terapia Intensiva , Contração Muscular/fisiologia , Debilidade Muscular/fisiopatologia , Atrofia Muscular/fisiopatologia , Respiração Artificial/métodos
8.
Artigo em Alemão | MEDLINE | ID: mdl-34251465

RESUMO

The annual Poverty and Health congress, which has been organized by Gesundheit Berlin-Brandenburg e. V. since 1995, has become one of the biggest public health events in Germany. It offers an exchange platform for science, practice, and politics. This year's congress topic was "From Crisis to Health in All Policies," which aimed to address the SARS-CoV­2 pandemic's impact on society in general and public health in particular. Overall, 80 panels were organized with close to 500 experts discussing a wide range of subjects and questions, for example, the connection between poverty and COVID-19, the current challenges in the care sector, the situation of homeless people, and the impact of the pandemic on (young) families or students as well as global questions on vaccination strategy and key issues for a public health strategy for Germany.


Assuntos
COVID-19 , Pobreza , Berlim , Alemanha , Humanos , Políticas , SARS-CoV-2
9.
BMC Public Health ; 21(1): 1440, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289829

RESUMO

BACKGROUND: Self-reported health (SRH) and life satisfaction (LS) are patient-reported outcomes (PROs) that independently predict mortality and morbidity in older adults. Emergency department (ED) visits due to serious health problems or accidents might pose critical life events for patients. This study aimed (a) to characterize older patients' SRH and LS during the distinct event of an ED stay, and (b) to analyze concomitant associations of PROs with ED patients' sociodemographic, disease-specific and care-related variables. METHODS: Study personnel recruited mostly older ED patients from three disease groups during a two-year period (2017-2019) in eight EDs in central Berlin, Germany, in the context of the health services research network EMANet. Cross-sectional data from the baseline patient survey and associated secondary data from hospital information systems were analyzed. Multilevel linear regression models with random intercept were applied to assess concomitant associations with SRH (scale: 0 (worst) to 100 (best)) and LS (scale: 0 (not at all satisfied) to 10 (completely satisfied)) as outcomes, including sensitivity analyses. RESULTS: The final sample comprised N = 1435 participants. Mean age was 65.18 (SD: 16.72) and 50.9% were male. Mean ratings of SRH were 50.10 (SD: 23.62) while mean LS scores amounted to 7.15 (SD: 2.50). Better SRH and higher LS were found in patients with cardiac symptoms (SRH: ß = 4.35, p = .036; LS: ß = 0.53, p = .006). Worse SRH and lower LS were associated with being in need of nursing care (SRH: ß = - 7.52, p < .001; LS: ß = - 0.59, p = .003) and being unemployed (SRH: ß = - 8.54, p = .002; LS: ß = - 1.27, p < .001). Sex, age, number of close social contacts, and hospital stays in the previous 6 months were additionally related to the outcomes. Sensitivity analyses largely supported results of the main sample. CONCLUSIONS: SRH and LS were associated with different sociodemographic and disease-related variables in older ED patients. Nursing care dependency and unemployment emerged as significant factors relating to both outcomes. Being able to identify especially vulnerable patients in the ED setting might facilitate patient-centered care and prevent negative health outcomes. However, further longitudinal research needs to analyze trajectories in both outcomes and suitable intervention possibilities in the ED setting. TRIAL REGISTRATION: EMANet sub-studies were registered separately: German Clinical Trials Register (EMAAge: DRKS00014273, registration date: May 16, 2018; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014273; EMACROSS: DRKS00011930, registration date: April 25, 2017; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011930); ClinicalTrials.gov (EMASPOT: NCT03188861, registration date: June 16, 2017; https://clinicaltrials.gov/ct2/show/NCT03188861?term=NCT03188861&draw=2&rank=1).


Assuntos
Satisfação do Paciente , Satisfação Pessoal , Idoso , Berlim , Estudos Transversais , Serviço Hospitalar de Emergência , Alemanha/epidemiologia , Humanos , Lactente , Masculino , Autorrelato
10.
BMJ Open ; 11(7): e049688, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266843

RESUMO

INTRODUCTION: Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is-to a large extent-caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services. METHODS AND ANALYSIS: Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis. ETHICS AND DISSEMINATION: Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences. TRIAL REGISTERATION: The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results.


