Neue Versorgungsmodelle in der Psychosebehandlung

Zusammenfassung: In einem modernen psychiatrischen Versorgungssystem gilt die Empfehlung: ambulant vor teilstationär vor stationär. Die komplexen Behandlungserfordernisse einer gemeindenahen Betreuung für chronisch und schwerer psychisch Erkrankter sowie die Beteiligung verschiedener Sozialleistungsträger an der Finanzierung führen jedoch zu einer problematischen Versorgungsfragmentierung. Die Schizophrenie ist die teuerste psychiatrische Erkrankung in Deutschland. Die indirekten Kosten (in Geldwert umgerechnete Folgen der Schizophrenie) werden bis zu 5-mal höher als die direkten Behandlungskosten geschätzt. Von den verschiedenen neueren Versorgungskonzepten hat sich bisher vor allem das Konzept der aufsuchenden gemeindepsychiatrischen Teams bewährt. Dieser Ansatz führt zu einer Reduktion der Wiederaufnahmerate und der Verweildauer im Krankenhaus, zu einer besseren sozialen Integration und größerer Patientenzufriedenheit. Es gibt keine empirische Evidenz für eine "Psychiatrie ohne Betten". Eine bedenkenswerte Alternative zu einer stationären Behandlung kann jedoch für eine Teilgruppe die Behandlung in einem akuttagesklinischen Setting, in Krisenhäusern oder die Krisenversorgung im häuslichen Umfeld sei

Antibiotic use for upper respiratory tract infections in children: A cross-sectional survey of knowledge, attitudes, and practices (KAP) of parents in Greece

<p>Abstract</p> <p>Background</p> <p>Upper respiratory tract infections (URTIs) are common in children. The cause of URTIs is usually viral, but parents' attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance. The objective of this study was to document and analyse parental beliefs on antibiotic use for children with URTIs in Greece, a country with high levels of antibiotic use and antibiotic resistance.</p> <p>Methods</p> <p>A knowledge-attitude-practice questionnaire was developed and distributed to Greek parents caring for children who were 5-6 years old, between January and July of the same school year. The sample of the study contained parents from all geographic areas of Greece.</p> <p>Results</p> <p>The majority of Greek parents (80%) believed that UTRIs are mostly self-limited, although 74% of them expected to receive antibiotics when such a diagnosis was given. Earache was the most common reason for which parents expected antibiotics (45%). Greek parents rarely gave antibiotics to their children without medical advice (10%) and most (88%) believed that unnecessary antibiotic use drives antibiotic resistance and they were happy to receive symptomatic therapy if instructed by their physician. Almost 70% of parents confused antibiotics with other medicines used for symptomatic therapy for a child with URTI.</p> <p>Conclusion</p> <p>Greek parents have a trusted relationship with their paediatrician and rarely give antibiotics without medical advice, indicating that parents contribute less than expected to antibiotic misuse. Parents also appreciate the benign course of most URTIs and the fact that unnecessary antibiotic use is harmful. More time needs to be invested in educating mostly physicians on the potential benefit from reducing antibiotic prescribing for children with URTI.</p

Surveillance study of vector species on board passenger ships, Risk factors related to infestations

