Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology,Germany, 2018–2020

Human bornavirus encephalitis is a severe and often fatal infection caused by variegated squirrel bornavirus 1 (VSBV-1) and Borna disease virus 1 (BoDV-1). We conducted a prospective study of bornavirus etiology of encephalitis cases in Germany during 2018–2020 by using a serologic testing scheme applied along proposed graded case definitions for VSBV-1, BoDV-1, and unspecified bornavirus encephalitis. Of 103 encephalitis cases of unknown etiology, 4 bornavirus infections were detected serologically. One chronic case was caused by VSBV-1 after occupational-related contact of a person with exotic squirrels, and 3 acute cases were caused by BoDV-1 in virus-endemic areas. All 4 case-patients died. Bornavirus etiology could be confirmed by molecular methods. Serologic testing for these cases was virus specific, discriminatory, and a practical diagnostic option for living patients if no brain tissue samples are available. This testing should be guided by clinical and epidemiologic suspicions, such as residence in virus-endemic areas and animal exposure.     

Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany

Objectives

Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.

Recurrent costs of HIV/AIDS-related health services in Rwanda: implications for financing

Objective To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. Methods A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. Results Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non‐ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41–46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. Conclusion Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk‐pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.     

Attitudes of Health Care Professionals towards Female Obese Patients

ObjectiveThe health care setting has been reported to be one main source of weight stigma repeatedly; however, studies comparing different professions have been lacking.Methods682 health care professionals (HCP) of a large German university hospital were asked to fill out a questionnaire on stigmatizing attitudes, perceived causes of obesity, and work-related impact of obesity. Stigmatizing attitudes were assessed on the Fat Phobia Scale (FPS) based on a vignette describing a female obese patient.ResultsOnly 25% graded current health care of obese patients to be ‘good’ or ‘very good’. 63% of all HCPs ‘somewhat’ or ‘strongly’ agreed that it was often difficult to get the resources needed in order to care for obese patients. The mean FPS score was comparable to that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes compared to physicians and therapists. Higher age, higher BMI, and ascribing personal responsibility for obesity to the individual were associated with a higher level of stigmatizing attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians attributed obesity to the individual.ConclusionsIn summary, by making complex models on the causes of obesity known among health care professionals, stigmatizing attitudes might be reduced. Ongoing further education for health care professionals ought to be part of anti-stigma campaigns in the medical field.Key Words: Health care professionals, Obesity, Care, Stigma     

Attitudes Towards Bariatric Surgery in the General Public

Background

Prevalence rates of obesity are still rising. Weight loss surgery (WLS) is the most invasive but also most effective treatment option when behavioral modification has failed. Research indicates that health care professionals hold ambivalent views on bariatric surgery, while views of the general public have not yet been investigated.

Methods

In a German representative sample of n?=?3,003 respondents in a computer-assisted telephone interview, n?=?1,008 persons were interviewed on their views of the effectiveness of bariatric surgery and other interventions for obesity. Also, willingness to recommend a treatment was assessed.

Results

Lifestyle-based interventions were viewed as most effective in terms of weight loss. About 50 % of the population stated that WLS is “very effective” while still a quarter of respondents did not ascribe effectiveness to WLS. Higher age was associated with lower expectations of effectiveness while higher stigmatizing attitudes and genetic attributes for obesity were associated with higher expectations of effectiveness. Seventy-two percent would not recommend WLS or undergo it, if applicable, themselves. Higher educated respondents and those that viewed WLS as effective were more likely to recommend WLS.

Conclusions

The German general public seems to be rather cautious regarding bariatric surgery. It may be assumed that false beliefs on the effectiveness and risk patterns of bariatric surgery are still very common, despite rising surgery numbers. Our results further emphasize the need for providing evidence-based information on bariatric surgery to the general public.     

Association of costs with somatic symptom severity in patients with medically unexplained symptoms

Objective

To analyse the association of direct and indirect costs in patients with medically unexplained symptoms (MUS) with somatic symptom severity (SSS).

Methods

A cross-sectional cost analysis for retrospective 6 months was conducted in 294 primary care patients with MUS. Health care utilisation and loss of productivity were measured by questionnaires. SSS was measured using the “Patient Health Questionnaire 15” (PHQ-15). Direct and indirect costs and the association of costs with SSS were analysed via multiple linear regression analysis.

Results

Patients with MUS had average 6-month direct costs of 1098 EUR and indirect costs of 7645 EUR. For direct costs, outpatient physician visits were the most expensive single cost category (36%), followed by pharmaceuticals (25%) and hospital stays (19%). Indirect costs were predominantly caused by productivity reduction at work (56%) followed by early retirement (29%) and acute sickness absence (14%). As compared to mild SSS, moderate SSS was not significantly associated with direct, but with indirect costs (+ 2948 EUR; p < .001); severe SSS was associated with increased direct cost (+ 658 EUR; p = .001) and increased indirect costs (+ 4630 EUR; p < .001). Age was positively associated with direct cost (+ 15 EUR for each additional year; p = .015) as well as indirect cost (+ 104 EUR for each additional year; p < .001).

Conclusions

MUS are associated with relevant direct and even much higher indirect costs that strongly depend on SSS.     

Pet ownership,loneliness, and social isolation: a systematic review

Purpose

Several publications explored a relationship between pet ownership and lower levels of loneliness and social isolation. However, to the best of our knowledge, no systematic review has yet synthesized the evidence on these associations. Thus, this systematic review aims to evaluate the findings regarding the relations between pet ownership, loneliness, and social isolation.

Methods

PubMed, CINAHL, and PsycInfo were searched in January 2022. Observational studies relying on appropriate instruments to assess the exposure and the outcome variables were included. Two reviewers independently executed study selection, data extraction, and quality assessment.

Results

n = 24 studies were included. Among adult samples, the studies examining the relationship between pet ownership and social isolation found that owning a pet was associated with lower levels of social isolation. Concerning loneliness, studies that were conducted after the outbreak of COVID-19 mostly showed that pet ownership can contribute to lower levels of loneliness, but did not reveal an overall significant association until then. In turn, the studies that examined child and adolescent samples suggest that pet ownership was related to reduced loneliness before COVID-19. Furthermore, most of the studies did not reveal any differences between dogs, cats, and other kinds of pets regarding their relationship to loneliness and social isolation.

Conclusion

All in all, only a part of the studies detected a significant association between pet ownership, loneliness and social isolation. However, the COVID-19 pandemic seemed to strengthen this relationship, so that future research is required to assess the longevity of this potential effect.

     

Prevalence and correlates of loneliness,perceived and objective social isolation during the COVID-19 pandemic. Evidence from a representative survey in Germany

Social Psychiatry and Psychiatric Epidemiology - Our aim was to identify the prevalence and correlates of loneliness, perceived and objective social isolation in the German population during the...