Assuntos
Letramento em Saúde , Aplicativos Móveis , Autogestão , Berlim , Acesso aos Serviços de Saúde , Humanos , Saúde Mental , Participação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Artigo em Inglês | MEDLINE | ID: mdl-34205730

RESUMO

OBJECTIVES: We assessed the costs of dental services in statutorily insured, very old (geriatric) Germans. METHODS: A comprehensive sample of very old (≥75 years) people insured at a large Northeastern statutory insurer was followed over 6 years (2012-2017). We assessed dental services costs for: (1) examination, assessments and advice, (2) operative, (3) surgical, (4) prosthetic, (5) periodontal, (6) preventive and (7) outreach services. Association of utilization with: (1) sex, (2) age, (3) region, (4) social hardship status, (5) International Disease Classification (ICD-10) diagnoses and (6) Diagnoses Related Groups (DRGs) was explored. RESULTS: 404,610 individuals with a mean (standard deviation, SD) age 81.9 (5.4 years) were followed, 173,733 did not survive follow-up. Total mean costs were 129.61 (310.97) euro per capita; the highest costs were for prosthetic (54.40, SD 242.89 euro) and operative services (28.40, SD 68.38 euro), examination/advice (21.15, SD 28.77 euro), prevention (13.31, SD 49.79 euro), surgery (5.91, SD 23.91 euro), outreach (4.81, SD 28.56 euro) and periodontal services (1.64, SD 7.39 euro). The introduction of new fee items for outreach and preventive services between 2012 and 2017 was reflected in costs. Total costs decreased with increasing age, and this was also found for all service blocks except outreach and preventive services. Costs were higher in those with social hardship status, and in Berlin than Brandenburg and Mecklenburg-Western Pomerania. Certain general health conditions were associated with increased or decreased costs. CONCLUSIONS: Costs were associated with sex, social hardship status, place of living and general health conditions. CLINICAL SIGNIFICANCE: Dental services costs for the elderly in Germany are unequally distributed and, up to a certain age or health status, generated by invasive interventions mainly. Policy makers should incentivize preventive services earlier on and aim to distribute expenses more equally.


Assuntos
Assistência Odontológica , Custos de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Berlim , Custos e Análise de Custo , Alemanha , Humanos
12.
Crit Care Med ; 49(10): 1664-1673, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34166284

RESUMO

OBJECTIVES: The rapid diagnosis of acute infections and sepsis remains a serious challenge. As a result of limitations in current diagnostics, guidelines recommend early antimicrobials for suspected sepsis patients to improve outcomes at a cost to antimicrobial stewardship. We aimed to develop and prospectively validate a new, 29-messenger RNA blood-based host-response classifier Inflammatix Bacterial Viral Non-Infected version 2 (IMX-BVN-2) to determine the likelihood of bacterial and viral infections. DESIGN: Prospective observational study. SETTING: Emergency Department, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany. PATIENTS: Three hundred twelve adult patients presenting to the emergency department with suspected acute infections or sepsis with at least one vital sign change. INTERVENTIONS: None (observational study only). MEASUREMENTS AND MAIN RESULTS: Gene expression levels from extracted whole blood RNA was quantified on a NanoString nCounter SPRINT (NanoString Technologies, Seattle, WA). Two predicted probability scores for the presence of bacterial and viral infection were calculated using the IMX-BVN-2 neural network classifier, which was trained on an independent development set. The IMX-BVN-2 bacterial score showed an area under the receiver operating curve for adjudicated bacterial versus ruled out bacterial infection of 0.90 (95% CI, 0.85-0.95) compared with 0.89 (95% CI, 0.84-0.94) for procalcitonin with procalcitonin being used in the adjudication. The IMX-BVN-2 viral score area under the receiver operating curve for adjudicated versus ruled out viral infection was 0.83 (95% CI, 0.77-0.89). CONCLUSIONS: IMX-BVN-2 demonstrated accuracy for detecting both viral infections and bacterial infections. This shows the potential of host-response tests as a novel and practical approach for determining the causes of infections, which could improve patient outcomes while upholding antimicrobial stewardship.


Assuntos
Infecções Bacterianas/diagnóstico , RNA Mensageiro/análise , Viroses/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Infecções Bacterianas/sangue , Infecções Bacterianas/fisiopatologia , Berlim , Biomarcadores/análise , Biomarcadores/sangue , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Mensageiro/sangue , Curva ROC , Viroses/sangue , Viroses/fisiopatologia
13.
Emerg Infect Dis ; 27(7)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34152970

RESUMO

Within 5 weeks in 2021, B.1.1.7 became the dominant severe acute respiratory syndrome coronavirus 2 lineage at an outpatient testing site in Berlin, Germany. Compared with outpatients with wild-type virus infection, patients with B.1.1.7 had similar cycle threshold values, more frequent sore throat and travel history, and less frequent anosmia/ageusia.


