Analysis of seven SARS-CoV-2 rapid antigen tests in detecting omicron (B.1.1.529) versus delta (B.1.617.2) using cell culture supernatants and clinical specimens.

PURPOSE: Omicron is rapidly spreading as a new SARS-CoV-2 variant of concern (VOC). The question whether this new variant has an impact on SARS-CoV-2 rapid antigen test (RAT) performance is of utmost importance. To obtain an initial estimate regarding differences of RATs in detecting omicron and delta, seven commonly used SARS-CoV-2 RATs from different manufacturers were analysed using cell culture supernatants and clinical specimens. METHODS: For this purpose, cell culture-expanded omicron and delta preparations were serially diluted in Dulbecco's modified Eagle's Medium (DMEM) and the Limit of Detection (LoD) for both VOCs was determined. Additionally, clinical specimens stored in viral transport media or saline (n = 51) were investigated to complement in vitro results with cell culture supernatants. Ct values and RNA concentrations were determined via quantitative reverse transcription polymerase chain reaction (RT-qPCR). RESULTS: The in vitro determination of the LoD showed no obvious differences in detection of omicron and delta for the RATs examined. The LoD in this study was at a dilution level of 1:1,000 (corresponding to 3.0-5.6 × 106 RNA copies/mL) for tests I-V and at a dilution level of 1:100 (corresponding to 3.7-4.9 × 107 RNA copies/mL) for tests VI and VII. Based on clinical specimens, no obvious differences were observed between RAT positivity rates when comparing omicron to delta in this study setting. Overall positivity rates varied between manufacturers with 30-81% for omicron and 42-71% for delta. Test VII was only conducted in vitro with cell culture supernatants for feasibility reasons. In the range of Ct < 23, positivity rates were 50-100% for omicron and 67-93% for delta. CONCLUSION: In this study, RATs from various manufacturers were investigated, which displayed no obvious differences in terms of analytical LoD in vitro and RAT positivity rates based on clinical samples comparing the VOCs omicron and delta. However, differences between tests produced by various manufacturers were detected. In terms of clinical samples, a focus of this study was on specimens with high virus concentrations. Further systematic, clinical and laboratory studies utilizing large datasets are urgently needed to confirm reliable performance in terms of sensitivity and specificity for all individual RATs and SARS-CoV-2 variants.

[Bavarian online database for corona screening tests-development and use of a digital solution in the pandemic]. / Bayerisches Meldeportal für Corona-Reihenuntersuchungen ­ Entwicklung und Einsatz einer digitalen Lösung in der Pandemie.

During the SARS-CoV­2 pandemic, various data had to be collected to support political decisions for pandemic preparedness and response. Nevertheless, using analogue tools like paper and pencil as well as sending files with media discontinuity that have to be merged later are not useful and can hardly provide usable data in real time. With the selected system architecture, the Bavarian Online Database for Corona Screening Tests (BayCoRei) is a central, Bavaria-wide, consistent digital solution that is agile and easy to use. BayCoRei uses established technical components and interfaces. Apart from this, the support of the individual stakeholders (e.g., health authorities, service providers, and district governments) plays a decisive role in the success of the solution. The present article describes BayCoRei and two other online databases as examples that comprise the technology and architecture that have proven to be (rapidly) deployable and points out the gap between intention and reality regarding pandemic management.

Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016.

BACKGROUND: The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns. METHODS: Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18-81 years for AUD (n = 46,706) and 18-70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization. RESULTS: Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order. CONCLUSIONS: Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care.

[Preparedness on Assaults with Highly Toxic Substances in Public Space]. / Vorbereitung auf Anschläge mit hochtoxischen Substanzen im öffentlichen Raum.

The use of chemical substances in terrorist scenarios is to be feared everywhere, especially in the western world, after the events that have become known in recent years. In order to protect civilian populations in an emergency, it is essential that the poisoning pattern (toxidrome) is recognized as quickly and reliably as possible through further training of the relevant agents and the provision of necessary rescue equipment (antidotes) in prepared facilities. In the event of a chemical attack with terrorist motivation, doctors from the Public Health Service (PHS) will foreseeably play a key role in communicating with decision-makers and the public a spart of a competency network.

