Psychopharmaka

TREND: Die Verordnungsstruktur der Psychopharmaka hat sich in den letzten Jahren auffällig verändert. Im Durchschnitt haben die Verordnungen der Antidepressiva in der letzten Dekade nochmals um mehr als 40 % zugenommen. Dieser Anstieg wurde vor allem von den selektiven Serotonin-Rückaufnahme-Inhibitoren (SSRI) und den Serotonin-Noradrenalin-Rückaufnahme-Inhibitoren (SNRI) getragen, während die älteren nichtselektiven Monoamin-Rückaufnahme-Inhibitoren (NSMRI, Trizyklika) seit 2010 in ihrer Verordnung rückläufig waren. Ungebrochen ist auch der Verordnungsanstieg bei den sog. atypischen Neuroleptika, der durch einen nur sehr moderaten Rückgang der Verschreibung klassisch hochpotenter Neuroleptika nicht kompensiert wird. Es handelt sich also vermutlich um Indikationsausweitungen oder einen Trend zu höheren Dosierungen. Niedrigpotente Neuroleptika werden in stets gleichbleibendem Umfang verordnet. Die Verordnungen von Psychostimulanzien sind seit starken Zuwächsen in den 2000er Jahren nunmehr seit 5 Jahren annähernd konstant, und die von Tranquillantien schon seit vielen Jahren weiter rückläufig. Circa ein Drittel der Psychopharmakaverordnungen stammen von Allgemeinmedizinern

Current challenges and implications for dengue, chikungunya and Zika seroprevalence studies worldwide: A scoping review.

BACKGROUND:Arboviral infections are a public health concern and an escalating problem worldwide. Estimating the burden of these diseases represents a major challenge that is complicated by the large number of unapparent infections, especially those of dengue fever. Serological surveys are thus required to identify the distribution of these diseases and measure their impact. Therefore, we undertook a scoping review of the literature to describe and summarize epidemiological practices, findings and insights related to seroprevalence studies of dengue, chikungunya and Zika virus, which have rapidly expanded across the globe in recent years. METHODOLOGY/PRINCIPAL FINDINGS:Relevant studies were retrieved through a literature search of MEDLINE, WHOLIS, Lilacs, SciELO and Scopus (2000 to 2018). In total, 1389 publications were identified. Studies addressing the seroprevalence of dengue, chikungunya and/or Zika written in English or French and meeting the inclusion and exclusion criteria were included. In total, 147 studies were included, from which 185 data points were retrieved, as some studies used several different samples. Most of the studies were exclusively conducted on dengue (66.5%), but 16% were exclusively conducted on chikungunya, and 7 were exclusively conducted on Zika; the remainder were conducted on multiple arboviruses. A wide range of designs were applied, but most studies were conducted in the general population (39%) and in households (41%). Although several assays were used, enzyme-linked immunosorbent assays (ELISAs) were the predominant test used (77%). The temporal distribution of chikungunya studies followed the virus during its rapid expansion since 2004. The results revealed heterogeneity of arboviruses seroprevalence between continents and within a given country for dengue, chikungunya and Zika viruses, ranging from 0 to 100%, 76% and 73% respectively. CONCLUSIONS/SIGNIFICANCE:Serological surveys provide the most direct measurement for defining the immunity landscape for infectious diseases, but the methodology remains difficult to implement. Overall, dengue, chikungunya and Zika serosurveys followed the expansion of these arboviruses, but there remain gaps in their geographic distribution. This review addresses the challenges for researchers regarding study design biases. Moreover, the development of reliable, rapid and affordable diagnosis tools represents a significant issue concerning the ability of seroprevalence surveys to differentiate infections when multiple viruses co-circulate