Assuntos
COVID-19 , SARS-CoV-2 , Berlim , Alemanha/epidemiologia , Humanos , Pacientes Ambulatoriais
14.
Emerg Infect Dis ; 27(8): 2169-2173, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34102098

RESUMO

One week after second vaccinations were administered, an outbreak of B.1.1.7 lineage severe acute respiratory syndrome coronavirus 2 infections occurred in a long-term care facility in Berlin, Germany, affecting 16/20 vaccinated and 4/4 unvaccinated residents. Despite considerable viral loads, vaccinated residents experienced mild symptoms and faster time to negative test results.


Assuntos
COVID-19 , SARS-CoV-2 , Berlim , Surtos de Doenças , Alemanha/epidemiologia , Humanos , Assistência de Longa Duração , Vacinação
15.
BMJ Open ; 11(6): e045576, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162642

RESUMO

PURPOSE: The study 'Sex- and gender-sensitive prevention of cardiovascular and metabolic disease in older adults in Germany', the GendAge study, focuses on major risk factors for cardiovascular and metabolic diseases and on the development of major outcomes from intermediate phenotypes in the context of sex and gender differences. It is based on a follow-up examination of a subsample (older group) of the Berlin Aging Study II (BASE-II). PARTICIPANTS: The GendAge study assessments took place between 22 June 2018 and 10 March 2020. A total of 1100 participants (older BASE-II subsample, aged ≥65 years) with baseline data assessed at least by one of the BASE-II partner sites were investigated in the follow-up. These participants had a mean age of 75.6 years (SD ±3.8), with a mean follow-up at 7.4 years (SD ±1.5). FINDINGS TO DATE: Data from different domains such as internal medicine, geriatrics, immunology and psychology were collected, with a focus on cardiometabolic diseases and in the context of sex and gender differences. Diabetes mellitus type 2 was reported by 15.6% and 8.6% of men and women, respectively. In contrast, this disease was diagnosed in 20.7% of men and 13.3% of women, indicating that a substantial proportion of almost 30% was unaware of the disease. Echocardiography revealed that left ventricular ejection fraction was higher in women than in men, in agreement with previous reports. FUTURE PLANS: A gender questionnaire assessing sociocultural aspects implemented as part of the follow-up described here will allow to calculate a gender score and its evaluation based on the newly collected data. At the same time, the other BASE-II research foci established over the past 10 years will be continued and strengthened by the BASE-II transition into a longitudinal study with follow-up data on the older subsample. TRIAL REGISTRATION NUMBER: DRKS00016157.


Assuntos
Envelhecimento , Função Ventricular Esquerda , Idoso , Berlim , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Volume Sistólico
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 557-562, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112292

RESUMO

OBJECTIVE: To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO2/FiO2, SOFA score, APACHE II score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. RESULTS: Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHE II score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO2/FiO2 (r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHE II score (r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ2 = 3.979, P = 0.046). CONCLUSIONS: The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.


Assuntos
Síndrome do Desconforto Respiratório , Berlim , Edema , Humanos , Unidades de Terapia Intensiva , Pulmão , Prognóstico , Curva ROC , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Estudos Retrospectivos
17.
Front Public Health ; 9: 667253, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34095070

RESUMO

Background: Germany is a low prevalence country for hepatitis B virus (HBV) infection with higher prevalence in vulnerable groups. The number of treated chronic hepatitis B (CHB) patients is unknown. We aimed to determine the number of CHB patients treated with nucleos(t)ide analogs (NUCs), the treatment costs within the statutory health insurance (SHI) in Germany and per patient per month. Methods: Data on pharmacy bills of NUCs to patients with SHI between 2008 and 2019 were purchased from Insight Health™ and described. Negative binomial regression was used for trend analysis. Results: Number of patients increased between 2008 and 2019 (4.9% per year) with little changes in treatment options. Overall prescription costs were increasing (6.7% per year on average) until the introduction of tenofovir and entecavir generics in 2017 after which costs decreased by 31% in 2019. Average therapy costs peaked at 498 Euro per patient per month in 2016 and decreased to 214 Euro in 2019. Prescriptions changed from 30 to 90 pills per pack over time. HBV therapy was prescribed to 97% by three medical specialist groups, mainly specialists in internal medicine (63%), followed by hospital-based outpatient clinics (20%) and general practitioners (15%). Contrary to guideline recommendation, adefovir was still prescribed after 2011 for 1-5% of patients albeit with decreasing tendency. Prescriptions per 100,000 inhabitants were highest in Berlin and Hamburg. Conclusion: Our data shows, that the number of treated CHB patients increased steadily, while NUC therapy costs decreased. We recommend continued testing and treatment for those eligible to prevent advanced liver disease and possibly decrease further transmission of HBV.