Disparities in accessibility to evidence-based breast cancer care facilities by rural and urban areas in Bavaria, Germany.

BACKGROUND: Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. METHODS: Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. RESULTS: Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. CONCLUSIONS: Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.

Detection of the new SARS-CoV-2 variants of concern B.1.1.7 and B.1.351 in five SARS-CoV-2 rapid antigen tests (RATs), Germany, March 2021.

SARS-CoV-2 variants of concern (VOC) should not escape molecular surveillance. We investigated if SARS-CoV-2 rapid antigen tests (RATs) could detect B.1.1.7 and B.1.351 VOCs in certain laboratory conditions. Infectious cell culture supernatants containing B.1.1.7, B.1.351 or non-VOC SARS-CoV-2 were respectively diluted both in DMEM and saliva. Dilutions were analysed with Roche, Siemens, Abbott, nal von minden and RapiGEN RATs. While further studies with appropriate real-life clinical samples are warranted, all RATs detected B.1.1.7 and B.1.351, generally comparable to non-VOC strain.

High-Pressure Behavior of Nickel Sulfate Monohydrate: Isothermal Compressibility, Structural Polymorphism, and Transition Pathway.

Single crystals of synthetic nickel sulfate monohydrate, α-NiSO4·H2O (space-group symmetry C2/c at ambient conditions), were subject to high-pressure behavior investigations in a diamond-anvil cell up to 10.8 GPa. By means of subtle spectral changes in Raman spectra recorded at 298 K on isothermal compression, two discontinuities were identified at 2.47(1) and 6.5(5) GPa. Both transitions turn out to be apparently second order in character, as deduced from the continuous evolution of unit-cell volumes determined from single-crystal X-ray diffraction. The first structural transition from α- to ß-NiSO4·H2O is an obvious ferroelastic C2/c-P1̅ transition. It is purely displacive from a structural point of view, accompanied by symmetry changes in the hydrogen-bonding scheme. The second ß- to γ-NiSO4·H2O transition, further splitting the O2 (hydrogen bridge acceptor) position and violating the P1̅ space-group symmetry, is also evident from the splitting of individual bands in the Raman spectra. It can be attributed to symmetry reduction through local violation of local centrosymmetry. Lattice elasticities were obtained by fitting second-order Birch-Murnaghan equations of state to the p-V data points yielding the following zero-pressure bulk moduli values: K0 = 63.4 ± 1.0 GPa for α-NiSO4·H2O, K0 = 61.3 ± 1.9 GPa for ß-NiSO4·H2O, and K0 = 68.8 ± 2.5 GPa for γ-NiSO4·H2O.

[Political Implementation of Population-Level Prevention: Challenges and Success Factors]. / Politische Umsetzung von Verhältnisprävention auf Bevölkerungsebene: Herausforderungen und Erfolgsfaktoren.

Public policy plays a key role in creating health-promoting environments. Implementation of effective policies is often hampered by lobbyism, compartimentalized policy fields, and cultural rifts between academia and politics. Improved communication and cooperation between researchers and policymakers, engagement of the public, and alliances with civil society can help to overcome these barriers.

[Modeling the Effectiveness of Infection Control Measures for the Elimination of Measles: Focus on Adults Born After 1970]. / Modellierung der Effektivität von Infektionsschutzmaßnahmen zur Elimination der Masern unter besonderer Berücksichtigung der nach 1970 geborenen Erwachsenen.

