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Frontotemporal lobar degeneration (FTLD) is likely to be the second-most common cause of dementia in individuals under 65 years of age. Pathognomonic changes in personality, behavior and motivation are known to lead to high caregiver stress and burden, with little support being available. The aim of this work is to present the current state of knowledge on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions.
Two scoping reviews on caregiver burden using the PRISMA checklist for scoping reviews were conducted using PubMed, Web of Science and ScienceDirect in April 2017 and November 2019, respectively. A total of 107 articles were considered eligible and were analyzed qualitatively and summarized.
Our results show that caregivers of patients with FTLD are often female, spouses of the PwD, younger in age, have underage children and provide care at home. Behavioral and motivational disturbances in the PwD are perceived to be the most burdensome aspects of caregiving. Those caring for an individual with the bvFTD subtype thus report higher levels of burden than caregivers of an individual with a form of PPA. With rising dementia severity, caregivers report higher levels of burden. Many caregivers experience a decline in their own physical and mental health as well as a significant financial burden resulting from care duties. The deterioration of the relationship between the PwD and their caregivers is a main burdensome aspect. Only few interventions were conducted so far, and none of those that were identified were designed as an RCT. The most efficacious interventions were those aimed directly at caregivers, whereas interventions aiming at the amelioration of symptoms in the PwD showed little effect.
Further research should reproduce and validate efficacious interventions and establish new interventional approaches. Another focus should be set on the situation of underage children of individuals with FTLD and relatives of a person with hereditary FTD. More research from non-Western countries is needed in order to identify culture-specific factors of caregiver burden. Along those lines, support structures for FTLD caregivers should be assessed on a local basis and extended accordingly. So far, no study has assessed the relationship between caregiver burden and possible consequences for the quality of care provided to the PwD in FTLD specifically. Awareness both in the wider population and among healthcare professionals is an urgent need for the future since FTLD is often misdiagnosed, leading to a delay in obtaining the correct diagnosis and access to suitable support.
Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany.
Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke).
Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models.
Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.
Introduction
Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.
Methods and analysis
The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.
Ethics and dissemination
The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.
Trial registration number NCT04704635.
Die Messung der endexspiratorischen Ammoniakkonzentration bei Patienten mit terminaler Niereninsuffizienz während der Dialyse stellt eine neue nicht-invasive Methode zur Evaluation des Dialyseerfolges dar.
Ziel dieser Studie ist es die endexspiratorische Ammoniakkonzentration von Patienten mit terminaler Niereninsuffizienz während der Dialyse zu messen, um einen signifikanten Abfall der endexspiratorischen Ammoniakkonzentration während des Dialysevorganges nachzuweisen. Des Weiteren gilt es Einflussfaktoren auf die endexspiratorische Ammoniakkonzentration vor der Dialyse zu finden sowie eine mögliche positive Korrelation zwischen der endexspiratorischen Ammoniakkonzentration und der Harnstoffkonzentration im Blut zu untersuchen.
Insgesamt wurden 45 Dialysepatienten (22 Frauen, 23 Männer) im Alter zwischen
dem 28. und dem 85. Lebensjahren für diese Studie rekrutiert. Es erfolgte eine standardisierte Befragung der Patienten bezüglich ihrer Vorerkrankungen und kardiovaskulären Risikofaktoren. Die restlichen relevanten Diagnosen wurden aus den Krankenunterlagen entnommen. Neben der Messung der endexspiratorischen Ammoniakkonzentration erfolgten laborchemische Bestimmungen der Ammoniakkonzentration im EDTA-Blut ebenfalls vor und nach der Dialyse. Auch weitere Laborparameter, wie Aspartataminotransferase, Alaninaminotransferase, Gamma-Glutamyl-Transferase, Harnstoff, Kreatinin sowie Hämoglobin HbA1c wurden mitbestimmt. Die Analyse der endexspiratorischen Ammoniakkonzentration erfolgte mittels des durchstimmbaren Infrarotdiodenlasers unter der Anwendung der Absorptionsspektroskopie als eine hoch sensitive und selektive Methode zur Bestimmung der organischen Atembestandteile.
