In May 2011, an outbreak of the hemolytic–uremic syndrome associated with Shiga-toxin–producing
Escherichia coli
O104:H4 occurred in northern Germany. In this report, the investigation identified ...sprouts as the likely transmission vehicle.
Human infection with Shiga-toxin–producing
Escherichia coli
is a major cause of postdiarrheal hemolytic–uremic syndrome. This life-threatening disorder, which is characterized by acute renal failure, hemolytic anemia, and thrombocytopenia, typically affects children under the age of 5 years. Shiga-toxin–producing
E. coli
O157 is the serogroup that is most frequently isolated from patients with the hemolytic–uremic syndrome worldwide.
1
In May 2011, a large outbreak of the hemolytic–uremic syndrome associated with the rare
E. coli
serotype O104:H4 occurred in Germany.
2
–
5
The main epidemiologic features were that the peak of the epidemic was reached on May 21 and May 22
4
,
5
and that . . .
Background
Lyme borreliosis (LB), caused by
Borrelia burgdorferi
(
Bb
), is the most common tick-borne infection in Germany. Antibodies against
Bb
are prevalent in the general population but ...information on temporal changes of prevalence and estimates of seroconversion (seroincidence) and seroreversion are lacking, especially for children and adolescents.
Aim
We aimed at assessing antibodies against
Bb
and factors associated with seropositivity in children and adolescents in Germany.
Methods
We estimated seroprevalence via two consecutive cross-sectional surveys (2003–2006 and 2014–2017). Based on a longitudinal survey component, we estimated annual seroconversion/seroreversion rates.
Results
Seroprevalence was 4.4% (95% confidence interval (CI): 3.9–4.9%) from 2003 to 2006 and 4.1% (95% CI: 3.2–5.1%) from 2014 to 2017. Seroprevalence increased with age, was higher in male children, the south-eastern regions of Germany and among those with a high socioeconomic status. The annual seroconversion rate was 0.3% and the annual seroreversion rate 3.9%. Males were more likely to seroconvert compared with females. Low antibody levels were the main predictor of seroreversion.
Conclusion
We did not detect a change in seroprevalence in children and adolescents in Germany over a period of 11 years. Potential long-term changes, for example due to climatic changes, need to be assessed in consecutive serosurveys. Seroconversion was more likely among children and adolescents than among adults, representing a target group for preventive measures. Seroreversion rates are over twice as high in children and adolescents compared with previous studies among adults. Thus, seroprevalence estimates and seroconversion rates in children are likely underestimated.
Endoscopic tri-modal imaging incorporates high-resolution white-light endoscopy (HR-WLE), narrow-band imaging (NBI), and autofluorescence imaging (AFI). Combining these advanced techniques may ...improve endoscopic differentiation between adenomas and non-neoplastic polyps. In this study, we aimed to assess the interobserver variability and accuracy of HR-WLE, NBI, and AFI for polyp differentiation and to evaluate the combined use of AFI and NBI.
First, still images of 50 polyps (22 adenomas; median 3 mm) were randomly displayed to three experienced and four non-experienced endoscopists. All HR-WLE and NBI images were scored for Kudo classification and AFI images for color. Second, the combined AFI and NBI images were assessed using a newly developed algorithm by six additional non-experienced endoscopists.
The outcomes measured were interobserver agreement and diagnostic accuracy using histopathology as reference standard. Experienced endoscopists had better interobserver agreement for NBI (kappa=0.77) than for AFI (kappa=0.33), whereas non-experienced endoscopists had better agreement for AFI (kappa=0.58) than for NBI (kappa=0.33). The accuracies of HR-WLE, NBI, and AFI among experienced endoscopists were 65, 70, and 74, respectively. Figures among non-experienced endoscopists were 57, 63, and 77. The algorithm was associated with a significantly higher accuracy of 85% among all observers (P<0.023). These figures were confirmed in the second evaluation study.
Non-experienced endoscopists have better interobserver agreement and accuracy for AFI than for HR-WLE or NBI, indicating that AFI is easier to use for polyp differentiation in non-experienced setting. The newly developed algorithm, combining information of AFI and NBI together, had the highest accuracy and obtained equal results between experienced and non-experienced endoscopists.
Tick-borne encephalitis (TBE) is a growing public health problem with an average of 361 cases notified annually to Germany’s passive surveillance system since 2001. We aimed to assess clinical ...manifestations and identify covariates associated with severity.