The German National Action Plan for the implementation of the WHO goal of measles elimination still faces considerable challenges regarding reaching its goal of increasing adult's vaccination rates and better outbreak management. METHODS: The description of the target population group -adults born after 1970 - as well as other potentially vulnerable groups was carried out by means of a systematic literature review. A further systematic review outlines options for the prevention of new infections. Finally, recommendations for action are discussed. A modeling to clarify the influence of the various epidemiological parameters was performed. RESULTS: For the population group of 20-29 year old persons, the vaccination rate was 79.8% and for the group of 30-39 year old people, 46.7%. In contrast, the seroprevalences showed a seropositivity of about 91.5% for the target group of the 20-29-year-olds and of approximately 95% for the 30-39-year-olds. A variety of vulnerable subgroups with low vaccination rates was identified: a negative attitude towards scientific and technical medicine due to religious or ideological backgrounds (vaccination rates of 50-75%), migrants (85.9-95.1%) and asylum seekers (89.9%). The systematic literature review shows that interventions for increasing the vaccination rate and a reduction of the contact rate via appropriate isolation measures in an outbreak context can be effective. With an ideal isolation, a vaccination rate of 73% could be sufficient to control an outbreak. The modeling clarifies the relevance of high vaccination rates compared with other influencing factors for an effective outbreak control. The extent of further interventions necessary to contain an outbreak was calculated. CONCLUSIONS: The results obtained suggest that the basic immunisation rate should be increased further and, in the event of an outbreak, rigorous quarantine procedures should be implemented. The target group of young adults, especially those with a migratory background from countries with a high susceptibility to the disease, and other vulnerable subgroups, should be addressed in a more focused manner, and the previous focus on children and adolescents should be extended to adults. In order to do so, diversity-sensitive information and facilitated access to vaccinations appear particularly suitable.

[Subjective Health and Unemployment in Germany: Analysis of 2005-2014 EU-SILC Data]. / Subjektive Gesundheit und Erwerbslosigkeit in Deutschland auf Basis der EU-SILC-Daten von 2005 bis 2014.

BACKGROUND: This study aims to analyze self-perceived health and chronic illness in the working population and to explore disparities between social groups. METHODS: The annual EU-SILC Survey has been conducted in Germany since 2005. The reference population is defined as all private households. In the EU-SILC 2014, a random sample of 22,695 persons aged 16 years and older was interviewed in Germany (860 unemployed and 11,390 employed). RESULTS: In accordance to the EU-SILC-Surveys 2005 until 2014, the self-perceived general health of the population has improved in Germany. 65.2% of the population (aged 16 years and older) in Germany assessed their health as very good or good in 2014 vs. 60.7% in 2005, despite an ageing population. However, there was an increase in health inequalities between employment status groups. In 2014, only 37.2% among unemployed persons vs. 77.1% of the employed perceived their general health as very good or good (53.8 vs. 73.2% in 2005). Multivariate logistic regression models revealed strong associations of subjective general health and chronic illness with age groups and social determinants on the EU-SILC-Survey 2014. Cross-sectional analysis showed unemployed persons to be much less likely to have very good or good self-perceived health (OR=0.26) and more likely to have chronic illness (OR=3.99) compared to employed people after adjustment for sociodemographic characteristics. The probabilities of better health and lower chronic illness rose with the increasing disposable (net) income as well as educational levels. 78.8% of the household members in the highest income quintile vs. 51.7% of the household members in the lowest income quintile said they had very good or good health (OR=2.53). In all investigated age groups, members of the households at risk of poverty were more likely to have poor health on average. High educational level (ISCED 5-8) was associated with higher positive self-rated health (OR=1.78). CONCLUSION: The EU-SILC-Survey shows distinct health developments and inequalities in Germany. EU-SILC is useful as an annual general population survey to monitor public health targets and reduce health inequalities.

[Overview of the Organization of the Emergency Medical Service in Germany: What is the Basis for the Hospital Restructuring Act and the Supply Enhancement Act?] / Übersicht über die Organisation des vertragsärztlichen Bereitschaftsdienstes in Deutschland: Auf welche Basis bauen Krankenhausstrukturgesetz und Versorgungsstärkungsgesetz auf?