Die Ergebnisse dieser Studie zeigen einen signifikanten Abfall der endexspiratorischen Ammoniakkonzentrationen im Verlauf der Dialyse (mediane Werte: von 236,3 ppb
auf 120,6 ppb (p < 0,001)). Beim genaueren Betrachten des individuellen Verlaufs von Dialysepatienten fällt auf, dass 18 Patienten mit einer hohen endexspiratorischen Ammoniakkonzentration vor der Dialyse (über 300 ppb) einen deutlichen Abfall (> 100 ppb) im Verlauf der Behandlung aufweisen. Von den Patienten, bei denen vor der Dialyse ein niedriger Atemammoniakspiegel (< 300 ppb) erfasst wurde, zeigten sich bei fünf Probanden ein deutlichen Abfall, bei elf Probanden ein geringerer Abfall (< 100 ppb), bei vier Probanden keine signifikante Veränderung (±10 ppb) und bei sieben Teilnehmern eine Erhöhung der endexspiratorischen Ammoniakkonzentration während der Dialyse.
Die statistische Analyse ergab weiterhin eine deutlich positive Korrelation zwischen den Ammoniakkonzentrationen im Blut vor der Dialyse mit den Blutammoniakwerten nach der Dialyse und eine mäßig positive Korrelation zwischen den endexspiratorischen Ammoniakkonzentrationen vor der Dialyse mit den Ammoniakspiegel im Atem nach der Dialyse. Eine schwach positive Korrelation wurde zwischen den endexspiratorischen Ammoniakwerten nach der Dialyse mit den Blutammoniakwerten nach der Dialyse gefunden. Die lineare Regressionsanalyse ergab eine signifikante Assoziation von Nephrektomie und Restdiurese mit den endexspiratorischen Ammoniakwerten, welche vor der Dialyse gemessen wurden. Damit wird verdeutlich, das nephrektomierte Patienten und Patienten mit einer höheren Restdiurese einen deutlichen Abfall der endexspiratorischen Ammoniakkonzentrationen während der Dialyse aufzeigten und somit vermehrt von der Dialyse als Behandlung profitieren.
In Anlehnung an die Ergebnisse dieser Studie, dass im Verlauf der Dialyse ein signifikanter Abfall der endexspiratorischen Ammoniakkonzentration vorliegt, wird eine klinische Etablierung der nicht-invasiven Ammoniakkonzentrationsmessung vor und nach der Dialyse als eine gute Möglichkeit der Überwachung einer Dialysesitzung empfohlen. Aus unserer Sicht sollte am besten die Messung nicht offline mittels Sammelns der Atemproben im Tedlar-Beutel, sondern durch direktes Ausatmen in das Messsystem erfolgen, um den Verlust von an der Oberfläche des Beutels haftenden Ammoniaks zu verhindern. Falls jedoch die offline Methode bevorzugt werden sollte, müsste gewährleistet werden, dass die Atemgasproben so schnell wie möglich analysiert werden, um die Messgenauigkeit zu stärken.
Hintergrund
Akupunktur wurde 2007 für die Indikationen chronische Knie- und Rückenschmerzen in den Leistungskatalog der gesetzlichen Krankenversicherung aufgenommen. Die Studie untersucht, wer Akupunktur erhält, wer Akupunktur anbietet und ob es zeitliche und regionale Unterschiede gibt.
Methoden
Für die retrospektive Beobachtungsstudie wurde eine knapp vier Millionen große Stichprobe anonymisierter GKV-Abrechnungsdaten verwendet. Diese ist für das Jahr 2013 gemäß Alter und Geschlecht repräsentativ für Deutschland.
Ergebnisse
Rückenschmerzen war die am häufigsten kodierte Indikation (86 %) für die Abrechnung von Akupunktur. Überwiegend Frauen nahmen Akupunktur in Anspruch, das mittlere Alter lag bei 61,1 Jahren. Bei 63 % der Versicherten mit Akupunktur in 2014 wurde jene erstmals abgerechnet, 37 % nahmen bereits in 2012 oder 2013 Akupunktur in Anspruch. Der Anteil an Versicherten mit frühzeitiger Beendigung (< 6 Sitzungen) ihres ersten Akupunkturbehandlungszyklus in 2014 betrug bei Knieschmerzpatienten 14 % und bei Rückenschmerzpatienten 21 %. Von 2008 bis 2015 ließ sich ein signifikant abnehmender Trend der Inanspruchnahme nachweisen. Es zeigten sich deutliche regionale Unterschiede zwischen den neuen und alten Bundesländern sowie den Stadtstaaten. Knapp 11 % aller durchführenden Ärzte rechneten die Hälfte aller erbrachten Sitzungen in 2014 ab.
