Nosokomiale Infektionen,systemischer Antibiotikaeinsatz und multiresistente Erreger bei Bewohnern von Altenpflegeheimen

Background

Residents of long-term care facilities (LTCF) are at risk of healthcare associated infections (HAI) and are often treated with antibiotics. In Germany a current HAI prevalence of 1.6 % and antibiotic use in 1.15?% have been reported. However, data published on the current prevalence of multidrug-resistant organisms (MRDO) in LTCFs in Germany are scarce. Therefore, the prevalence of HAI, antibiotic use and presence of MDROs were investigated in LTCF residents in Frankfurt am Main, Germany.

Methods

A point prevalence study of HAI and antibiotic use according to the European HALT protocol (health care associated infections in long-term care facilities) was carried out; swabs from the nose, throat and perineum were analyzed for methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE).

Results

A total of 880 residents in 8 LTCFs were enrolled in the study in 2012. The study participants were 30?% male, 46.7?%? were more than 85 years old, 70?% exhibitied urinary or fecal incontinence, 11.4?% had an indwelling urinary catheter and 0.1?% a vascular catheter. Prevalence rates of HAI and of antibiotic use were 2.5 % and 1.5?%, respectively. The prevalence of MDROs in 184 residents who agreed to being tested for MDROs was 9.2?% MRSA, 26.7?% ESBL and 2.7?% VRE.

Conclusion

The HAIs and antibiotic use were comparable to the German HALT data from 2010. Compared to other German studies there is a steadily increasing MRSA problem in German LTCFs. High and increasing ESBL rates have been detected in German LTCFs. Further studies are needed to confirm this trend, preferably encompassing molecular methods to study epidemiology.     

Entwicklung der Zahn- und Mundgesundheit in Deutschland von 1997 bis 2014

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Zur Veränderung der oralen Krankheitslast in der deutschen Allgemeinbevölkerung über die letzten 20 Jahre...     

Studie zum Vorkommen von Methicillin-resistenten Staphylococcus aureus in Alten- und Altenpflegeheimen in Nordrhein-Westfalen

The reason for conducting this study in North Rhine-Westphalia was the world-wide increase in MRSA hospital infections leading to the question about the occurrence of MRSA in old people's homes and nursing homes. Between March 2000 and March 2001, 21 community health departments on a voluntary basis collected samples to be examined from a total of 1057 residents of old people's homes and 193 nursing staff members and, together with a completed questionnaire, sent them to the Institute of Public Health (lögd) NRW. In this cross-sectional study 32 residents and one staff member proved positive. This corresponds to a prevalence of MRSA of 3.0% with a confidence interval (95% CI) of 2.1–4.2 if the number of participants is taken for reference as has until now been the usual practice in MRSA examinations in old people's homes in Germany. But if examinations are based on a Staph. aureus proportion of almost 50% as is done in MRSA examinations in hospitals, MRSA prevalence increases to 6.3% with a CI of 4.3–8.8. Catheterization, particularly urinary catheterization, entails an almost three times higher risk of contracting MRSA (OR = 2.72, significant). MRSA prevalence for urinary catheterization was 11.2%, related to the S. aureus-positive residents.     

Selbstwahrgenommene Mundgesundheit und assoziierte Faktoren bei Erwachsenen in Deutschland. Ergebnisse aus GEDA 2019/2020-EHIS

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Informationen zur Mundgesundheit der Bevölkerung sind wichtig für die Einschätzung von (vermeidbarer)...     

Staublungenerkrankungen bei der Gewinnung und Bearbeitung von Porphyr und Porphyrtuffen

Zusammenfassung Bei der Untersuchung von Steinbruchsarbeitern und Steinmetzen in Porphyrtuffbrüchen wurden 5 sichere Staublungenerkrankungen festgestellt. Eine hiervon war röntgenologisch II. Grades. Das verursachende Gestein war Quarzporphyrtuff mit Einsprenglingen aus Quarzporphyr. Als Ursache der Silikosen wird die im Quarzporphyr und Quarzporyhyrtuff in reichem Maße enthaltene Kieselsäure angesehen.     

Akzeptanz von Informations- und Kommunikationstechnologien bei Senioren

Background

Considering the fundamental changes in everyday life that accompany rising age, the need to support older adults regarding information and communication technologies (ICT) is increasing. Contact with new technology is a problem for many older adults.

Objective

The goal of the present study was to examine how family members support older adults in the acquisition and usage of ICT.

Methods

In the qualitative preliminary study, structured interviews with older adults (n?=?5) and their family members (n?=?6) were performed, which included questions on technology biography, technology acquisition and the effect of the technology usage on the social network. The results were part of the questionnaire of the main study. The main study was part of an accompanying intervention study. A total of 46 adults older than 60 years were included. In addition to aspects from the preliminary study, questions to sex-specific differences regarding the technical support of the social network were also analyzed.

Results

Data analysis revealed that mainly family members purchase ICT for the older adults, and they are the main contact persons for technical problems. Above all, the seniors asked their own children for advice. Moreover, seniors who had increased technology use in everyday life (95.7%, n = 22) and higher technology acceptance (mean = 44.0, standard deviation = 7.4) had already had previous experience with technology during school age/career.

Conclusion

In the households of older adults, fewer new ICT are found. The interest to purchase ICT is triggered by the technology support of family members. If the technical assistance was distributed to several members of the family and other networks, the burden of an individual family member could be reduced. In addition, the influence of different participants could increase the technology usage of older adults.