In response to the increased use of emergency rooms, the increasing cost pressure on hospitals and the growing difficulty of filling emergency services in structurally weaker areas, the introduction of central practices (Portalpraxen) has been decided at federal level. Several Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen (KVen)) have already started to transform the medical on-call service before this legislative change and are now at different stages of the reform process. At many hospitals there are already so-called standby duty clinics (BDP). For the assessment of the current reform status as the basis for the Hospital Structure Act and the Nursing Reform Act, the present study aims to provide an overview of the organizational forms of the on-call medical service in the respective districts of the Associations of Statutory Health Insurance Physicians. METHODS: All 17 KV districts were contacted by telephone and/or in writing in order to conduct a semi-structured interview along 3 dimensions: the general organizational structure, the personnel (above all physicians) and the supply mandate. KV Brandenburg, KV Hamburg and KV Nordrhein (subsidiary Gesundheitsmanagementgesellschaft mbH) completed the questionnaire. RESULTS: In the districts of Hesse, Schleswig-Holstein, Thuringia and Westphalia-Lippe, at the time of the 2017 survey, the out-of-hour service was exclusively organised in emergency service practices. Baden-Wuerttemberg, Lower Saxony, North Rhine, Rhineland-Palatinate and Saarland have extensively introduced emergency service practices. However, the traditional service remains present in some regions. There are huge organisational differences between metropolitan and rural areas reflecting various challenges: Bavaria, Brandenburg and Mecklenburg-Western Pomerania only established emergency service practices in major cities due to economic considerations. CONCLUSION: Emergency service practices provide a way to address the challenges of physician shortage and patient control. With their flexibility regarding the organization, they are adaptable to regional differences and are already playing a major role in assuring out-of-hour medical service in Germany.

[Epidemic Vitamin D Deficiency in Prisoners Compared to the German Population: An Analysis Based on Laboratory Results]. / Existiert ein epidemischer Vitamin D-Mangel bei weiblichen Inhaftierten und in der deutschen Wohnbevölkerung? Ergebnisse einer Studie unter Inhaftierten und einer systematischen Literaturrecherche.

OBJECTIVE: Effects of long-term imprisonment on the vitamin D (vitD) status of prison inmates in Germany have not been systematically assessed so far. Special circumstances in prisons - little sunlight exposure combined with restricted outdoor activities - may lead to vitD deficiency among prisoners. The aim of this study was to assess the vitD status of prisoners and the general population in order to quantify the extent of vitD deficiency in both groups. METHODS: VitD status (25(OH)D in blood serum samples) was assessed in female inmates of a prison in southern Germany between May 2012-June 2013. Suboptimal vitD status was defined as levels of 10-<20 µg/l, severe deficiency as<10 µg/l. A systematic literature search in PubMed was conducted in order to compare study results with vitD levels in the general population. RESULTS: Blood sera of 84 inmates (median age: 43 years; range: 19-75) were analyzed. Thirty women (36%) showed severe vitD deficiency, 47 (56%) suboptimal vitD levels. The literature search identified 10 studies which reported considerable vitD deficiency in the general population in Germany. CONCLUSION: VitD deficiency is very common in both prison inmates and the general population. Unlike prison inmates, the population is able to decide whether, when and how long they want to exposure to sunlight. Moreover, they can counteract deficiency via a nutrition rich in vitD. This is not possible for inmates. To prevent long-term effects of vitD deficiency, intake of vitD supplements during duration of imprisonment seems reasonable.

Facilitating evidence uptake: development and user testing of a systematic review summary format to inform public health decision-making in German-speaking countries.

BACKGROUND: Systematic reviews are an important source of evidence for public health decision-making, but length and technical jargon tend to hinder their use. In non-English speaking countries, inaccessibility of information in the native language often represents an additional barrier. In line with our vision to strengthen evidence-based public health in the German-speaking world, we developed a German language summary format for systematic reviews of public health interventions and undertook user-testing with public health decision-makers in Germany, Austria and Switzerland. METHODS: We used several guiding principles and core elements identified from the literature to produce a prototype summary format and applied it to a Cochrane review on the impacts of changing portion and package sizes on selection and consumption of food, alcohol and tobacco. Following a pre-test in each of the three countries, we carried out 18 user tests with public health decision-makers in Germany, Austria and Switzerland using the 'think-aloud' method. We analysed participants' comments according to the facets credibility, usability, understandability, usefulness, desirability, findability, identification and accessibility. We also identified elements that hindered the facile and satisfying use of the summary format, and revised it based on participants' feedback. RESULTS: The summary format was well-received; participants particularly appreciated receiving information in their own language. They generally found the summary format useful and a credible source of information, but also signalled several barriers to a positive user experience such as an information-dense structure and difficulties with understanding statistical terms. Many of the identified challenges were addressed through modifications of the summary format, in particular by allowing for flexible length, placing more emphasis on key messages and relevance for public health practice, expanding the interpretation aid for statistical findings, providing a glossary of technical terms, and only including graphical GRADE ratings. Some barriers to uptake, notably the participants' wish for actionable recommendations and contextual information, could not be addressed. CONCLUSIONS: Participants welcomed the initiative, but user tests also revealed their problems with understanding and interpreting the findings summarised in our prototype format. The revised summary format will be used to communicate the results of Cochrane reviews of public health interventions.