Diskussion
Dass überwiegend Frauen im höheren Alter Akupunktur in Anspruch nehmen entspricht der Epidemiologie von Rücken- und Knieschmerzen sowie ihrer höheren Präferenz für komplementäre Behandlungsverfahren. Der hohe Anteil von Patienten, die Akupunktur wiederholt in Anspruch nehmen, deutet auf einen wahrgenommenen Nutzen in einer Teilgruppe hin. Dem gegenüber stehen die geringe und kontinuierlich abnehmende Inanspruchnahme sowie der hohe Anteil an frühzeitigen Beendigungen.
The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.
Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance.
Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks.
Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables “face mask obligation for children” and “face mask obligation for adults”, two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children).
Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = −1.9; 95% CI: −2.9 to −1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = −0.6; 95% CI: −0.9 to −0.2; p = 0.004.
Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.
(1) Background: Predicting chronic low back pain (LBP) is of clinical and economic interest as LBP leads to disabilities and health service utilization. This study aims to build a competitive and interpretable prediction model; (2) Methods: We used clinical and claims data of 3837 participants of a population-based cohort study to predict future LBP consultations (ICD-10: M40.XX-M54.XX). Best subset selection (BSS) was applied in repeated random samples of training data (75% of data); scoring rules were used to identify the best subset of predictors. The rediction accuracy of BSS was compared to randomforest and support vector machines (SVM) in the validation data (25% of data); (3) Results: The best subset comprised 16 out of 32 predictors. Previous occurrence of LBP increased the odds for future LBP consultations (odds ratio (OR) 6.91 [5.05; 9.45]), while concomitant diseases reduced the odds (1 vs. 0, OR: 0.74 [0.57; 0.98], >1 vs. 0: 0.37 [0.21; 0.67]). The area-under-curve (AUC) of BSS was acceptable (0.78 [0.74; 0.82]) and comparable with SVM (0.78 [0.74; 0.82]) and randomforest (0.79 [0.75; 0.83]); (4) Conclusions: Regarding prediction accuracy, BSS has been considered competitive with established machine-learning approaches. Nonetheless, considerable misclassification is inherent and further refinements are required to improve predictions.
Background
Vulnerable groups, e.g. persons with mental illness, neurological deficits or dementia, are often excluded as participants from research projects because obtaining informed consent can be difficult and tedious. This may have the consequence that vulnerable groups benefit less from medical progress. Vulnerable persons are often supported by a legal guardian in one or more demands of their daily life. We examined the attitudes of legal guardians and legally supervised persons towards medical research and the conditions and motivations to participate in studies.
Methods
We conducted a cross-sectional study with standardized surveys of legal guardians and legally supervised persons. Two separate questionnaires were developed for the legal guardians and the supervised persons to asses previous experiences with research projects and the reasons for participation or non-participation. The legal guardians were recruited through various guardianship organizations. The supervised persons were recruited through their legal guardian and from a previous study among psychiatric patients. The data were analysed descriptively.
Results
Alltogether, 82 legal guardians and 20 legally supervised persons could be recruited. Thereof 13 legal guardians (15.6%) and 13 legally supervised persons (65.0%) had previous experience with research projects. The majority of the guardians with experience in research projects had consented the participation of their supervised persons (n = 12 guardians, 60.0%; in total n = 16 approvals). The possible burden on the participating person was given as the most frequent reason not to participate both by the guardians (n = 44, 54.4%) and by the supervised persons (n = 3, 30.0%). The most frequent motivation to provide consent to participate in a research study was the desire to help other patients by gaining new scientific knowledge (guardians: n = 125, 78.1%; supervised persons: n = 10, 66.6%).
Conclusions
Overall, an open attitude towards medical research can be observed both among legal guardians and supervised persons. Perceived risks and no sense recognized in the study are reasons for not participating in medical research projects.