Assuntos
Hepatite B Crônica , Hepatite B , Antivirais/uso terapêutico , Berlim , Alemanha/epidemiologia , Hepatite B/tratamento farmacológico , Hepatite B Crônica/tratamento farmacológico , Humanos
18.
MMW Fortschr Med ; 163(Suppl 2): 28-35, 2021 06.
Artigo em Alemão | MEDLINE | ID: mdl-34146315

RESUMO

The steady development of the antiretroviral therapy (ART) has led to a significant change in the demands on the quality of care. There are different regional challenges.It is a non-interventional, bicentric correlation study in the form of a retrospective data analysis including data of 43 HIV-positive patients in Greifswald and 1669 in Berlin. All variables were evaluated with R. Statistical significance was assumed at a p-value of ≤ 0.05.The immunological parameters showed a significantly lower CD4+ T-lymphocyte cell count in patients from Greifswald compared to those from Berlin (B: 516/µl blood; G: 266/µl blood; p < 0.001). The supply of ART was > 80% (B: 153/184 [83.15%]; G: 36/41 [87.8%]; p = 0.64) in both cohorts and led to a permanent (> than 4 quarters) drop of the viral load below the detection limit in 115/184 [62.25%] patients in Berlin and 23/41 [56.09%] patients in Greifswald (p = 0.008).This study has shown that the quality of care for HIV-infected patients in both urban and rural areas is of a high standard and carried out in accordance with the guidelines.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Berlim , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Estudos Retrospectivos , Carga Viral
19.
Anaesthesia ; 76(10): 1342-1351, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33960404

RESUMO

Delirium occurs commonly following major non-cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri-operative administration of dexmedetomidine on the incidence of postoperative delirium in non-cardiac and cardiac surgical patients. In this randomised, double-blind placebo-controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non-cardiac surgery, we conclude that the peri-operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.


Assuntos
Dexmedetomidina/uso terapêutico , Delírio do Despertar/epidemiologia , Delírio do Despertar/prevenção & controle , Hipnóticos e Sedativos/uso terapêutico , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios , Idoso , Berlim/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Prospectivos
20.
J Am Heart Assoc ; 10(10): e018326, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33982599

RESUMO

Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with recurrent vascular events and death in patients with first-ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS-B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs-cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all-cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6% women; median National Institutes of Health Stroke Scale=2; hs-cTnT above upper reference limit, 39.2%). During a mean follow-up of 3 years, the primary outcome occurred in 89 patients (15.8%), including 40 (7.1%) recurrent strokes, 4 (0.7%) myocardial infarctions, and 51 (9.1%) events of all-cause death. The primary outcome occurred more often in patients with hs-cTnT above the upper reference limit (27.3% versus 10.2%; adjusted hazard ratio, 2.0; 95% CI, 1.3-3.3), with a dose-response relationship when the highest and lowest hs-cTnT quartiles were compared (15.2 versus 1.8 events per 100 person-years; adjusted hazard ratio, 4.8; 95% CI, 1.9-11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs-cTnT is dose-dependently associated with an increased risk of recurrent vascular events and death within 3 years after first-ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs-cTnT for individualized risk stratification after stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01363856.


Assuntos
AVC Isquêmico/sangue , Medição de Risco/métodos , Troponina T/sangue , Doenças Vasculares/epidemiologia , Idoso , Berlim/epidemiologia , Biomarcadores/sangue , Causas de Morte/tendências , Feminino , Seguimentos , Humanos , Incidência , AVC Isquêmico/complicações , AVC Isquêmico/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Doenças Vasculares/sangue , Doenças Vasculares/etiologia
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