<p>Abstract</p> <p>Background</p> <p>Passenger ships provide conditions suitable for the survival and growth of pest populations. Arthropods and rodents can gain access directly from the ships' open spaces, can be carried in shiploads, or can be found on humans or animals as ectoparasites. Vectors on board ships may contaminate stored foods, transmit illness on board, or, introduce diseases in new areas. Pest species, ship areas facilitating infestations, and different risk factors related to infestations were identified in 21 ferries.</p> <p>Methods</p> <p>486 traps for insects and rodents were placed in 21 ferries. Archives of Public Health Authorities were reviewed to identify complaints regarding the presence of pest species on board ferries from 1994 to 2004. A detail questionnaire was used to collect data on ship characteristics and pest control practices.</p> <p>Results</p> <p>Eighteen ferries were infested with flies (85.7%), 11 with cockroaches (52.3%), three with bedbugs, and one with fleas. Other species had been found on board were ants, spiders, butterflies, beetles, and a lizard. A total of 431 <it>Blattella germanica </it>species were captured in 28 (9.96%) traps, and 84.2% of them were nymphs. One ship was highly infested. Cockroach infestation was negatively associated with ferries in which Hazard Analysis Critical Control Point system was applied to ensure food safety on board (Relative Risk, RR = 0.23, <it>p </it>= 0.03), and positively associated with ferries in which cockroaches were observed by crew (RR = 4.09, <it>p </it>= 0.007), no cockroach monitoring log was kept (RR = 5.00, <it>p </it>= 0.02), and pesticide sprays for domestic use were applied by crew (RR = 4.00, <it>p </it>= 0.05). Cockroach infested ships had higher age (<it>p </it>= 0.03). Neither rats nor mice were found on any ship, but three ferries had been infested with a rodent in the past.</p> <p>Conclusion</p> <p>Integrated pest control programs should include continuing monitoring for a variety of pest species in different ship locations; pest control measures should be more persistent in older ships. HACCP system aids in the prevention of cockroach infestations on board.</p

Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry

BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0-Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7-99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC > or = 15000/microL (OR 2.19) with a PPV of 77.8% (95%CI 40.0-97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age > or = 1 year (OR 2.04), absence of headache (OR 3.01), CSF Glu < 40 mg/dL (OR 3.62) and peripheral WBC < 15,000/microL (OR 1.74) with a PPV of 58.5% (95%CI 42.1-73.7). CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied

Building an Integrated Enhanced Virtual Research Environment Metadata Catalogue

Purpose The purpose of this paper is to boost multidisciplinary research by the building of an integrated catalogue or research assets metadata. Such an integrated catalogue should enable researchers to solve problems or analyse phenomena that require a view across several scientific domains. Design/methodology/approach There are two main approaches for integrating metadata catalogues provided by different e-science research infrastructures (e-RIs): centralised and distributed. The authors decided to implement a central metadata catalogue that describes, provides access to and records actions on the assets of a number of e-RIs participating in the system. The authors chose the CERIF data model for description of assets available via the integrated catalogue. Analysis of popular metadata formats used in e-RIs has been conducted, and mappings between popular formats and the CERIF data model have been defined using an XML-based tool for description and automatic execution of mappings. Findings An integrated catalogue of research assets metadata has been created. Metadata from e-RIs supporting Dublin Core, ISO 19139, DCAT-AP, EPOS-DCAT-AP, OIL-E and CKAN formats can be integrated into the catalogue. Metadata are stored in CERIF RDF in the integrated catalogue. A web portal for searching this catalogue has been implemented. Research limitations/implications Only five formats are supported at this moment. However, description of mappings between other source formats and the target CERIF format can be defined in the future using the 3M tool, an XML-based tool for describing X3ML mappings that can then be automatically executed on XML metadata records. The approach and best practices described in this paper can thus be applied in future mappings between other metadata formats. Practical implications The integrated catalogue is a part of the eVRE prototype, which is a result of the VRE4EIC H2020 project. Social implications The integrated catalogue should boost the performance of multi-disciplinary research; thus it has the potential to enhance the practice of data science and so contribute to an increasingly knowledge-based society. Originality/value A novel approach for creation of the integrated catalogue has been defined and implemented. The approach includes definition of mappings between various formats. Defined mappings are effective and shareable.Published929-9514IT. Banche datiJCR Journa

