Significance and clinical impact of routinely tested urinary ethyl glucuronide after liver transplantation – development of a risk score

Alcohol abuse after liver transplantation can seriously impact graft and patient survival. However, to date, there is no defined standard procedure to identify patients consuming alcohol after liver transplantation. The aim of this study was to analyze the diagnostic value and clinical impact of routinely measured urinary ethyl glucuronide (uEtG) – a metabolite of ethanol – in patients after liver transplantation. Data of 362 consecutive patients after liver transplantation who visited the University Hospital of Tuebingen for outpatient follow-up were analyzed. Forty-eight patients (13%) displayed positive uEtG results. The uEtG positive group contained significantly more patients with pretransplant alcoholic liver disease. However, two thirds of the uEtG positive patients had no history of pretransplant alcoholic liver disease. Several clinical parameters were significantly associated with positive uEtG. In order to enable a more cost-effective application of uEtG in the future, a clinical risk score was developed (specificity 0.95). In conclusion, routine testing for uEtG reveals a considerable percentage of patients practicing alcohol intake after liver transplantation. Application of our proposed risk score could help focusing uEtG testing on patients at risk.     

Association of antiviral prophylaxis and rituximab use with posttransplant lymphoproliferative disorders (PTLDs): A nationwide cohort study

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation (SOT). Most PTLD cases are associated with Epstein–Barr virus (EBV) infection. The role of antiviral prophylaxis or rituximab therapy for prevention of PTLD in SOT recipients is controversial. In a nationwide cohort, we assessed the incidence, presentation, and outcome of histologically proven PTLD. We included 4765 patients with a follow-up duration of 23 807 person-years (py). Fifty-seven PTLD cases were identified; 39 (68%) were EBV positive (EBV+ PTLD). Incidence rates for EBV+ PTLD at 1, 2, and 3 years posttransplant were 3.51, 2.24, and 1.75/1000 py and 0.44, 0.25, and 0.29/1000 py for EBV− PTLD. We did not find an effect of antiviral prophylaxis on early and late EBV+ PTLD occurrence (early EBV+ PTLD: SHR 0.535 [95% CI 0.199–1.436], p = .264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751–6.521], p = .150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but 57 of 4574 patients without rituximab induction developed PTLD. In an adjusted restricted mean survival time model, PTLD-free survival was significantly longer (0.104 years [95% CI 0.077–0.131]) in patients receiving rituximab as induction treatment. This study provides novel data on the association of rituximab induction and reduced risk for PTLD.     

Impact of COVID‐19 on wound care in Germany

Recent studies showed that the COVID‐19 pandemic caused collateral damage in health care in terms of reduced hospital submissions or postponed treatment of other acute or chronic ill patients. An anonymous survey was sent out by mail to patients with chronic wounds in order to evaluate the impact of the pandemic on wound care. Sixty‐three patients returned the survey. In 14%, diagnostic workup or hospitalisation was cancelled or postponed. Thirty‐six percent could not seek consultation by their primary care physician as usual. The use of public transport or long travel time was not related to limited access to medical service (P = .583). In ambulatory care, there was neither a significant difference in the frequency of changing wound dressings (P = .67), nor in the person, who performed wound care (P = .39). There were no significant changes in wound‐specific quality of life (P = .505). No patient used telemedicine in order to avoid face‐to‐face contact or anticipate to pandemic‐related restrictions. The COVID‐19 pandemic impaired access to clinical management of chronic wounds in Germany. It had no significant impact on ambulatory care or wound‐related quality of life. Telemedicine still plays a negligible role in wound care.     

Media representation of telemedicine in the German medical journal “Deutsches Ärzteblatt”: an acceptance-theoretical analysis

Journal of Public Health - Media reporting can influence the perception and development of attitudes through the frequency and the way certain topics are presented. The German Medical Journal...     

Socio-economic factors and mortality in Switzerland

Summary This review paper is concerned with the topic of mortality differences by socio-economic group in Switzerland. After a short introduction to the topic and the pitfalls associated with it, the paper reviews work done in the course of a ten year programme investigating socio-economic mortality differentials in Switzerland. This programme was carried out by a working group at the Department of Social and Preventive Medicine of the University of Berne. The paper reviews methodological difficulties and pitfalls and relates the Swiss results to findings from other countries including England and Wales and Sweden. The disadvantages of socially isolated groups such as children of single women are shown. The relatively high mortality of groups under economic pressure, such as skilled manual workers in Switzerland, is demonstrated. The Swiss situation is interesting in that skilled manual workers have a higher mortality than the unskilled and semi-skilled groups. It is concluded that this is not an artifact but may be due to the fact that only Swiss workers were investigated and that Switzerland has a large proportion of foreign workers, especially in the less skilled groups. In addition, some results of an investigation of cancer mortality by occupation are reported too. Apart from some occupation-specific findings, there are some interesting cross-references to socio-economic differential mortality.

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Sozio-ökonomische Sterblichkeitsunterschiede in der Schweiz

Zusammenfassung Nach einer kurzen Einführung in das Thema Unterschiede in der Sterblichkeit nach sozioökonomischen Gruppen befasst sich diese Übersichtsarbeit mit einem Forschungsprogramm am Institut für Sozial- und Präventivmedizin der Universität Bern, in dem eine Arbeitsgruppe dieses Problem seit 10 Jahren von verschiedenen Seiten umfassend angegangen hat. Neben methodologischen Überlegungen (Datenqualität, Verzerrungsmöglichkeiten) wird vor allem auf die ungünstige Lage von sozial Benachteiligten, wie den Kindern alleinerziehender Mütter sowie von ökonomisch unter Druck stehender Gruppen, wie den manuellen Arbeitern, hingewiesen. Nebst Untersuchungen nach sozio-ökonomischen Gruppen werden auch Ergebnisse zur Krebssterblichkeit nach Berufen vorgestellt. Es ergeben sich hier neue Erkenntnisse auf dem berufsspezifischen Gebiet und Quervergleiche zu den Untersuchungen über sozio-ökonomische Sterblichkeitsunterschiede.

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Differences socio-économiques de la mortalité en Suisse

Résumé Après une courte introduction sur les différences de mortalité entre les différentes groupes socioéconomiques ce travail prèsente un programme de recherche de l'Institut de médecine sociale et préventive de l'Université de Berne, un programme dans lequel un groupe de travail a étudié ce problème. En dehors de réflexions méthodologiques (qualité des données, possibilités de biais) l'accent est surtout mis sur la mauvaise situation de personnes socialement désavantagées, comme les enfants de mères seules et de groupes sous pression de la situation économique, comme les travailleurs manuels. Avec les études par groupes socio-économiques les résultats sur la mortalité par le cancer de différentes professions sont présentés. Il en résulte de nouvelles connaissances sur le plan professionnel et des comparaisons transversales avec les études sur les différences socio-économiques de mortalité.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.