[Benefits of Measures to Promote Development in Language, Mathematics and Singing in Kindergardeners: Analysis of Data Collected at School Entrance Examination in the County of Biberach]. / Analyse von Daten aus der Einschulungsuntersuchung zur Evaluation von Fördermaßnahmen in Kindertageseinrichtungen im Landkreis Biberach.

To evaluate the benefits of implementing measures to promote skills in the areas of language, mathematics and singing in kindergardeners by statistical analysis of data collected during the school entrance examination (ESU) of 4-5-year-old children from the county of Biberach. Study 1 employs multivariate regression analysis to analyse - in chronological order - the ESU data on 4 cohorts (2011-2014; n=7 148) of children of the Biberach county. Study 2 qualitatively compares identical data representative of the entire state of Baden-Württemberg (N=3×80 000) with the Biberach results. Study 3 focuses on the cohort 2014 in Biberach county (n=1 783) and employs logistical regression techniques to correlate curriculum content and child development. There are significant performance improvements in the Biberach population (2011-2014) in the development of language and early mathematics, as well as in visual comprehension and visuomotor skills, but not in the area of gross motor skills. Similar improvements are much more difficult to demonstrate for the entire state of Baden-Württemberg. The detailed analysis of the 2014 Biberach County data reveal that kindergardeners with increased exposure to mathematics will have a decreased risk of failure in early mathematics (OR 0.72) and grammar skills (OR 0.53-0.75). Children with speech impairment or children not fluent in German that had extra language tutorials, typically in small groups and 4 times a week for 30 min, still have a higher risk of failure in all developmental aspects, save gross motor skills (e. g. OR 3.32 in grammar skills, OR 3.08 for hyperactivity). Programs with emphasis on singing have little effect on the above data. The risk of failure in German language is high (OR 2.78) for those of non-German backgrounds, but less in visuomotor skills (OR 0.52) and hyperactivity (OR 0.51). Statistical analyses show positive correlation of curriculum content and early child development for the kindergardens in Biberach county. The gains in performance are consistent with those reported from kindergardens known for pedagogical excellence.

[Compatibility of Work and Family Life of Employees in the Healthcare Sector: An Issue in Health Services Research]. / Vereinbarkeit von Familie und Beruf bei Beschäftigten im Gesundheitswesen als Handlungsfeld der Versorgungsforschung.

BACKGROUND: Healthcare professionals are confronted with specific work-related demands that influence work-family relations and might indirectly affect the quality of healthcare. This paper seeks to provide an overview of the current state of research on this topic of relevance to health services research. The overview may serve as a starting point for modifying structures in the healthcare system (especially in rural regions) with the aim of improving work-family compatibility. METHODS: A systematic national and international literature search was conducted in terms of a scoping review. The following criteria/contents to be covered in publications were defined: work-family compatibility; work-family interface and work-family conflict in employees working in healthcare; healthcare professions in rural areas and links with work-family issues; interventions to improve work-family compatibility. 145 publications were included in the overview. RESULTS: The available literature focuses on physicians and nursing staff while publications on other professions are largely lacking. The methodological quality of existing studies is mostly low, including a lack of meta-analyses. Several studies document dissatisfaction in physicians and nursing staff regarding reconciliation of work and family life. Only few intervention studies were found that seek to improve work-life compatibility; few of them focus on employees in healthcare. There are also deficits with respect to linking work-family issues with aspects of healthcare in rural areas. CONCLUSIONS: There is a shortage of systematic national and international research regarding work-family compatibility, especially when it comes to the evaluation of interventions. The overview provides starting points for improving work-family compatibility in healthcare.