     

Die Rolle von Zytokinen bei Allergien und Asthma

Allergic reactions are characterized by inappropriate immune responses to antigens which are tolerated by most people.After the initial demonstration of different subpopulations of T-helper cells characterized by their cytokine expression profile it has been recognized that T_H2 cells and their cytokines (IL-4, IL-5, IL-9 and IL-13) are strongly associated with allergic responses.T_H2 cytokines have crucial functions in the development of allergic hyperreactivity and during initiation and progression of allergic responses.Therapeutic approaches for the selective inhibition of T_H2 cytokines are already in clinical trials.Further subpopulations of T cells (T_H1,T_H3,T_R1) mediate allergic responses through the secretion of cytokines which suppress T_H2 cells and their effector functions.Allergysuppressing cytokines like IFN-γ, IL-10 and TGF-β can be considered as further targets for manipulating the immune system in allergic diseases.These cytokines as well as agents modulating their specific expression are currently under intensive investigation.     

Entstehung von Bromat bei der Aufbereitung von Schwimm- und Badebeckenwasser Gesundheitliche Bewertung

Zusammenfassung Bei der Aufbereitung und Desinfektion von Schwimmbadewasser entsteht eine gro?e Zahl von Nebenreaktionsprodukten. In jüngster Zeit wurde vor allem der Entstehung von Bromat aus Bromid Aufmerksamkeit geschenkt. Bromat hat mutagene Eigenschaften und wurde von der IARC als Tierkanzerogen eingestuft. Die EU sieht für die novellierte Trinkwasserrichtlinie einen Grenzwert von 10 μg/l vor. Da beim Schwimmbadbesuch lediglich von einer oralen Aufnahme von etwa 100–200 ml Badewasser ausgegangen werden mu?, erscheinen im Badebeckenwasser h?here als für das Trinkwasser vorgesehene Bromatkonzentrationen zul?ssig. Repr?sentative Studien über das Vorkommen von Schwimm- und Badebeckenwasser liegen in Deutschland nicht vor, geeignete Technologien zur Minimierung dieses unerwünschten Nebenreaktionsproduktes müssen entwickelt werden.      

Kodieren von Krankenhausleistungen allgemein und speziell bei Malignomen und HIV/AIDS

The new DRGs reimbursement system will start as an optional model in 2003.The compulsory introduction of this new system will take place on 1 January 2004.The reimbursement system based on diagnosis-related groups (DRGs) is supposed to be implemented within 4 or 5 years. In order to guarantee a performance-oriented reimbursement, comparable cases will be assigned to the same DRGs.This can only be achieved if diagnosis and classification procedures are standardized.The general and special German DKRs regulate and support this process. The structured classification of diseases is guaranteed by ICD-10-SGB V.Thus, standardization of diagnoses according to an internationally accepted system recommended by WHO will be achieved.Moreover, further developments in medical progress and adjustments for costs will be taken into consideration to advance clinical performance. A far-reaching general structural change in health care will take place and will not be restricted to hospitalized patients. It is absolutely necessary that the DRGs be adapted to the German standards in order to guarantee a highly economic and efficient health service.The growing bureaucracy in medicine should not prevent doctors from their responsibilities towards their patients.     

Politische Verantwortung bei der Entwicklung von Gesundheitstelematik und -informationssystemen

Health care belongs to the infrastructure and service sectors, which are influenced and restructured by the development and implementation of information and communication technologies.However, health care itself gives momentum to economic and social development, which leads to the information and knowledge society.This interaction results in increased efficiency, improvements of quality, and cost savings.To achieve these goals, a suitable general framework must be created.Important key applications need to be developed. In this regard, four important initiatives are currently underway. 1.At the European level, the action plan “eEurope 2002 – An Information Society for All” with its four action lines on the subject of “Health Online” was launched in Feira in 1999, followed by the action plan “eEurope 2005” in Sevilla in June 2002 . 2. In Germany, the Federal Government's program “Innovation and Workplaces in the Information Society of the 21st Century.” On 6 March 2002 the Government approved a progress report entitled “Information Society Germany”. 3.The decisions of the health ministers' conference in June 2001 and June 2002 to ask the Federal-State Working Group on Telematics to discuss and to compile comprehensive reports on telematics. 4.The joint declaration of the Federal Ministry of Health and the German Health Care Associations of 3 May 2002 to establish a high-level Steering Group on Telematics and to implement the electronic health card within a new telematic infrastructure.     

Ergonomische Untersuchung von Teilzeit-Schichtsystemen und Pausen bei informatorischer Arbeit

Zusammenfassung An 16 Frauen und 2 MÄnnern wurden Messungen im Belastungsbereich (Cycluszeiten, deren motorische und informatorische Komponenten, Fehlleistungen) und Beanspruchungsbereich (Herzfrequenz, Arrhythmie, horizontales und vertikales Elektrooculogramm, Elektromyogramm des Musculus extensor digitorum und des Stamm-Muskels Musculus rhomboideus) zur Beurteilung von fünf unterschiedlichen, über den Tag verteilten Teilzeit-Schichten und drei verschiedenen Pausenregimes durchgeführt.Ergebnisse: Die untersuchte informatorische Arbeit ist in allen Tagschichten ertrÄglich. Die optimale Schicht-Arbeitsdauer ist 4 Std. In den Nachtschichten ist die Arbeit bei den verfügbaren Pausenzeiten unertrÄglich.Das untersuchte Kurzpausenregime ist vom Leistungsgesichtspunkt optimal, führt jedoch zu einem Antriebseffekt, der die Beanspruchung physiologischer Funktionen oberhalb der Dauerleistungsgrenze ignoriert und damit hohe Ermüdungsgrade hervorruft.