We included cases notified 2018–2020 in a prospective cohort study and collected data with telephone interviews, questionnaires to general practitioners, and hospital discharge summaries. Covariates’ causal associations with severity were evaluated with multivariable logistic regression, adjusted for variables identified via directed acyclic graphs.
Of 1220 eligible cases, 581 (48%) participated. Of these, 97.1% were not (fully) vaccinated. TBE was severe in 20.3% of cases (children: 9.1%, ≥70-year-olds: 48.6%). Routine surveillance data underreported the proportion of cases with central nervous system involvement (56% vs. 84%). Ninety percent required hospitalization, 13.8% intensive care, and 33.4% rehabilitation. Severity was most notably associated with age (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.02–1.05), hypertension (OR: 2.27, 95%CI: 1.37–3.75), and monophasic disease course (OR: 1.67, 95%CI: 1.08–2.58).
We observed substantial TBE burden and health service utilization, suggesting that awareness of TBE severity and vaccine preventability should be increased. Knowledge of severity-associated factors may help inform patients’ decision to get vaccinated.
•Comprehensive description of clinical TBE manifestations and symptom persistence.•Evidence against the assumption that TBE is usually mild in children (50% of the pediatric cases were moderate/severe).•Uncovering underreporting of CNS symptoms in routine TBE data (>80% vs. ∼50%).•Novel factors associated with acute severity: hypertension, monophasic course.•Documenting current diagnostic and treatment practices and potential deficits.
The production of Σ0 baryons in the nuclear reaction p (3.5 GeV) + Nb (corresponding to sNN=3.18 GeV) is studied with the detector set-up HADES at GSI, Darmstadt. Σ0s were identified via the decay ...Σ0→Λγ with subsequent decays Λ→pπ− in coincidence with a e+e− pair from either external (γ→e+e−) or internal (Dalitz decay γ⁎→e+e−) gamma conversions. The differential Σ0 cross section integrated over the detector acceptance, i.e. the rapidity interval 0.5<y<1.1, has been extracted as ΔσΣ0=2.3±(0.2)stat±(−0.6+0.6)sys±(0.2)norm mb, yielding the inclusive production cross section in full phase space σΣ0total=5.8±(0.5)stat±(−1.4+1.4)sys±(0.6)norm±(1.7)extrapol mb by averaging over different extrapolation methods. The Λall/Σ0 ratio within the HADES acceptance is equal to 2.3±(0.2)stat±(−0.6+0.6)sys. The obtained rapidity and momentum distributions are compared to transport model calculations. The Σ0 yield agrees with the statistical model of particle production in nuclear reactions.
The permeability of blood vessels for albumin can be altered by using ultrasound and polymer or lipid-shelled microbubbles. The region in which the microbubbles were destroyed with focused ultrasound ...was quantified in gel phantoms as a function of pressure, number of cycles and type of microbubble. At 2MPa the destruction took place in a fairly wide area for a lipid-shelled agent, while for polymer-shelled agents at this setting, distinct destruction spots with a radius of only 1mm were obtained. When microbubbles with a thicker shell were used, the pressure above which the bubbles were destroyed shifts to higher values. In vivo both lipid and polymer microbubbles increased the extravasation of the albumin binding dye Evans Blue, especially in muscle leading to about 6–8% of the injected dose to extravasate per gram muscle tissue 30min after start of the treatment, while no Evans Blue could be detected in muscle in the absence of microbubbles. Variation in the time between ultrasound treatment and Evans Blue injection, demonstrated that the time window for promoting extravasation is at least an hour at the settings used. In MC38 tumors, extravasation already occurred without ultrasound and only a trend towards enhancement with about a factor of 2 could be established with a maximum percentage injected dose per gram of 3%. Ultrasound mediated microbubble destruction especially enhances the extravasation in the highly vascularized outer part of the MC38 tumor and adjacent muscle and would, therefore, be most useful for release of, for instance, anti-angiogenic drugs.
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Beliefs about medicines are regarded as influencing factors on medication adherence (Horne, 1997). Adherence levels in patients with chronic pulmonary diseases are low (Bourbeau and Bartlett, 2008; ...Sumino and Cabana, 2013). A better understanding of the predictive role of patients' beliefs about medicines for adherence might be a crucial step to improve medication adherence.
This prospective study investigated the association between beliefs about medicines and medication adherence in patients with asthma and COPD.
The Beliefs about Medicines Questionnaire (BMQ) and the Medication Adherence Rating Scale (MARS) were administered to 402 patients (49% asthma, 51% COPD, 50% female, mean age 56.7 years (SD = 15.9)) at baseline. Follow-ups were carried out after 3 (N = 255) and 12 months (N = 171). Multivariable logistic regression analyses were performed analysing the association between the BMQ subscales at baseline and adherence at each follow-up inquiry. Sociodemographic, psychosocial, and disease related factors were considered as potential confounders.