The role of cytokines and hot flashes in perimenopausal depression

<p>Abstract</p> <p>Background</p> <p>An imbalance in the production of proinflammatory and anti-inflammatory cytokines may play a role in the pathophysiology of perimenopausal depression. The aim of this study was to examine serum levels of the proinflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor α (TNFα), and the anti-inflammatory cytokine IL-10, in perimenopausal women suffering from depression. Furthermore, to assess whether serum cytokine levels are associated with the presence of hot flashes or the use of selective serotonin reuptake inhibitors (SSRIs). We also evaluated the possible association of hot flashes and perimenopausal depression.</p> <p>Methods</p> <p>Serum samples from 65 perimenopausal women, 41 with depression and 24 without depression, were assessed for serum IL-6, TNFα and IL-10 by conventional enzyme-linked immunosorbent assays. Depression was evaluated by the 17-item Hamilton Depression Rating Scale (HAM-D 17) and a psychiatric interview. The presence and severity of hot flashes were examined using the Menopause Rating Scale (MRS).</p> <p>Results</p> <p>Serum levels cytokines did not differ between depressed women and normal controls. Serum levels of cytokines did not change significantly in depressed women with hot flashes or in depressed women treated with SSRIs. Hot flashes were strongly associated (<it>P </it>< 0.0001) with perimenopausal depression.</p> <p>Conclusion</p> <p>The study supports the hypothesis that perimenopausal depression is not characterized by increased proinflammatory cytokines and decreased anti-inflammatory cytokines. Women with perimenopausal depression suffer from more severe and more frequent hot flashes than women without perimenopausal depression.</p

Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis remains a source of substantial morbidity and mortality in childhood. During the last decades gradual changes have been observed in the epidemiology of bacterial meningitis, related to the introduction of new polysaccharide and conjugate vaccines. The study presents an overview of the epidemiological patterns of acute bacterial meningitis in a tertiary children 's hospital during a 32-year period, using information from a disease registry. Moreover, it discusses the contribution of communicable disease registries in the study of acute infectious diseases.</p> <p>Methods</p> <p>In the early 1970s a Meningitis Registry (MR) was created for patients admitted with meningitis in Aghia Sofia Children's Hospital in Athens. The MR includes demographic, clinical and laboratory data as well as treatment, complications and outcome of the patients. In 2000 a database was created and the collected data were entered, analyzed and presented in three chronological periods: A (1974–1984), B (1985–1994) and C (1995–2005).</p> <p>Results</p> <p>Of the 2,477 cases of bacterial meningitis registered in total, 1,146 cases (46.3%) were classified as "probable" and 1,331 (53.7%) as "confirmed" bacterial meningitis. The estimated mean annual Incidence Rate (IR) was 16.9/100,000 for bacterial meningitis, 8.9/100,000 for <it>Neisseria meningitidis</it>, 1.3/100,000 for <it>Streptococcus pneumoniae</it>, 2.5/100,000 for <it>Haemophilus influenzae </it>type b (Hib) before vaccination and 0.4/100,000 for Hib after vaccination. <it>Neisseria meningitis </it>constituted the leading cause of childhood bacterial meningitis for all periods and in all age groups. Hib was the second most common cause of bacterial meningitis before the introduction of Hib conjugate vaccine, in periods A and B. The incidence of bacterial meningitis due to <it>Streptococcus pneumoniae </it>was stable. The long-term epidemiological pattern of <it>Neisseria meningitidis </it>appears in cycles of approximately 10 years, confirmed by a significant rise of IR in period C. The Case Fatality Rate (CFR) from all causes was 3.8%, while higher CFR were estimated for <it>Streptococcus pneumoniae </it>(7.5%, RR=2.1, 95% CI 1.2–3.7) and <it>Neisseria meningitidis </it>(4.8%, RR=1.7, 95% CI 1.1–2.5) compared to other pathogens. Moreover, overall CFR varied significantly among the three time periods (p = 0.0015), and was estimated to be higher in period C.</p> <p>Conclusion</p> <p>By using the MR we were able to delineate long-term changes in the epidemiology of bacterial meningitis. Thus the MR proved to be a useful tool in the study and the prevention of communicable diseases in correlation with prevention strategies, such as vaccinations.</p