One third of the patients showed adherent behavior (18% and 46% of people with asthma and COPD). In the COPD sample, the subscale Specific-necessity showed a significant positive association with adherence at the 3-months-follow-up (OR = 2.6, 95% CI 1.4–5.1) and the subscale Specific-concerns showed a significant inverse association with adherence at the 3-months-follow-up (OR = 0.6, 95% CI 0.3–0.95) and the 12-months-follow-up (OR = 0.4, 95% CI 0.2–0.8). No significant association was found for the asthmatic sample.
Beliefs about medicines are important factors predicting future medication adherence in patients with COPD, but not asthma. Physicians should primarily focus on the specific beliefs of their patients in order to diminish medication non-adherence.
•In a population of 402 asthma & COPD patients one third of participants was adherent.•Specific beliefs were associated with medication adherence in patients with COPD.•No significant association could be found for asthma patients in our sample.•The longitudinal study design allows a cautious interpretation in terms of causality.
•One Health investigation of the first identified cluster of human infections with highly lethal Borna disease virus 1 (BoDV-1) in a small municipality in Bavaria, Germany.•BoDV-1 was detected only ...in the known reservoir, the bicoloured white-toothed shrew (Crocidura leucodon).•Two different phylogenetic subclades were detected circulating in parallel in the study area.•Despite a high probability of shrew contact and confirmed BoDV-1-presence in shrews, no oligo-/asymptomatic or additional clinically manifest human BoDV-1-infections were detected.•BoDV-1 was neither detected in ticks nor in any of the environmental samples.
Zoonotic Borna disease virus 1 (BoDV-1) causes fatal encephalitis in humans and animals. Subsequent to the detection of two paediatric cases in a Bavarian municipality in Germany within three years, we conducted an interdisciplinary One Health investigation. We aimed to explore seroprevalence in a local human population with a risk for BoDV-1 exposure as well as viral presence in environmental samples from local sites and BoDV-1 prevalence within the local small mammal population and its natural reservoir, the bicoloured white-toothed shrew (Crocidura leucodon).
The municipality's adult residents participated in an anonymised sero-epidemiological study. Potential risk factors and clinical symptoms were assessed by an electronic questionnaire. Small mammals, environmental samples and ticks from the municipality were tested for BoDV-1-RNA. Shrew-derived BoDV-1-sequences together with sequences of the two human cases were phylogenetically analysed.
In total, 679 citizens participated (response: 41 %), of whom 38 % reported shrews in their living environment and 19 % direct shrew contact. No anti-BoDV-1 antibodies were detected in human samples. BoDV-1-RNA was also undetectable in 38 environmental samples and 336 ticks. Of 220 collected shrews, twelve of 40 C. leucodon (30%) tested BoDV-1-RNA-positive. BoDV-1-sequences from the previously diagnosed two paediatric patients belonged to two different subclades, that were also present in shrews from the municipality.
Our data support the interpretation that human BoDV-1 infections are rare even in endemic areas and primarily manifest as severe encephalitis. Sequence analysis linked both previous paediatric human infections to the local shrew population, but indicated independent infection sources.
The project was partly financed by funds of the German Federal Ministry of Education and Research (grant numbers: 01KI2005A, 01KI2005C, 01KI1722A, 01KI1722C, 01KI2002 to MaBe, DR, RGU, DT, BS) as well as by the ReForM-A programme of the University Hospital Regensburg (to MaBa) and by funds of the Bavarian State Ministry of Health, Care and Prevention, project “Zoonotic Bornavirus Focal Point Bavaria – ZooBoFo” (to MaBa, MaBe, BS, MMB, DR, PS, RGU).
Examination of health care organizations that have achieved and sustained substantial performance improvements reveals that lasting transformation requires the relentless hard work of local ...operational redesign, led by multidisciplinary teams.
Governments and regulators influence the performance of health care organizations and practitioners primarily through positive and negative financial incentives, regulatory constraints on their licenses to practice, and support of performance-improvement activities through education, research, and measurement programs. The financial approaches aim to motivate change in the way organizations and practitioners configure their systems and deliver care, under the assumption that once they’re motivated to seek surplus or avoid sanction, they’ll be willing and able to make local operational changes to reduce cost and improve safety, patient experience, and outcomes. Unfortunately, experience shows that although a changed market may be a . . .
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